New Roads on the EHR Interstate

First, the good news:  We now know that some 83 percent of primary care physicians are using electronic health records (EHRs) in some fashion.

In the best of all worlds, all that collected information would be securely available to a patient at the touch of a button. How close are we?

For starters, New York is about to become the largest state with a unified patient portal and provider access to electronic health records.

That’s thanks to the New York eHealth Collaborative, a non-profit initiative and participant in TEDMED 2013’s Hive innovation showcase, which will be piloting the portal, SHIN-NY, in a few hospitals over the next few weeks.  It will reach patients across the state in 2015.

The state’s portal is Blue Button compliant, meaning it meets technical standards set out by that initiative, a public-private partnership with the goal of providing all Americans secure access to their health information.

In designing the portal, NYeHealth asked residents to choose from among various submissions; the winner after 100,000 votes was Mana Health.


When might we see national conformity and communication?

“That is the vision, and the challenge,” says Anuj Desai, NYeHealth’s Vice President of Market Development. Though a number of small states have their own portals, each model is slightly different.  A few states have started programs, however; Florida and Michigan now allow for direct, secure email between physicians and specialists to account for “snow-bird” patients that fly south to avoid winter cold.

NYeHealth is also driving a multi-state initiative, which has gathered 19 states 47 vendors to drive interoperability, by developing specifications for eventual industry-wide use.

A number of organizations have joined the effort as well and are leveraging NYeHealth’s specifications, including the U.S. Department of Veterans Affairs (VA), Department of Defense and Kaiser Permanente. The biggest stumbling blocks at this level are policy versus technical differences, Desai says. Some states automatically opt patients in for electronic health data sharing; others assume patients records are off-limits unless patients specifically opt-in.

“We’re excited about the pace of things; it’s gaining urgency. Consumers are expecting it to happen. If you go to an ATM, you get instant access to your money. If you’re using social media, you can access your account anywhere. Why shouldn’t health care be like that?” he says.

Meanwhile, at Blue Button Headquarters

One feels that sense of urgency when speaking to Adam Dole, a Presidential Innovation Fellow working on the Blue Button Initiative, which also appeared in the Hive. Blue Button had its beginnings some seven years ago when the VA began making records accessible to its patients, culminating in the launch of an online portal in 2010. Today, more than 50 percent of providers use some form of electronic health records (EHRs) and 150 million or so Americans are able to access a least a part of their health records.

“The culture of medicine has gotten in the way of enabling consumers to be an equal member of their care team.  For many people, it’s still an intimidating experience to go to the doctor, let alone let ask for additional services. But I’m happy to say there is a quick tide change here, and we’re seeing huge advancement in their way [consumers] see their right to access information,” he says.

Blue Button rolled out a beta of its Connector portal just this month, which offers consumers a first look at an eventual one-stop access to their health data. (Dole’s predecessor, Ryan Panchadsaram, spoke at TEDMED 2013 about why info delivery design is critical to Blue Button’s success.  Watch his talk here.)

Source: Office of the National Coordinator for Health Information Technology
Source: Office of the National Coordinator for Health Information Technology

Over the past few months, Dole and the Blue Button team have concentrating on bringing national pharmacy chains to its data pool, including Walgreens, CVS, Rite-Aid, Kroger and Safeway.

“The reason we chose retail pharmacy chains is not only do they have a huge reach, but they also represent major issues in our healthcare system that access to human machinery and data could actually solve, like medication adherence, dosage management and drug interactions. We think that people behind the counter have all those records, but they don’t,” Dole says.

Future goals include bringing more insurers into the loop.  The added benefit to them may be presenting a more open, friendlier presence than they currently have, Dole says, likening their current public persona to the DMV (ouch) and the ultimate goal to be as well-known for customer service as Zappos.

Yet the remaining technical task, Dole admits, is gargantuan.

“We’re probably still in the development phase comparable to when mainframes were the size of an entire building and there was no value proposition for PC’s. That took 30 years to bring to fruition. We’re at that same early stage with data liquidity and interoperability, we have a long way to go,” Dole says.

— Stacy Lu