photo by Ted Eytan via Flickr
Despite major technological advancements in healthcare, the digitization of medical records has, until recently, seen little progress. The American Recovery and Reinvestment Act, will soon flip this status quo on its head.
The marriage of healthcare and technology has, for the most part, been one characterized by a sort of symbiosis–the sale of medical technology nourishes the companies who invent it, while the patients and doctors benefit from utilizing it. This relationship and the promise that technological innovation may save and improve human lives has continually driven the healthcare tech market forward.
However mutually beneficial this relationship may be, and despite the inherent benefits of technologizing healthcare, not every aspect of the way we care for our bodies has advanced at the same rate. This lack in equitability may be most evident when it comes to the filing of medical records, some of which are still kept on paper.
Until recently, these records have almost completely escaped a major push towards digitization, and with a reported 400,000 deaths per year attributed to medical errors (making them the third leading cause of death in the U.S.) scrutiny of such records is more stringent than ever before.
If the American Recovery and Reinvestment Act (ARRA) has anything to do with it, this era of rampant medical errors (at least ones stemming from medical records) may be coming to an end. As mandated by ARRA, all doctors and hospitals must be able to provide patients with Electronic Health Records (EHRs) by 2015, or else face major medicaid and medicare penalties.
Riding on the coattails of the ARRA’s mandate, software development company, SIPPA, is hoping to take full advantage of EHRs mandated usage by offering a platform which puts them into the palm of your hand–or more accurately, your smartphone.
Dr. Bon Sy
Though Dr. Bon Sy’s arena of expertise lies primarily within computer science–he’s a professor at Queens College in New York–he has, as he puts it, “spent the last two years learning about the complexities of our healthcare system.”
Even as co-founder of SIPPA, a fledgling software development company aiming to provide patients and doctors with a secure and mobile-accessible platform to receive their EHRs, Dr. Sy’s entry point into the field of healthcare has been an experience reflective of countless others.
“Two and a half years ago when I visited my brother in Europe, [he] was complaining that it took him four trips just to get an X-Ray before he could go see a specialist” Dr. Sy said in reference to his inspiration for SIPPA. “I said ‘if you have your own health records, why do you need to make four trips for that?’ ”
It was this formative experience as well as another more personal visit to the hospital (which Dr. Sy reflects ruefully upon) that propelled him and a small team of developers to start conceptualizing SIPPA, which has since secured a $150,000 grant from the National Science Foundation.
SIPPA, which is still in its development stage, is aiming to offer users several unique features which include; biometric security (fingerprint and voice recognition software), a mobile platform with which one can request and receive EHRs, and an interface that caters to both doctors and patients equally.
It’s hard to believe that the SIPPA solution, which sounds like a no-brainer in a world where mobile accessibility is the status quo, would have been nearly impossible just four years ago. In order to understand SIPPA more fully, it may be critical to look at the fractured state of medical records that lies at the heart of Dr. Sy’s crusade.
The Digitization of Medical Records
Contrary to what one might expect, the idea of EHRs was first introduced in the late 1960’s when physician and medical iconoclast Larry Weed dreamt of inventing an easier method of wading through a patients’ voluminous medical records.
Perhaps even more surprising than EHR’s unexpectedly early invention is that in 2008–36 years after their inception–only 9 percent (pdf) of hospitals had adopted even the most basic form of EHR technology.
This trend is seemingly on its way out. According to the Office of the National Coordinator for Health Information Technology, an unprecedented 44 percent of acute care non-federal hospitals have adopted at least a basic EHR system–a percentage that jumps to 85 percent in regard to certified EHR systems.
This increase correlates to a over tripling in usage in just three years.
So, what can we attribute for this sudden and dramatic rise in ubiquity? In short, the answer is incentive.
The climb in EHRs all began with the Health Information Technology for Economic and Clinical Health Act, or HITECH. Within this bill–which was signed by president Obama in 2009 to stimulate the growth of health information technology–a clause was included. This clause which healthcare providers, and hospitals alike are now very familiar with, is referred to as “meaningful use.”
