Are Privacy Standards Enough to Push Electronic Health Records? - Electronic Health Records: Challenges Ahead

New Challenges Lie Ahead
Even with enforcement issues settled, though, a number of challenges continue to stymie PHR penetration. First and foremost, may just be general consumer apathy toward the use of online health records.   The Markle survey, conducted by Knowledge Networks, found that of those not interested in using a PHR, approximately 46 percent said it was at least partly because they didn’t feel they needed one to handle their health needs satisfactorily.   "Consumers are just not that excited about these (services)," Forrester analyst Elizabeth Boehm told the Wall Street Journal last fall. "They just don't understand what's in it for them."  

These factors are particularly challenging, Evans explains, because they are held back by an extremely creaky national health care IT infrastructure.

“There are plenty of standards available that would specify how one might take health information from system A to system B, from a hospital medical records system into a PHR system. There's no lack of clarity on that,” he says. “The question is, have all of these different institutions implemented all of these standards in their legacy IT environment?”  

The answer is no, says Evans, adding that even a very conservative average would put most health care IT systems 10 years behind systems in any other vertical.

“Frankly, it’s because they've not been forced to invest in IT as a competitive necessity,” he says. “If you talk to a health plan, even the ones that claim that they're leading-edge health plans, they've got systems that are incapable of really linking data at the individual level. The systems weren't built to know something about individual customers; they were built to do claims management, optimization, loss adjustment or market analysis. They've got old systems, and they're not very responsive about changing that.”  

Unless employers apply more heat to the market, this will remain the weakest technological link to the health information exchange ecosystem, Evans says. “The reason we are doing Dossia is that we believe that if we give information to our employees, they will become smarter consumers and will ultimately still spend less money and be healthier people,” Evans says. “Health plans themselves claim they are customer-oriented, but the person that is getting treated at the doctor and is filing their claims really isn't their customer. The customer is the employer that is paying the bill. So the employer needs to start stepping into the space and saying 'We think you need to be more efficient in dealing with us.'”

Beyond that, there are also major technological hurdles that still need to be overcome. Evans points to two that Dossia is trying to address: “One is the data itself has to be in a format that is usable to clinicians. If it is just gobbledy gook, no doctor will ever use it. Secondly, it has to be auto-populated; people are not going to type in their own information on their drugs and their allergies and their treatments. It is too complicated.”