Part six in an ongoing series on the concept of a Coordinated Record System by James McGauley, M.D.
Editor’s note: This article is the sixth in an ongoing series by James McGauley, M.D., on the idea of a Coordinated Medical Record system, which literally produces a single comprehensive medical record for every patient. The record contains all of the patient’s clinical and financial healthcare information over space and time. The credit card industry is the model. This type of information system will do more to increase the quality and decrease the cost of healthcare simultaneously than any other single initiative.
If the healthcare industry is truly interested in being patient-focused, then its information system should reflect that fact. A Coordinated Medical Record system is by definition the ultimate patient-focused system.
If one was going to develop a patient-centered information system from scratch and had to decide whether all of a patient’s clinical and financial information should be in a single record or scattered among hundreds of different records, Occam’s Razor would definitely point to the single record — the simplest explanation is usually the correct one.
If a single record is indeed the ideal patient-focused record, and it is also the type of record that will do the most to increase the quality and decrease the cost of healthcare simultaneously, then it seems reasonable to vigorously pursue the deployment of this type of record system both for the benefit of the patient and the industry as a whole.
Every current electronic medical record system contains its own unique view of a patient’s clinical picture. Even caresites that use the same medical record system can have significantly different information about the same patient. Some of the major EMR systems that contain numerous modules don’t even install their modules uniformly at every caresite.
Every time information is entered into a patient’s medical record at any caresite, that information becomes the new reality for the patient, and it negates the accuracy and the reliability of the information that sits in the medical records at all of the previous caresites that the patient has visited.
In the web of hundreds of unconnected electronic medical record systems, health information exchanges, new and old code sets, new and old standards, and technical middleware, where is the truth about any given patient. Where is the single medical record that everyone can rely on for its comprehensiveness, accuracy, and availability? Where’s Waldo — where is the accurate and reliable picture of the patient?
From the standpoint of the patient, every current healthcare information system is flawed. As a patient moves through space and time, every system will eventually contain incomplete, inaccurate, or conflicting information about that patient. And, these are the very problems that lead to misdiagnoses, inappropriate medications, duplicate tests, frequent emergency department visits and hospitalizations, nursing home care, and even death.
Because there is no central database of longitudinally reliable patient records anywhere in the healthcare industry, no one really knows the full extent of information-related morbidity and mortality.
However, the medical literature does suggest that 10-20% of all medical cases are misdiagnosed, and that most people will experience at least one diagnostic error in their lifetime. If this information is correct, it means that between 275,000 and 550,000 people could be misdiagnosed every day in this country.
A recent article in the Annals of Pharmacotherapy estimates that inappropriate medication problems in this country result in about 160 million repeat physician office visits, 24 million emergency department visits, 12 million hospital admissions, 4 million long term care stays, and 276,000 deaths each year.
If these numbers are anywhere near correct, it means that every day in this country 440,000 people are returning to physician offices specifically for treatment of an inappropriate medication problem. 66,000 people are going to emergency rooms, 33,000 are being hospitalized, 11,000 are entering long term care, and 800 are dying -- all for the same underlying reason.
All of the people that are suffering these information-related problems have faces — they are us. Hardly anyone gets all of their lifetime healthcare at one institution. As we all move through healthcare’s space and time, we invariably interact with information systems that have incomplete, inaccurate, or conflicting information about us. We experience these problems as different degrees of inconvenience, discomfort, disruption and tragedy in our lives.
If fragmentation of information is the underlying cause of most information-related problems, then coordination of information must be the solution. For every patient, there is only one clinical picture that is both currently and historically accurate, and 21st century technology is capable of generating that Coordinated Medical Record picture.
Unless every caregiver is given the opportunity to work from the same comprehensive and reliable medical record for every patient, it is likely that all information-related problems with their attendant morbidity and mortality will continue unabated.
We are all in the same boat. We are all potential victims of information-related problems. But, the people that can solve these problems are with us in this boat. An amazing number of people know from personal experience how inaccurate or unavailable information has caused a significant problem for them or a family member. Among these people are the activist physicians, business executives and government decision makers who can be the drivers and the instigators of making a Coordinated Medical Record system a reality.
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