Meaningful use dictates that simply introducing health information technologies is not sufficient enough to satisfy the objective of the HITECH bill, but rather, hospitals and clinicians must quantifiably prove (using predetermined guidelines) that they are putting such systems to “meaningful use.”
Though neither HITECH nor the meaningful use clause federally mandate the implementation of such systems, but the bill and clause do offer incentive of a different nature–money.
Through HITECH and the meaningful use clause the government has made available up to $27 billion in incentive payments to those who adopt and implement EHR systems in their practice or hospital.
Specifically, these available funds equate to $44,000 for medicare eligible clinicians and $67,750 for medicaid on an individual basis.
So, such incentives have indeed amplified the rate of EHR adoption by hospitals and clinicians alike–propelling them nearly to the point of ubiquity.
But now that they’re here, just how much have EHRs helped?
As it turns out, the impact has not been quite as significant as healthcare providers and lawmakers may have hoped. In fact, according to the American Medical Association (AMA), the progress made by the use of EHRs has been marginal to say the least.
The President of AMA Steven J. Stack states, “The health system desperately needs working information technology to help support quality care,” in an interview with the Wall Street Journal. “The current generation of EMRs and the way they are deployed is not supporting the quality of care we need it to,” he continues.
This sentiment has been most evidently mirrored in a 2014 report (pdf) by the nonprofit Physicians Foundation which shows the 85 percent of physicians have adopted some form of EHR system, but conversely, only 24 percent report that it has aided their practice.
“What we’re trying to address is this issue of fragmented health records,” said SIPPA representative Christina Shonfeld. “Right now people see multiple providers… and these records are just kept all over the place.”
For SIPPA, even though EHRs have made great strides towards widespread usage, it’s now the problem of fragmentation that lies at the heart of their quest to improve medical records. By providing clinicians and patients with a medical record system that offers uniformity and consolidation, SIPPA hopes to expedite medical experiences from both a patient and clinical standpoint.
“The most traditional and conventional way we do things between two doctors is, guess what? We pick up the phone and we call and we fax over the paper,” said Dr. Sy. “This is all fine if all we want is to pile all the paper into one file for the patient, but if we do that then we may not be doing a the patient any favors… If I go see a doctor because I’m having a heart pain, I don’t want the doctor to spend 10 of the 15 minutes he has with me flipping through [my record]…If we can combine digital health records in a structural form then there’s a common understanding and a common way we can search information fast,” he said punctuating with a snap of his finger.
SIPPA’s quest to aggregate health records and provide uniformity to the EHR infrastructure is a something of a monumental task, but for SIPPA, squaring away the logistics of collection and distribution aren’t the only objectives.
Since SIPPA aims to provide mobile accessible records that are readily available to patients and clinicians, safety is paramount to SIPPAs usability. To combat the fear of compromised documents, SIPPA has developed a biometric technology which uses both fingerprint and voice recognition software–one they hope will keep patients’ documents airtight.
SIPPA is far from alone when it comes to innovating EHRs, but even in spite of major corporations like Samsung who are offering similar services to SIPPA with their SAP mobile healthcare system, they feel confident that they still occupy a unique space in the arena of EHRs.
“In the whole eco-system of healthcare [technology] everything will be converging,” said Dr. Sy, “But if you look at the efforts of Samsung or Apple, the effort is geared more towards the wellness… Our position is more centered around the need of healthcare.”
It would seem on the surface that SIPPA has a long and arduous road ahead in convincing doctors to opt into their system, but under the umbrella of ARRA, this step is rendered unnecessary. According the ARRA, clinicians will be required to provide patients with an electronic health record upon request–a mandate that Dr. Sy predicts will expedite the usability of SIPPA as EHR adoption increases.
In the end, what separates SIPPA from others is their target audience. For them it’s about the patients more so than the doctors. As exemplified through the so far ineffective adoption of EHRs, technology alone may not be sufficient enough to improve care. Often, technology is only as effective as the person using it.
If this is this case, SIPPA may be putting EHRs in the best hands of all.
“If we can improve the patient engagement, meaning that if we can help the individual be more proactively aware of their health condition so they will be able to more actively interact with their care provider,” said Dr. Sy. “That has a much better chance to affect their lifestyle.”