The lack of hospital-to-hospital communication through database systems can lead to a whole host of problems accessing patient data and knowing what treatment to provide.
America’s healthcare system has the reputation of being one of the most complicated in the world.
In February 2009, as part of a push to modernize the healthcare system, the American Reinvestment & Recovery Act was enacted to centralize Electronic Health Records (EHR) throughout the country. This pushed hospitals to update their pen-and-paper record system to a more centralized EHR. While many of these hospitals have their own EHR system, problems often arise when one hospital needs to access the records of someone who was a patient at another.
TMS spoke to Dr. James Hamilton, Jr., an American College of Surgeons Fellow and Assistant Professor in the Bariatric Surgery Division at the University of Kansas Medical Center, about his process accessing data across hospitals.
Dr. Hamilton works at four different hospitals in Kansas, three run by the University of Kansas Health System as well as Stormont Vail Healthcare, a separate hospital.
EHR
Most hospitals purchase custom EHR systems from a handful of companies, two of which, Epic and Cerner, Dr. Hamilton works with. These custom EHR systems tend to be designed to work specifically for the specific hospital it’s built for. As a result, most of the time data put into these systems is only visible through that hospital’s portal. Systems that exist in other hospitals are usually able to interact with one another.
As Dr. Hamilton explains, this can lead to issues when he receives a patient from another hospital in order to perform some procedure that hospital is unable to perform.
“If I’m looking for an X-Ray from another hospital, for example, the VA, which we get transfers from all the time, nothing from the VA hospital system communicates with anything that I have with Epic.”
The only solution then is to wait for the information from the other hospital to arrive, a process that can be incredibly time consuming.
“I have to request the VA to send the patient to my office with a CD-Rom disk of their films, or to Cloud it to my main hospital. But if I do that, I don’t get the diagnosis that the radiologist at the VA has done; I have to completely interpret that slide for myself. Although I have access to the information, it requires multiple requests, it takes time, and I don’t get the reports that I need that might be helpful in telling me at least where to look, where to scan.”
Dr. Hamilton reported that he doesn’t typically use these systems to access important information about his patients.
“In order to pull data from Epic, the Epic folks would charge you for that kind of data.”
Systems from both Cerna and Epic are able to communicate with each other, but only in limited ways.
The can communicate with each other “only if you are searching for that information, know what you’re looking for, and are persistent enough to find it,” Dr. Hamilton explained.
Dr. Hamilton goes on to say that most of the time he ends up getting the information from the patient and then has to enter it into his own system.
Vaccinations
Dr. Hamilton was able to receive the first round of the COVID-19 vaccine in late December through the hospitals he works at.
“I was never entered in any electronic health record. I had to fill out a separate document to give to my primary physician, who works in a competing hospital a few weeks later. There is no way for her to know that I received any vaccinations through any kind of software as the information just isn’t available.”
Dr. Hamilton was offered one way of tracking the information, which was through a completely voluntary application from the Centers for Disease Control and Prevention (CDC) that routinely asks follow-up questions in the days after receiving the vaccine.
“This was not linked to any health care provider, so there’s no way that anybody could know that I’d been vaccinated … I was not entered into any of the Epic databases because, quite frankly, those are designed for billing, not designed for tracking personal health information.”
The lack of hospital-to-hospital communication through these database systems, even though they are on the same platform, causes other vaccine related problems as well.
“If I were doing a splenectomy, I would need to know that someone’s been vaccinated. If I could put out a query that would go out to all of these databases that would give me an answer, [that] would be much simpler than me going into each database and searching for it. Many public health departments that would be the major provider of vaccines for people from lower incomes do not have online systems.”
Even if Dr. Hamilton searched for the pneumovax vaccine in the database, information he would need to safely finish the procedure, the information is not stored in a place he could easily access.
Dr. Hamilton explained that many of the doctors end up giving their patients the vaccine anyway. Instead of spending hours looking for information that may not be there and risking the danger of removing someone’s spleen, giving patients the vaccine just in case helps mitigate the risk.
Privacy laws in the United States also need to be addressed.
Right now, if Dr. Hamilton requests information that he is not certified to receive due to the Health Insurance Portability Accountability Act (HIPAA), he would have to request the information from the patient in order to access their medical records.
“But if all of the hospitals around the country were mandated to join an information exchange, every hospital would have to sign a privacy agreement so the information could be freely shared, and the government would have to watch out for liabilities.”
Dr. Hamilton believes that the solution lies in the creation of a national health system with a single medical record that everybody accesses and uses.
With this type of system, “we can collect meaningful population data … and really do something about providing really fine healthcare. They can track the long-term effects. They can show the vaccines are exceptionally safe, which the data is already showing.
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