Despite all of the government legislation and discussions toward interoperability in recent years, medical records today are still incomplete.

Each provider has a small fragment, or maybe even a larger fragment, or a patient’s full medical record. This is because medical records are stored based on the provider.

Example:

Bill goes to see his primary care physician. Because this is his primary doctor, many of his records are in the primary care doctors EHR. But over the last 10 years, Bill's been in and out of the hospital with chronic pain and has had some trouble managing his diabetes. He’s seen a few specialists, in addition to physical therapy and pain management doctors. Each provider Bill sees creates a record of their encounter with Bill, but they don't always share this information with Bill's other providers including Bill's primary care doctor. 

The way the system exists today – many of those pieces of Bill’s history are missing from his medical record – resulting in potential for medical errors, repeat procedures, incorrect medication information, and so much more. The problem with our current system is that it doesn't allow us to be able to see all of Bill's medical records from all of Bill's providers in a single lifetime view .

This example illustrates the problem: most providers don't have the patients' complete medical information. This problem gets worse the more providers the patient sees such as specialists like cardiology, dermatology, and radiology.

When patients see multiple different providers in different care settings, none of whom have access to complete information, it's easier for things to go wrong.

And, when things go wrong in healthcare it can cost you your health, your wealth, and even your life.

Our current process is broken. But why? 

The patients' medical record should contain all of the information regarding a patient’s health and medical history such as doctor’s office visits, laboratory test results, and surgical reports.

According to CMS, a medical record may be considered “complete”, it contains sufficient information to identify the patient, support the diagnosis/condition, justify the care, treatment and services, document and course and results of care, treatment, and services, and promote continuity of care among providers.

While each provider’s medical record may be complete to support their encounter with the patient, they are not always effectively shared with other providers that also care for the patient This means that the medical records at each provider that the patient sees is different from the medical records that are at other providers and is therefore incomplete.

The problem is made worse because of how we share information.

A lot of the information that is passed back and forth between providers is done via the mail, fax (electronic or paper), or by the patient themselves.

Would you be surprised to learn that 75% of patient information is still sent via the fax? It's true!

Plus, faxed information still has to be re-entered into the EHR which can lead to typos making the medical records inaccurate or incomplete information.  

Furthermore, the probability of missing information goes up when the complexity of care increases. So, someone with multiple hospitalizations and/or providers are more likely to have an incomplete medical record and poorly coordinated care.

Some patients even try to keep track of their own medical records, but are often unable to get a copy of their record, faced with large fees, or incur delays in getting their medical records from their providers.

The 21st Century Cures Act

Congress, fed up by inability for patients to get their own medical records, enacted the 21st Century Cures Act.

This Act makes it clear to all providers, payers, and health IT vendors who participate Medicare, Medicare Advantage, Children's Health Insurance Program (CHIP), and Medical and Health Plans offered by a Federally Qualified Exchange that beginning January 1, 2021 patients have the right to access their own medical records via an API (application programming interface), period.

Further, a Provider Directory API will also have to be made available so that patients can look up their healthcare provider and request their medical records. Those that fail to comply will face penalties.

For more information on these deadlines see https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index

Interoperability and Integration: The next step in building a complete medical record

At iShare Medical, we've recognized this problem and have built the solution to fix it -- creating an interoperability solution that integrates with the EHR and enables the multiple systems that exist in healthcare today, to talk to one another and seamlessly and securely share medical information.

Interoperability and a lifetime medical records are the necessary prerequisites to support:

1. Care coordination and communication
2. Artificial intelligence and big data
3. Value-based care
4. Learning health system.

A learning health system takes the complete picture of the patient, including what has happened, what is happening now, and a predicts of what will most likely happen so we can help providers to detect, prevent, and treat diseases sooner.

What should hospitals and providers do?

The first place to start is with the safe and secure transmission of electronic medical information among authenticated and authorized providers. iShare Medical Messaging uses the Direct Protocol (also known as Direct Messaging) to send and receive HIPAA-compliant messages containing medical information such C-CDA, laboratory results, and radiology reports among patients, providers, and payers.

This medical data is used for referrals, transition of care, care coordination, and much more.

At iShare Medical, our direct secure messaging product is called iShare Medical^® Messaging.

iShare Medical^® Messaging streamlines workflow by replacing the fax machine to send medical records. While it may look like an email system, but this is no ordinary email program!

There are significant differences between iShare Medical^® Messaging and Fax.

iShare Medical Messaging includes iShare Medical Directory a directory of provider Direct Addresses (or electronic endpoints) so you can be found by referring providers and find providers to whom you need to communication.

iShare Medical Messaging and iShare Medical Directory are available as a standalone product, integrated with your EHR, or incorporated into your custom application by using iShare Medical’s RESTful API's.   iShare Medical Messaging and iShare Medical Directory make is easy to send and receive medical records – regardless of care setting, provider, or EHR across our nationwide network of more than 2.43 million direct addresses sending 141 million transactions quarterly. 

Say goodbye to the fax and hello to interoperability and integration with iShare Medical Messaging!

Conclusion

We’re making great strides toward interoperability, and putting an end to the medical records scavenger hunt is the first step. Creating a patient-centric medical record – one that stores your information in a longitudinal record so that we can see it – is the ultimate goal. We hope you’ll join us in that journey!