TMC PULSE

T M C » P U L S E | J U N E 2 0 1 8 6 Even today, instances in which patients or physicians have to track down hard copies of records "are unbelievably the norm," said Hardeep Singh, M.D., a patient safety researcher at the Center for Innovations in Quality, Effectiveness and Safety, based at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine. Health care providers often order duplicate tests and imaging for data simply because electronic records are not available, several experts say. "It's getting better, but I think it's going to take longer than we thought, and I think we aren't mov- ing fast enough," Singh said. Other experts who place more urgency on the current situation argue that a lack of communication and connectivity leaves patients and providers in a state of ignorance. "Frightening," is the stark term used by Lamar Pritchard, Ph.D., dean of the University of Houston College of Pharmacy. "A lot of patients believe we've been sharing this information all along," said Pritchard, a former board member of Greater Houston Healthconnect. "But when you speak to an ER doctor, and they're treating someone for a car accident in League City—and the patient lives in The Woodlands—the doctor will tell you they're practicing in the dark." * * * * * So why, exactly, has data sharing been such a challenge? Singh said the problem is more political than technical. In many instances, the culture of competition provides little incentive to share information. In other cases, the firms that main- tain patient records for providers have been accused of resisting an integrated system. In Houston, two major factors have slowed progress on sharing electronic health records, said Ryan Walsh, M.D., chief medical infor- mation officer for The University of Texas Health Science Center at Houston (UTHealth). First, unlike many communities, there isn't a lone dominant health care provider in the greater Houston area. Many hospitals, physician groups and independent practices have independent electronic health data systems. Second, Walsh said, there are fewer accountable care organiza- tions, or ACOs, in southeast Texas compared with other areas of the nation. In ACOs, providers share medical and financial responsibility for providing patient care with the goal of limiting wasteful or unnec- essary spending. Data sharing can reduce the cost of health care by eliminating redundant tests and procedures as well as helping pro- viders get the information they need to diagnose and treat patients more effectively. In those cases, there can be a big payoff when providers invest in data-sharing infrastructure. Still, the economic factors that encourage sharing aren't as strong in Houston, he said. "A lot of times, it takes financial motivation to do what's right, and doing what's right can be expen- sive," Walsh explained. "That finan- cial motivation hasn't hit Houston as hard as it's hit the coasts." Some have suggested more patient-centric solutions. If sys- tems struggle to share the data, can patients serve as gatekeepers of their own records on smartphones or other portable data devices? Most experts agree that this isn't the optimal solution. For starters, patients have not shown enthusi- asm about accessing their medical information electronically. Health care providers report success if half of their patients sign up for access to data portals, Singh said. Most critically, doctors don't want to rely on patients during an emergency. In addition, health care pro- viders must access information independently and in real time to provide the most informed care for individuals and groups. Storing health records with individuals would prevent doctors from bene- fiting from the broader insights that population data can provide. For example, software could theoreti- cally analyze all patients who meet a certain profile nationwide and determine which treatments have the best outcomes. So, what's the fix for electronic patient medical data accessibil- ity? Experts agree that health care providers will only make seamless record-sharing a priority when patients and their employers— specifically, those employers who ultimately pay for health care— demand connectivity. Eventually, providers that don't share data will be viewed as dated, unsophisticated and ineffective. "Would you use a bank that didn't have an app?" Walsh asked. "It's going to be that way with health care. Eventually, the market will demand that you offer interop- erability, or you're going to go out of business." Ryan Walsh, M.D., is the chief medical information officer at UTHealth. Would you use a bank that didn't have an app? It's going to be that way with health care. Eventually, the market will demand that you offer interoperability, or you're going to go out of business. — RYAN WALSH, M.D. Chief medical information officer at UTHealth

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