Decades after their first introduction an electronic health record is still very difficult for different healthcare providers to exchange.
It’s tempting—but, warns a veteran industry executive, probably wrong—to believe a technological shortcut will solve the problem.
According to a recent study by the National Academy of Medicine, 96% of U.S. hospitals and 78% of physicians’ offices use some form of electronic health records (EHR), theoretically enabling multiple providers to share vital data on patients and treatment. Due to a general lack of system interoperability, however, says the study, information from across the care continuum is unable to flow at the right time, or even to the right person.
“As much as anything else,” says James D’Arezzo, CEO, Condusiv Technologies, “this is a turf issue. Hospitals and other providers purchase systems and equipment from a variety of manufacturers, each of which has its own proprietary interface technology.” D’Arezzo, whose company is a world leader in I/O reduction and SQL database performance, adds, “As a result, most providers spend time and money setting each technology up in a different way, rather than being able to rely on a consistent standard of connectivity.”
Pressure to solve the Electronic Health Record problem is coming not only from healthcare institutions but from a variety of other sources, including the federal government.
Defense Secretary James Mattis and Veteran’s Affairs Secretary Robert Wilkie recently issued a joint statement confirming their commitment to enabling EHR interoperability and aligning plans, strategies, and structures as their respective EHR implementations progress. The VA’s EHR implementation is scheduled to go live at a minimal level at care sites in the Pacific Northwest by March 2020.
Meanwhile, blockchain has been suggested as a cure for Electronic Health Record interoperability challenges.
According to a recent report by Deloitte, blockchain has progressed from capturing cryptocurrency transactions to become a medium that can enable decentralized information sharing and application operations.
Blockchain, says the report, may offer a solution to more easily aggregate health data in a secure, automatic, and error-free way.
Apparently the industry is taking heed. In a recent study of major healthcare IT trends, 55% of surveyed hospitals indicated a desire to initiate some sort of blockchain program in the next 24 months.
There are, comments D’Arezzo, two basic problems with this idea.
- Blockchain is a database. It requires a good deal of input/output activity—interchanges between the computer’s CPU and storage, whether real or virtual.
- Blockchain is slow. In the most recent available study, the Bitcoin network—the largest and most widely tested application of blockchain technology—achieved maximum throughput nearly 50 times slower than PayPal, and 14,000 times slower than VisaNet.
Instead of hoping for a pre-emptive technological solution, D’Arezzo suggests that healthcare providers continue their progress, halting though it may be, toward widespread agreement on mutually usable Electronic Health Record file structure and content.
“If blockchain-based applications come in on top of the already staggering load of data handling required of IT in the healthcare sector today, the danger of major system slowdowns, and quite possibly system crashes, will increase dramatically,” says D’Arezzo. “This is not what healthcare providers need or want—and could be fatal.”
In the meantime, he adds, the performance of EHR systems can be dramatically improved by streamlining the I/O capability of existing implementations, as demonstrated by Condusiv’s recently announced work with a major EHR technology supplier.
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