Boston Marathon tragedy reveals potential EHR, HIE flaws


The Boston hospitals that have been treating the hundreds of victims of the horrific Boston marathon bombings this week have done a terrific job. They, in turn, have credited technology in helping them communicate to staff, volunteers and the public. I presume that these hospitals also have good electronic health record systems that they can rely on.

But I can't help but wonder: wouldn't their work have been enhanced even further and their jobs made easier if the nation was further along in health IT and interoperability? Would it have helped these hospitals if they had had electronic access to victims as they were rushed in, to know about an allergy to penicillin, a patient's blood type, a heart condition that could affect the outcome of surgery?

Of course. 

But our interoperable health information system is still in its infancy, and there are concerns that health information exchanges may never be fully interoperable or sustainable. And that's among providers that use EHRs. It doesn't include the providers who haven't yet made the transition. 

On top of that, the system is full of unintended holes.

Editor's Note: Check out Mike Bassett's FierceMedicalImaging commentary about the role radiologists played in helping to bring organization to the Boston tragedy.

For instance, what if a patient has invoked his right under the new HIPAA mega rule to pay a doctor out of pocket in full for his high blood pressure to keep his health plan from knowing about it--so when the doctor shares the patient's data with a trauma hospital, either directly or through an HIE, that crucial piece of information isn't included? Or what if patients opt not to shield some of their data from being transmitted to an HIE--as some advocates are recommending--so that the trauma hospital ends up working from an incomplete record? 

Although these patient rights are important, they could very well create situations that are worse than sharing no data, as trauma hospital providers may falsely believe that they have all of a patient's relevant information. When there's no interoperability, at least the hospital knows that it lacks information.  

Ironically, this week we commemorated National Health Care Decision Day, which aims to educate and empower the public and providers about the importance of advance care planning. 

As I write this, a number of the bombing victims' lives hang in the balance. It would be helpful to know what their wishes about end of life care are so that those wishes could be honored. Stages 2 and 3 of the Meaningful Use Incentive Program require providers to record in their EHRs whether patients 65 and older have an advance directive. But the Meaningful Use program doesn't require the providers to include the patient's actual preferences, or require them to share the information. 

And of course, many of the victims in Boston are younger than 65. 

The health IT programs in this country have made great strides in the past few years. But a disaster such as the one that occurred this week in Boston does reveal gaps and inadequacies that should be given a second look. - Marla (@MarlaHirsch)

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