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Cloud companies are expanding from sharing photos to medical records
Dec 23, 2021

Cloud companies are expanding from sharing photos to medical records

The current system for transferring medical records is labor intensive and inefficient, says Julia Adler-Milstein of the UCSF.

If you have access to regular medical care, you probably have had the experience of filling out — by hand — your medical history at every single provider.

Sharing medical records between doctors and hospitals can be pretty difficult. That’s because there’s no universal, digital system in the United States for sharing those records. Several companies are trying to change that.

The tech giant Oracle recently acquired Cerner, an electronic medical records company, for about $28.3 billion. Oracle says this move will make it easier for medical professionals to access patient information from the cloud, which could help lower health care costs and improve patient outcomes.

For more on what this deal will mean for patients and the pandemic, I talked to Julia Adler-Milstein, a professor of medicine at the University of California, San Francisco, where she researches electronic health records. She said it’s still unclear how much a merger like this will help consumers or even improve data sharing. The following is an edited transcript of our conversation.

Julia Adler-Milstein smiles wearing a navy dress in front of a red, brick building.
Julia Adler-Milstein (Photo courtesy UCSF)

Julia Adler-Milstein: Part of the issue is whether the big technology vendors in the space feel that they are better off when they’re part of an open ecosystem and data can be shared smoothly and easily, or whether they feel like that they actually have competitive advantages by just amassing their own data and using it for their own purposes. And for patients, you know, if you only get your care from organizations that are on Cerner, you might be fine and better off. But if like most patients, you’re moving across the health care system, so if you see a doctor that’s using a Cerner electronic health record, and then you see a doctor that’s using an electronic health record from a different vendor, it’s not obvious that the Oracle merger is going to help make that problem better.

Kimberly Adams: How much is the way that our current medical record system operates factoring into how the pandemic is playing out right now?

Adler-Milstein: It’s huge. I mean, really, the ability to access timely data is essential to inform decision making, and what we’ve seen is that we’re just not able to get the data where it needs to be to inform those decisions.

Adams: What’s happening instead?

Adler-Milstein: I mean, instead, we’re seeing, frankly, a lot of workarounds where we’re having hospitals, for example, enter data into spreadsheets, and then those have to be manually compiled. So it’s just a very labor-intensive and inefficient process. It also means, too, that there’s much more potential for error to be introduced into the data, if people don’t understand exactly what data they’re supposed to be entering.

Adams: Yeah, I mean, it seems a little obscure to be focusing on how records are handled. But what are the health consequences of these systems being so clunky right now?

Adler-Milstein: Yeah, there are many. I mean, I think, again, for an individual patient, it means that the decisions that are being made about their care are being made without complete information — with gaps in understanding about their health history. And again, from a broader population or public health perspective, it means we can’t necessarily get the resources allocated to the places that need to get there for public health officials who are trying to make decisions about public health behaviors that they want to pursue. And you know, there’s so much controversy, but should masking be reinstituted in certain places? If they don’t know the case loads in particular places, it makes it really hard to make those decisions.

Adams: Has the pandemic created any sense of urgency around improving how medical records are handled in the U.S.?

Adler-Milstein: Undoubtedly. I think it’s really brought into focus the fact that our data isn’t able to move smoothly and efficiently. And I think what it’s really brought that’s been valuable is a real focusing of attention on in particular lab test results, and how do we move that one type of data around between hospitals, doctors’ offices, labs? I mean, that’s a stakeholder that we don’t often think about, but they have part of our medical record. And they’re sort of a different stakeholder that we need to be sure can also be able to sort of contribute and move data around. So I think in some ways, it’s really focused us on one type of data, and how do we get lab test results moved around, but it’s also broadened the aperture around the types of stakeholders that need to be involved in data sharing.

Adams: I think for a lot of patients, they’ll be annoyed to find out that their doctor’s offices are still using fax machines, or that they still have to fill out by hand a form when they go to the doctor’s office. But there has been a lot of progress in this space.

Adler-Milstein: There’s been a really concerted effort at the policy level to try to make it easier to share patient health information where it’s needed and where it’s appropriate. Those policy efforts take time to have an impact and to trickle down to every single doctor’s office and every single hospital. And so I think what we’re seeing is that we’re sort of in this middle space between the policy and the policy frameworks being there, and those actually needing to be implemented on the frontlines of health care on a day-to-day basis. The appeal of the fax machine is that it’s easy. It’s really easy to use, and actually getting electronic health record systems to talk to each other is quite complex. We’re just going to need time to make sure that that technology is in place so that it can be routinely used when a patient walks into a doctor’s office.

Related Links: More insight from Kimberly Adams

My colleague Amy Scott spoke with Adler-Milstein last year about electronic records in the pandemic, when we were probably all way too optimistic about how long this would be an issue.

We also have a link to a story from The Wall Street Journal with more details of the Oracle-Cerner acquisition.

And a piece from Bloomberg highlighting how even though most patients now have access to their personal medical records, even if we get them, most of us still struggle to make sense of what’s in them.

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