Physicians’ first priority is patient care. They’ve taken an oath to do no harm. But the current electronic health record environment puts patients at risk because vital health information may not be available at the point of care when health information technology systems fail to communicate with one another.

When doctors across town must consult one another, their electronic health records should communicate with each other immediately as well. That virtually instant transmission of information is--after all--one the most important functions for a seamless health care system if we’re going to ensure that each patient gets the right care at the right time in the right place.


But in today’s health care environment, effective EHR interaction doesn’t dependably happen--much to the detriment of high-quality patient care. Subspecialists seeing patients for the first time need to know about their medical histories, allergies, medications and multiple other health issues. Primary care physicians must have records of subspecialist- or hospital-ordered tests and procedures to ensure continuous, coordinated care and to avoid duplicative and unnecessary testing and treatment. Without reliable communication, already-completed medical tests are repeated, patients receive prescriptions that adversely interact with medicine they’re currently taking, risks for complications rise, and costs go up for the patient and the health care system.

“To make informed health care decisions, providers and individuals must have timely access to information in a form that is usable,” the U.S. Department of Health and Human Services Office of the National Coordinator (ONC) for Health IT says in its recent Report on Health Information Blocking. “When health information is unavailable, decisions can be impaired--and so too the safety, quality, and effectiveness of care provided to patients.”

Where are the roadblocks? Many vendors provide EHR software that operates differently from their competitors. They use their own platforms, and their applications don’t easily communicate with other products. Virtually none will accept, download and integrate the health record from a competitor’s software. Important and often time-sensitive communication among health professionals lags while the physician prints a patient’s records and faxes, emails or hand-delivers them to the hospital or other health team member, who often must manually type important data into their own independent EHR system.

Perhaps, one wonders, whether fax machines and paper records aren’t equally efficient.

Worse, market competition--where information is power--creates business incentives for both vendors and health institutions to block the legitimate exchange of health information, according to ONC’s report.

The ONC report outlines actions that limit physicians’ ability to coordinate care. Among them: setting contract terms that restrict physicians’ access to their own EHR data; charging high prices for each request to send or receive a medical record or to download an interface with an outside health professional; and developing software that locks physicians in to the vendor’s system.

Equally obstructive are hospital or health systems that block information “to control referrals and enhance their market dominance,” the ONC report notes. For example, despite the privacy rules’ specific permission for exchanging protected health information for treatment decisions, institutional health providers cite privacy as a reason to refuse providing that information.

Health records should not be held hostage to the business interests of EHR manufacturers or health systems.

Wergin,  a family physician in Milford, Nebraska, is president of the American Academy of Family Physicians.