This was not the post I was going to write. This was supposed to be a story about some tenacious computer programmers working at the VA in the 80’s who decided to create a system which became one of the first EHR’s, and is still considered one of the most user friendly systems. They did this by eliminating layers of bureaucracy and simply worked directly with the clinicians who actually used the system. It’s still a great story, and I hope to write it one day, but something happened which has changed the provision of health care forever. I wanted to show the benefits of using open source software as opposed to a proprietary model, where information is locked behind corporate walls. I feel that the crisis in the past two months has proven this beyond a shadow of a doubt.

We all knew that a pandemic of this magnitude, or worse, was just a matter of time. We were not prepared on many levels, but we should have at least had access to healthcare data that would have gone a long way towards knowing early on how bad it was in real time. The government invested a lot of money and time via the HITECH act of 2009, which set goals and standards for electronic healthcare records. One of the major goals was for data to be compatible with every hospital in the US, while also ensuring that data, that has been stripped of personal identification, could be used for research and public health tracking to prevent potential pandemics. That didn’t happen. Instead, EHR systems have been primarily employed to maximize billing efficiencies. Healthcare data has become a commodity that is locked behind firewalls of the EHR vendors. This ceases to make any sense when that data could have been used by the CDC, NIH, and state and local governments to deal with the pandemic earlier, which would have saved lives and money.

How have the EHR vendors responded to the crisis? Clearly they are trying to make the patient data they have in their databases available, but why wasn’t this built in as hoped for in 2009? One article pointed out that, “...pooling data from the digital records systems in thousands of hospitals has proved a technical nightmare thus far. That’s largely because software built by rival technology firms often cannot retrieve and share information...” Probably the best indication of the benefit of EHR’s during this crisis comes within Executive Order #202.18 issued by Governor Cuomo of New York:

“Notwithstanding any law or regulation to the contrary, health care providers are relieved of recordkeeping requirements to the extent necessary for health care providers to perform tasks as may be necessary to respond to the COVID-19 outbreak, including, but not limited to, requirements to maintain medical records that accurately reflect the evaluation and treatment of patients, or requirements to assign diagnostic codes or to create or maintain other records for billing purposes....”

In other words, the process of adding documentation in EHR’s is so onerous that Governor Cuomo saw fit to relieve the doctors of this burden so that they could take care of patients. Those computer scientists that came together at the VA in the 1980’s wanted a system that would help clinicians and patients. In 2009, similar goals were made by those who were spearheading development of electronic healthcare systems. It is possible to have our important health information both accessible and secure. I can access my bank account, my health insurance plan, and just about anything you can think of because a man named Tim Berners-Lee set up a system that used standardized computer languages to enable access to this information. It is called the World Wide Web, and the World Wide Web Consortium (W3C) is an organization that oversees these standards to keep openness and interoperability. It’s a great model for what open source is capable of, and a technology called FHIR (Fast Healthcare Interoperability Resource), uses similar technology to the World Wide Web, and is currently being implemented by the CDC as a tool for reporting cases of COVID-19.

The delivery of healthcare will never be the same again. We can wring our hands over this fact, or we can work together to build a system where healthcare information is shared for disease tracking, research, and to increase quality of care. Yes, digital technology can be used to wring every penny out of the business of healthcare, but it can be so much more. After all, how much has more efficient billing helped us in this pandemic?