Executive Summary: A Lifetime Electronic Health Record for Every American
At age 52, Tracie Storie came down with chills after a trip abroad where she suffered from a urinary tract infection. She was staying with her daughter in Boston over the weekend and was planning to return home to Austin, Texas. Her daughter insisted on taking to her to the emergency room because she couldn’t talk without her teeth chattering. The doctors discovered she had sepsis, a potentially fatal infection in the blood stream, which may have started with the urinary tract infection. But they couldn’t treat her. Tracie was allergic to certain antibiotics but was in no condition to recall the names of those drugs, and her medical records were locked up in her doctor’s office in Austin. On Monday, the doctors in Boston finally got her records from Austin. Tracie recovered, but she had to return to the ER a few days later with severe pain in her head and neck, which likely occurred due to the untreated sepsis.
Tracie would have suffered less and recovered more quickly if her medical records had been available digitally and under her control. Her brush with death occurred six years after President George W. Bush set a national goal for all Americans to have an electronic health record by 2014. Tragically, despite this commitment and $30 billion in federal funding, no patient in America today has a complete electronic record. Instead, patients’ data languishes in the individual computer systems of hospitals and doctors’ offices. Providing a complete, lifetime health record—compiled from individual systems and available 24 x 7 for every American—would improve the patient experience and ensure that patients get optimal care whenever and wherever they need it. And it would save the federal government $41.7 billion over ten years by eliminating wasteful, unnecessary care.
This idea brief is one of a series of Third Way proposals that cuts waste in health care by removing obstacles to quality patient care. This approach directly improves the patient experience—when patients stay healthy, or get better quicker, they need less care. Our proposals come from innovative ideas pioneered by health care professionals and organizations, and show how to scale successful pilots from red and blue states. Together, they make cutting waste a policy agenda instead of a mere slogan.
What is Stopping Patients from Getting Quality Care?
After more than a decade of efforts, no one in the country has a complete and comprehensive electronic health record (EHR). Instead, individual health information is stored in various places, and as records become increasingly digitized, they are seldom integrated. This lack of interoperability means that one EHR system cannot readily exchange data with another system and interpret shared data. A health information exchange can improve interoperability, but such exchanges do not have a record of success. These issues have caused frustration among patients and providers, as well as duplicative exams and procedures and adverse events.
Where are Innovations Happening?
Despite the many challenges, the basic task of exchanging health information is succeeding in several places throughout the country, including:
- The California Integrated Data Exchange is an independent, not-for-profit centralized health information exchange spawned by two leading health insurers in the state. The exchange collects information from any health plan or provider in the state that wishes to contribute and receive information.
- The Georgia Health Information Network is a decentralized network connecting regional health information exchanges and providers. With more than 16 million patient records, the network recently announced the first cross-state connection of two health information exchanges with the South Carolina Health Information Exchange.
- HealthShare Montana initially integrated claims and clinical data for Billings’ city employees and provided them with a personal health web platform. Now, HealthShare Montana offers providers a comprehensive view of their patients’ medical records.
- The Veterans Administration health care system allows patients to download their medical records and share them with health care providers using “Blue Button.”
How Can We Bring Solutions to Scale?
Every Medicare and Medicaid beneficiary should have a complete electronic health record—provided through a health information exchange and financed by savings from eliminating wasteful care. Doing this would give every beneficiary a “personal health record,” which contains their insurance and clinical data as well as the opportunity to add their own data from health-related devices like Fitbits, mobile phones, and scales with Bluetooth capability.
This could be created with federal funding through either a centralized or decentralized model. Through both models, providers and plans could still retain (and use) the original records they generate, but the exchanges would assemble and maintain a complete and unaltered copy of the patient’s medical records.
For people not in Medicare or Medicaid, the incentives for health plans to offer a personal health care record should be strong enough to create information exchanges without further public investment. But, if needed, Congress could guarantee all Americans access to a personal health record by including it as part of the essential health benefits package.
Federal savings from this proposal total $41.7 billion over ten years. States will save slightly over $5 billion. And private health insurance and individuals will save another $50.9 billion over ten years.