Silver linings in electronic medical records

The COVID-19 pandemic brought so much aside from the virus itself. Angst, fear, and the unknown were at the top of the list for those in the United States, and for those across the world. It was uncertain when countries would open, travel destinations would reopen, and when families could reunite for special occasions. And while it may remain unknown how this virulent disease originated, a few silver linings were able to come to light. 

One very large silver lining, somewhat unnoticed, was patient access to their own electronic medical records (“EMR”). Prior to 2020, large EMR’s tied themselves to healthcare providers and facilities, not allowing for cross communication from one facility to the other. 

For example, if a patient goes to Hospital Care of America and the EMR system is Cerner, and then the patient goes to see Dr. Smith at Smith’s Family Practice, who used Epic for their EMR system, the information cannot be exchanged between the two systems. Currently, the easiest way to have a full comprehensive medical record is to duplicate the Cerner records with the Epic records and vice versa. However, this process was extremely manual, and often happened inconsistently. 

Large EMR companies were making billions of dollars off of selling this technology to healthcare facilities and cornering those customers into only using their solution with no option for integration or overlap. Why? The large EMR companies claim that the reason they restricted access to patients’ information from other EMRs was for privacy reasons. However, others could argue that it was done to carve out sections of the $28 billion (yes, billion) market, leaving these companies to compete to replace an existing EMR system or snatch up greenfield opportunities from their rivals. 

The purpose of EMRs

Over time, these EMR software companies lost track of their purpose: the patients. These patients are the ones who rely on EMRs to provide the healthcare providers with an accurate, comprehensive, and historical depiction of their medical care, as this can impact current care outcomes. With separate EMR systems and no ability to integrate, there often was not much data offered to the patient for their own record keeping. Segmented medical care evolved, siloed by provider and facility, but instead of physical colored folders at a doctor’s office, EMRs are now digitally living in a siloed EMR software.  

The COVID-19 pandemic brought this to light. The discussion around interoperability, the ability for software to talk to other software to prevent the siloing of information, began to ramp up in January 2020 with the final passage of a new federal mandate, the 21st Century Cures Act. The need for the ability to share medical records across facilities and providers became very apparent when patients’ medical information was difficult to exchange between already overrun healthcare facilities.

Back in the beginning

So how did we get here? How did EMR companies become healthcare walled gardens? And how come Instagram can talk to your internet browser to immediately show you ads of items you just Googled, but your eye doctor can’t share your vision prescription with your primary care physician? 

The way that software communicates with another software is via APIs (Application Programming Interfaces). APIs serve as the intermediary that allows for software applications to communicate with each other. In the case of large EMR companies, the software did not allow for APIs, so patients were unable to receive a comprehensive account of past medical treatment if it was at a different facility. 

With the healthcare market continuing to grow over the past decades, there was no incentive for these large companies to exchange information as they were able to contract directly with healthcare facilities or providers, earning contracts valued at hundreds of millions of dollars. Healthcare facilities didn’t have to actually be happy with their EMR system because the pain and cost associated with changing was simply too high, creating tolerance of feature limitations and slow innovation. The market and the exclusivity of data and information created the perfect storm of the EMR companies growing larger and larger in size with no requirements to provide patients’ data as a complete dataset to the patient themselves. 

In 2016, when the 21st Century Cures Act was signed into law, it was intended to improve the medical care and information that patients received. However, the legislation went back and forth and was finalized at the end of 2020. Portions of the Cures Act focus on the information blocking final rule that prohibits various healthcare parties from practices that inhibit patients’ and providers’ ability to use or exchange electronic health information. The rule also outlines criteria for API development for software that involves exchanging EHI. 

Companies and providers have until the end of 2022 to implement these changes to comply with the Cures Act. This has created the need for the EMR companies like Epic Systems to spend over $650 million and three years on upgrading and modifying their systems.

Future challenges

Data interoperability and portability isn’t as easy as flipping a switch, though. EMR companies, like Epic above, are begrudgingly investing substantial sums of time and money into becoming compliant with the new data sharing mandates. It takes effort to open up sharing functionality in a way that is still private and secure in regards to patient data. Systems that have never communicated before now need to be able to match patients without accidentally merging in the wrong patient’s record.

What this means for developers like MotionMobs is yet to be seen. How much of this data will be available to other kinds of healthcare companies? Will data sharing be restricted to other EMRs only, or will the system as a whole become open to innovation? How will these regulations actually be enforced, and which EMR is likely to become the target of inevitable litigation about how the Cures Act is interpreted?

Lessons Learned

At the end of the day, the Cures Act is a significant positive step for the patient. Patients will now not have to be concerned with which kind of software their care facility has. It will also be much easier to have all of their medical history in one location. It will also make it easier on healthcare insurance companies ideally reducing the amount of time it takes to provide coverage and reimbursement for medical treatment. 

Regardless, the implementation of this rule is one silver lining of the pandemic that will have a long-lasting impact for years to come.

Want to talk more about the Cures Act and EMR software? Reach out to us. We’re happy to discuss with you.

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