I turn 50 later this year, and as I’ve gotten further into middle age I find myself spending more time in doctors’ offices. I guess that comes with the territory. I’ve also found myself more often in specialists’ office. I’m not getting sicker – well, not that much sicker. But it comes with the age and the miles.
There’s my primary doctor, who I see a couple of times a year for a routine checkup. A chronic shoulder issue earlier this year sent me to an orthopedic surgeon for a course of treatment. My gastric bypass surgery from five years ago demands a regular course of treatment from those surgical specialists. I used to be diabetic, which means regular check-ins with an endocrinologist. Each of them wants me to get blood drawn. Some like to use one lab chain. Others like to use another. And then there are my prescriptions.
That means that there are an increasing number of different doctors providing me with essential care and services. But there’s barely any coordination between them. Over the course of the past few years, they’ve all put “patient portals” online, ostensibly to make it easier for all of us patients to get in touch, to see our records, and to do things like request refills on meds or coordinate upcoming appointments.
The promise to consumers of Electronic Health Records (EHR) was to put patients in better control of their records – to make them more portable. A patient in Massachusetts goes to Florida and they and their health care providers would have instantaneous access to the same information. (This is a regular occurrence in my “neighborhood” – lots of the folks who live around me are what we call “snowbirds” – they summer near me but they spend the winter in Florida in warmer climes.)
Of course, that hasn’t happened. In fact, EHR seems to have accelerated the problem.
Looking at my situation: Three of the doctors I see are all part of the same medical group, the biggest regional medical services provider in my area. Two of them use the same patient portal for EHR access. One, which was part of a separate medical group acquired by the same regional provider, and hasn’t yet been integrated. So they require a completely separate app in order to access.
My orthopedic doc is part of a different group altogether. They use the same the same underlying health records system, but it’s accessible only through a completely separate patient portal. Same with my bariatric doctor. And none of them are integrated with Apple’s Health app, at all. I need to use different third-party apps available for download through the App Store, or muddle through their web interfaces, which aren’t even optimized for mobile.
The bottom line is that I have to chase three separate apps to get access to my records. Assuming that the “patient portals” are actually updated. Because they frequently aren’t. I’m still waiting to see the results of blood work I had done weeks ago – stuff that my doctor has access to on their desktop, but stuff that isn’t updated in my own records and probably won’t be for weeks, if not months. Because it’s a low administrative priority for the business.
A few weeks ago a doctor asked me about the results of some blood work I’d had done previously. He checked his systems and couldn’t find any record of it, even though I assured him it had been done, because I happened to remember having it done. Checking the various apps I had access to on my phone turned up nothing. It wasn’t until I hauled my laptop out of my bag, logged onto the web-based patient portal, and pulled up a PDF image of a faxed lab file that we were able to finally find the test we were looking for.
That is a hot mess. This is not how any of this should work. This is not how any sane system of health care and records management should work.
Apple’s tried to correct this by providing hooks for essential EHR connectivity in the Health app. It supports industry standards like Fast Healthcare Interoperability Resources (FHIR) and OAuth 2.0 to handle patient authentication. The company’s worked with Epic, one of the leading EHR systems on the market, along with Cerner and athenahealth to connect Health to patient health records seamlessly with the iPhone.
But that requires actual buy-in from health care providers to do so, and near as I can tell, there is little if any incentive for them to do so. The EHR systems they use do one thing right – they’re right on top of billing me and my insurance company every time they need to file a claim.
There’s the rub – the fact is that convenience and records portability is completely incidental, and pretty much irrelevant, to EHR systems the way they’ve been implemented. They’re there for one major reason – to make it easier for everyone in the pipeline to get paid.
The net result of all this app balkanizaiton is that at least for me, the Health app is basically an island unto itself. It helps me keep track of that information which I can glean from my Apple Watch, such as activity and exercise, and that which I wish to proactively input – my various health issues and trends like my weight gain or loss, whatever might be changing – but that’s a lot more effort than I have any time or interest to do. So it mostly goes fallow.
I’m hoping that the VA’s decision to get its own Health Records system integrated with the iPhone Health app will make at least some health care providers revisit this and maybe get more serious about integrating iPhone Health app support. But I’m not counting on it. And in the interim, I’m muddling through with the patchwork of different apps and patient portal systems I’m forced to use to help keep track of my own health records.
What a mess.
How about you? Do you find yourself frustrated with the slow rate of EHR integration and the limited access they provide? Sound off in the comments – let me know what you think.