Imagine you’re at the checkout counter in a supermarket. After the cashier rings up all your groceries, you insert your debit card into the chip-and-pin machine and the cashier hands you a pen and a clipboard with some densely worded paperwork. “Please read and complete these forms, then sign and initial where indicated to authorize this transaction,” he says.
Assuming you do as requested and the people in line behind you haven’t started to riot, the cashier then tells you that your authorizations will be entered into the system and you will be notified in five to seven business days when your transaction is completed and your groceries can be released to you, and by the way, you may also have to re-shop for all your items at that time.
Sounds a bit insane, doesn’t it?
And yet this is the same process most people in America encounter when they utilize health or medical services. According to Reuters, “Less than one in three U.S. hospitals can find, send, and receive electronic medical records for patients who receive care somewhere else.” Citing a recent study published in the Health Affairs policy journal (Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data), Reuters reports that “to compensate, patients often obtain copies of records that they deliver in person to an outside provider or request that they be sent.” What if you had to go through such an ordeal every time you wanted to purchase something with your debit card or transfer funds between your accounts or use an ATM?
“Because EHRs” or “Because HIPAA” are common excuses for this Kafkaesque state of affairs.
But the ’90s-era Healthcare Insurance Portability and Accountability Act (HIPAA) was signed into law to improve the digitalization and portability of health insurance coverage and protect health data integrity, confidentiality, and availability. How could such a noble effort lead to such a bureaucratic nightmare?
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
According to Beyond the HIPAA Privacy Rule, a consensus study report published by the National Academies of Sciences, “HIPAA was designed to achieve two main goals: To make health care delivery more efficient and to increase the number of Americans with health insurance coverage. One way this was accomplished was by creating a standard for electronic health records. This allowed patients to change doctors, leave jobs, switch insurance, etc., without unnecessary paperwork. But HIPAA also made health records more accessible, which in turn led to a greater need for privacy laws, so attendant privacy regulations were proposed by the Department of Health and Human Services (HHS),” which have been adopted.
Then it seems everything came to a screeching halt.
While nearly all US hospitals have now adopted electronic health records, the Health Affairs study noted that “hospitals’ progress toward interoperability is slow and that progress is focused on moving information between hospitals, not on ensuring usability of information in clinical decisions.” Reuters reported that the most common barrier to inter-hospital health information use “was that their clinicians could not see it embedded into their own system’s electronic health record.”
Here we arrive at the crux of the issue. While patient data is obviously incredibly sensitive and security and privacy are of the utmost concern, it isn’t EHRs or HIPAA that are holding things back.
Everything can be digitalized and privacy-protected, but the information has to be both exchangeable and usable to enable the kind of instant access we get with our financial services. And to enable that, we should learn from the financial services sector, which overcame a similar problem years ago.
Back in the early 1970s, Telex was the only available means for financial institutions to confirm international funds transfers. According to the London School of Economics, a “transaction would often require the exchange of more than ten Telex messages, which made the process costly and time-consuming. Authentication procedures needed to ensure the necessary level of security for fund transfers were also complex and increased labor intensity. To make things even more complicated, Telex messages were being transmitted in the form of free text allowing the users to send payment instructions in various formats.”
Not so efficient, is it?
To address the issue, The Society for Worldwide Interbank Financial Telecommunication (SWIFT) was formed in 1974 to provide a network that enables global financial institutions to send and receive information about financial transactions through a system of codes in a secure, standardized and reliable environment. Within three years of introduction, “SWIFT membership had increased to 230 banks across five countries…Its success is attributed to how it continually adds new message codes to transmit different financial transactions…The robustness of the message format design allowed huge scalability through which SWIFT gradually expanded to provide services.”
There are now 11,000+ member institutions located in 200+ countries and territories and it is used by banks, brokerages, securities dealers, asset managers, treasury market players, and a host of other participants in the financial services ecosystem.
I’m not proposing that SWIFT can simply be overlaid on our health system and the problem will be solved. Healthcare comes with its own unique constraints and considerations. But we do possess the technology to implement a similar model, which most certainly can and should be applied. As with SWIFT, it could speedily provide the kind of data liquidity so obviously necessary for modernizing our health and medical services. It’s time to stop the insanity. Addressing the source of the problem is the first step toward mitigating it, and will free our health systems to function as they should in the 21st century.
Photo: Getty Images
