Cheryl Conrad no longer seethes with the frustration that threatened to overwhelm her in 2006. As described in IEEE Spectrum, Cheryl’s husband, Tom, has a rare genetic disease that causes ammonia to accumulate in his blood. At an emergency room visit two decades ago, Cheryl told the doctors Tom needed an immediate dose of lactulose to avoid going into a coma, but they refused to medicate him until his primary doctor confirmed his medical condition hours later.
Making the situation more vexing was that Tom had been treated at that facility for the same problem a few months earlier, and no one could locate his medical records. After Tom’s recovery, Cheryl vowed to always have immediate access to them.
Today, Cheryl says, “Happily, I’m not involved anymore in lugging Tom’s medical records everywhere.” Tom’s two primary medical facilities use the same electronic health record (EHR) system, allowing doctors at both facilities to access his medical information quickly.
In 2004, President George W. Bush set an ambitious goal for U.S. health care providers to transition to EHRs by 2014. Electronic health records, he declared, would transform health care by ensuring that a person’s complete medical information was available “at the time and place of care, no matter where it originates.”
President George W. Bush looks at an electronic medical record system during a visit to the Cleveland Clinic on 27 January 2005. Brooks Kraft/Corbis/Getty Images
Over the next four years, a bipartisan Congress approved more than US $150 million in funding aimed at setting up electronic health record demonstration projects and creating the administrative infrastructure needed.
Then, in 2009, during efforts to mitigate the financial crisis, newly elected President Barack Obama signed the $787 billion economic stimulus bill. Part of it contained the Health Information Technology for Economic and Clinical Health Act, also known as the HITECH Act, which budgeted $49 billion to promote health information technology and EHRs in the United States.
As a result, Tom, like most Americans, now has an electronic health record. However, many millions of Americans now have multiple electronic health records. On average, patients in the United States visit 19 different kinds of doctors throughout their lives. Further, many specialists have unique EHR systems that do not automatically communicate medical data between each other, so you must update your medical information for each one. Nevertheless, Tom now has immediate access to all his medical treatment and test information, something not readily available 20 years ago.
Tom’s situation underlines the paradox of how far the United States has come since 2004 and how far it still must go to achieve President Bush’s vision of a complete, secure, easily accessible, and seamlessly interoperable lifetime EHR.
“What we’ve essentially done is created 24/7/365 access to clinicians with no economic model for that: The doctors don’t get paid.” —Robert Wachter, chair of the department of medicine at the University of California, San Francisco
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