The Ebola epidemic, which has already caused over 3,800 deaths across West Africa, recently claimed its first victim within the U.S. -- Thomas Eric Duncan, a Liberian man who was visiting family in the Dallas area.
Duncan was initially admitted to Texas Health Presbyterian Hospital on Sept. 25 with symptoms. Although Duncan informed the nurse that he had visited West Africa within the past four months, the hospital released him the following day, after which he came into contact with as many as 100 people. On Sept. 28, Duncan was readmitted to Texas Health, where he died on Wednesday.
Texas Health initially stated that Duncan's release was caused by "a flaw in the way the physician and nursing portions of our electronic health records (EHRs) interacted." This immediately sparked a panic, since Texas Health's EHR vendor, Epic Systems, covers more than half of all patients in the U.S. However, Texas Health subsequently retracted its statement, claiming that "there was no flaw in the EHR," without a follow-up explanation.
Whether Epic's EHR, human error, or a combination of both were to blame is unclear, but the Texas Health case highlights some major problems with electronic health records in hospitals today.
The fragmented world of EHRs
In theory, EHRs should be a seamless way to digitize healthcare -- a patient's health records are entered into a system and kept in a synchronized database that can be accessed by different healthcare providers. To encourage the effective use of EHRs, President Barack Obama signed the HITECH Act in 2009 to award subsidies to practices that met "meaningful use" standards for electronic health records. Unfortunately, aging systems in hospitals and the lack of interoperability between providers have prevented EHRs from reaching their full potential.
The industry is split into fiefdoms. The biggest player is privately held Epic, while McKesson (NYSE: MCK) and Cerner (NASDAQ:CERN) are the two largest publicly traded EHR providers by revenue, according to GlobalData. The problem with these fiefdoms is that they don't like to share patient data with their rivals, which can cause problems when one hospital uses multiple EHRs or transfers patient data to another hospital.
Connecting the closed systems
Epic, in particular, is frequently criticized for its closed platform which hinders data sharing with other EHR providers. Yet Epic has received more than half of the $24 billion spent on the meaningful use program so far, thanks to its dominant market share, according to a recent RAND report.
Google (NASDAQ:GOOG) (NASDAQ:GOOGL) and Microsoft (NASDAQ: MSFT) previously tried to combine EHRs into single personal health records, or PHRs, with Health and HealthVault, respectively. However, Google canceled Health in 2011 due to a lack of interest from patients and doctors, and HealthVault continues to suffer from similar problems.
Apple's (NASDAQ:AAPL) new HealthKit platform, which combines EHRs from Epic, Cerner, and athenahealth (NASDAQ:ATHN) on iPhones, is a possible solution to this data fragmentation, but once Apple collects all that information, it's unlikely to share it with Google or Microsoft.
An industry of procrastinators
In response to Texas Health's initial statement regarding Epic's EHR, athenahealth CEO Jonathan Bush told CNBC that mistakes in electronic health records are "fixed only at the place where they appeared," and that such errors "constantly" occur. Athenahealth announced on Oct. 3 that it had updated its database with additional information about Ebola, and vendors scrambled to do the same.
But simply adding information about Ebola to EHRs doesn't solve the problem. The more pressing issue is the long overdue upgrade from ICD-9 to ICD-10. International Classification of Diseases codes are used to classify specific diseases. ICD-9, which most U.S. hospitals still use, only lists Ebola under a shared code with "multiple viral diseases," while ICD-10 gives it its own code. If Ebola is being lumped together with other diseases in EHR and hospital records, it could certainly cause additional confusion during the physician workflow.
China has been using ICD-10 since 2002, but the U.S. still hasn't upgraded all its systems to recognize ICD-10. In May, the Centers for Medicare and Medicaid Services extended the upgrade deadline to Oct. 1, 2015 -- its fourth deadline extension since January 2009. That wasn't surprising, since a QualiTest survey last June found that 75% of healthcare providers still weren't prepared for the change.
The Foolish takeaway
The spread of Ebola highlights just how messy and fragile the EHR industry is today. EHR companies need to share their data with each other and ICD codes must be updated to properly catch threats such as Ebola. If the healthcare industry can finally accomplish those two things, unifying platforms like HealthKit could help make the system healthier, more efficient, and better managed.