Why my EMR is still an island

Ever since I ended up in a Florida ER with a misdiagnosis of end-stage congestive heart failure four years ago, I have been keeping tabs on efforts to provide doctors anywhere with access to my most up-to-date medical records during an emergency away from home.

At that time the hospital I was visiting didn't have an electronic medical records (EMR) system and had no direct access to my records back home. I was disappointed to discover that four years after that incident things haven't gotten much better.

My health care provider did have an EMR system at the time The hospital in Florida did not. But the systems my provider uses were not fully electronic, so all of my data wasn't in my EMR. And that record only reflected activity with my primary care provider and the specialists within that hospital. Activities with other local providers were not integrated.

Furthermore, I had to request a paper copy of my medical records if I wanted a doctor to have access to them while I was on a trip, or if I moved and wanted a new primary care physician in another city to have access to the information.

Since then some things have changed, I discovered this week, but much remains the same. The system is closer to 100% electronic, but still not complete, and there's still no data sharing between all of my local providers.

By law, my provider must provide me with an electronic copy of my medical records, which they now save on a CD-ROM (four years ago it was paper only). But what I get is a PDF file -- essentially an image of my data that's not in a computer-readable format. It can't be imported into another system or searched. If I move and give it to a new provider they may be able to import it as a PDF, but then the doctor would have to page down through about 200 pages of imaged records to find what he's looking for. That's not very practical.

Currently my provider does not offer a mechanism for data interchange with other providers or with a health care exchange. Even if it did, providers don't want to integrate data from other providers into their systems. They want their own data separated from what others have created.

Other states have health information exchanges that feed EMR data into a centralized, shared database. But doctors don't want to use that. They already have a system they're used to accessing every day, with a user interface that's always up on the screen when they step into the exam room.

A federated data sharing model might help solve this problem, but that's a lot more work and it breaks the "separate from ours" rule.

As for the ER visit scenario, access to your EMR isn't what doctors there want, I am told. What they want is to have the pertinent information pulled out for them and delivered in an easy to read format. They don't want to access an EMR they're not familiar with, one that has a different user interface and structure than the system they use every day.

They just want an accurate medications list, problem list, significant surgeries, and other relevant information.

It still comes down to a "a computer-chair interface" -- a person who knows what to pull out based on the clinical presentation.

Interoperability standards such as Health Level Seven International (HL7) are all fine and good as far as they go, but vendors of EMR software offer differentiated products. Will those systems ever interoperate seamlessly to provide a complete view of the patient?

Maybe that's not realistic. But there's certainly still plenty of room for improvement.

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