But the thing that could immediately lower costs has eluded everyone so far: mandatory sharing of all electronic records into a centralized database with full access for clinicians and patients.
In a recent survey of clinicians, up to one-third of care was found to be unnecessary. This includes testing that is not known to improve health, or defensive ordering of diagnostics to avoid malpractice, but also duplication of testing already done elsewhere.
Medication errors abound, worsened by not having a cohesive database of which pills patients formerly took and what they’re taking now.
And management of many conditions is entirely different if there are previous tests available to review, particularly with X-rays and CT scans. Lab testing that has recently been completed by other providers is frequently duplicated since access to outside testing is limited.
Testing is expensive. Millions of laboratory tests are done each year. I see duplicated labs that are unnecessary several times a week because patients see doctors or other providers that are not part of the electronic medical record that I use.
Patients have access to their test results, but not many bring in a printout of their last five years of results, and if they can find the numbers, it may not include all of the tests. Although efforts are made to get outside records, these are faxed to medical offices, and not in a searchable format so that all former blood counts, for example, could be reviewed to see if there was a change.
A universal lab portal would eliminate the need to have paper faxes traveling between medical record departments and doctor’s offices. Trends in testing for cholesterol, sugar, liver numbers — all of this should be easily accessible with a few clicks of a mouse.
With the average blood panel costing several hundreds of dollars, this adds up.
Currently, if a patient goes to a local pharmacy for one prescription from me, and a mainland pharmacy for their prescription from another doctor using a different electronic medical record, I don’t see it in their records when they come in for a visit.
Periodically I get notified by insurance companies about the potential adverse reaction to certain medication combinations. I may have only prescribed one of the offending pills, and often when I look in my record, there isn’t a notation made of the other medication being taken regularly.
The Hawaii Prescription Drug Monitoring Program is a statewide database designed to list all opioid medications that patients are taking, and as of July 1, every prescriber has to check this system before giving an opioid prescription to their patient. If the system can be set up for opioids, it can be set up for all medications. The technology is already available.
There should also be a statewide database for X-rays, CT scans and MRIs. Often, there are subtle findings on scans that might have been there before but are potentially troublesome when there is no comparison from prior films. Knowing the progression might eliminate the need for invasive follow-up testing like lung or liver biopsies.
Frequent scans also expose patients to excess radiation, which over time may be harmful.
I see duplicated labs that are unnecessary several times a week.
A centralized medical record system could avoid that.
Each proprietary system would remain, but it should download into a larger database that can systematically list what testing was done elsewhere. Artificial intelligence could be put to use organizing tests such as scans, X-rays and EKGs into a convenient, comprehensive, searchable database.
After all the years of paper charts, almost 90 percent of doctors are using some type of electronic medical record. Coordination of these systems could provide an almost universal medical record for the entire United States.
Our nation needs an overhaul of the way health care is provided and paid for. Creating a national medical record system may be the first step.
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Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.