Techbeat: Electronic health records

NICK EICHER, HOST: Today is Thursday, June 21st. Thank you for turning to WORLD Radio to help start your day.

Good morning. I’m Nick Eicher.

MARY REICHARD, HOST: And I’m Mary Reichard. Nowadays, when you visit your doctor, it’s likely he or she will have an iPad handy with your medical records on it. Or maybe refer to a computer. Long gone are the days where the walls of the doctor’s front office were filled floor-to-ceiling with paper medical records.

EICHER: The new Electronic Health Records were supposed to minimize errors, lower costs, and allow more coordination between healthcare providers. But are these EHRs, as they’re known, delivering on this promise? Many doctors feel they’re spending more time interacting with the computer than with their patients.

REICHARD: Stanford University School of Medicine recently heard from healthcare workers dealing with EHRs at a national symposium.

WORLD Radio technology reporter Michael Cochrane is here now to talk about that.

Michael, why hold a national symposium on EHRs now? Is there any significance in the timing?

MICHAEL COCHRANE, REPORTER: Actually, yes. It’s been almost ten years since passage of the American Recovery and Reinvestment Act of 2009. That law basically gave hospitals and physicians’ offices until 20-14 to convert from paper-based medical records to digital EHRs. Beginning in 20-11, the federal government required these healthcare providers to start providing evidence that they had met various stages of what is called, “meaningful use” of EHRs. In other words, they had to document how effective they were at improving healthcare quality, safety and delivery efficiency. So by now, we have a lot of data on the benefits and problems of EHRs, so it’s a good time for the healthcare community to discuss where we are.

So did EHRs become mandatory in 2009?

COCHRANE: Well, with the 2009 law, the government basically used a carrot and stick approach to strongly encourage the transition to EHRs. For example, Medicare providers get an incentive of up to $44,000 per physician and up to $65,000 over six years under Medicaid. That’s the carrot. There’s also a penalty of a one percent reduction in Medicare reimbursements for failing to demonstrate meaningful use of EHRs.

What came out of the symposium? Are EHRs helping or hurting?

COCHRANE: In conjunction with this symposium, Stanford Medicine commissioned a nationwide Harris survey of more than 500 primary care physicians about their views on EHRs. Sixty-two percent reported that, on average, they spend the majority of their time interacting with EHRs and not patients. And seven out of ten said that EHRs “greatly contribute to physician burnout.” Nearly half think EHRs actually detract from their clinical effectiveness.

Well, did any good news come out of this survey?

COCHRANE: Absolutely! Despite the challenges, physicians haven’t lost faith in the promise of EHRs. The poll found that 70 percent of physicians thought EHRs have improved in the last five years. And nearly two-thirds felt that EHRs have generally helped improve patient care. The general conclusion of the symposium seemed to be that transforming EHRs into powerful clinical tools is much more than a technological problem. Physicians and researchers have to play a larger role in shaping the future of EHRs.

What are some examples of how the healthcare community might rethink EHR use?

COCHRANE: Well, here’s an interesting and recent example. It turns out that a seemingly non-medical data field in an EHR – the emergency contact information – could potentially be a genealogical gold mine for research into hereditary diseases.

How so? How would that work?

COCHRANE: In a paper published last month, researchers at Columbia University used a pool of more than 6-and-a-half million emergency contacts from millions of identity-stripped EHRs at three New York City hospitals to build a genealogical database. They were able to find intricate familial relationships because each of the emergency contacts also had patient records at the same hospitals. From there, they could query the database for potential relational patterns in various traits, conditions or diseases—called phenotypes.

Okay, so break that down for us. What’s the significance of this research?

COCHRANE: It’s important because, up until now, the primary way to identify heritable links was through the use of twin studies, which are both time consuming and limited in scope. So, essentially, EHRs could be opening up a whole new way to conduct research into genomics, population health, and even the impacts of social and environmental factors on health and wellness.

I remember the old days when the paper records of families were kept together and the doctor knew the health patterns of the entire family unit. This sounds like we’re getting back to that in a way that protects confidentiality.

Michael Cochrane is WORLD’s science and technology reporter. Thanks so much, Michael!

COCHRANE: You’re very welcome, Mary.

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