Doctors and patients still complain about medical records. Who can fix it?

Here’s what happens in a health utopia: You, the patient, have a medical record that documents every allergy, vaccine, and family history of illness since you were born. Instead of filling out new patient intake forms every time you see a specialist or change primary care physician, your doctor can access your medical record, add it, and send it to the healthcare professionals needed in your life.

Building such a platform is not a particularly difficult technological task. Still, most people cannot access childhood vaccination records. Crunchbase data shows funding for health record startups is $ 367 million, the highest since 2021, and 2022 is not over yet.

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But despite rapid innovation in space, electronic health records continue to be a thorn in doctors’ side. increase physician burnout rateswhich slows down its adoption and prevents us from reaching that health utopia.

The problem, it turns out, is not one that startups can solve, at least not without mass cooperation between the many doctors, laboratory clinics, and other healthcare startups that technology binds together.

“When you hear doctors constantly complain about the growing administrative burden and complexity; it has become cumbersome and complex because technology has allowed it, ”said Paul Chung, a Kaiser Permanente doctor and UCLA professor of health policy.

The history of the electronic health record is a perfect example of why the adoption of technology in healthcare lags behind any other industry. Such records are often trapped in an intricate web of disparate and isolated organizations that don’t work well together, leaving innovation behind.

Unravel that intricate EHR web

The movement for the quality of care in US medicine began in the 1960s improve patient outcomes in the healthcare systemand revived in the 80s and 90s with the advent of data storage computers.

Hospitals have adopted complex enterprise-centric platforms to cope with high influx of patients, and medical practices began adopting similar technology in 2009 after the HITECH Act. HITECH was an Obama-era push to move patient data on the computer as part of the goal of connecting healthcare institutions that a patient has to navigate. But the switch to computers quickly proved difficult for healthcare professionals.

“If you talk to most of the doctors, I think it has deprived them of a lot of the joy of clinical practice,” Chung said. “But there is also a general recognition that there is a need for supervision that you can probably only do with technology.”

The problem of interoperability

Individual clinicians and groups have adopted expensive EHR systems with high learning curves. But none of them were spoken of. HITECH promised an easy and affordable future, but doctors still had to fax patient information or feed it into multiple systems to update patient records.

“The first wave of Healthtech said, ‘Well, if the doctor had entered more data into this record, we would have a lot more'” She said Jacob Effronprincipal investor at Redpoint Ventures which focuses on healthcare investments. “But the doctors are so busy. It’s not realistic. “

Others have blamed the design of the EHR systems. Epic Systems, one of the oldest and best known hospital systems, it was expressly accused in Congress of being deliberately shut down. Receiving a digital medical record from companies like Epic resulted in high fees. Epic reacted by pointing out that medical institutions using its technology had great interoperability. This didn’t help.

“It’s like the 800-pound gorilla problem,” he said Kevin Zhangpartner focused on health care at Early initiatives. “EHR’s legacy suppliers are pretty nefarious about how they’ve blocked the market. Basically he created IT systems that [makes] hospitals where it is extremely difficult to integrate ”.

Additionally, hospitals themselves have an incentive to maintain independent EHR systems. Epic customizes specific features for different hospital systems to create exactly what they need. This means that the platform in one healthcare organization looks drastically different from another. If you were a hospital that paid Epic to do it, you might want to make it easier for patients to come back to you instead of taking your records and visiting another one.

One step closer

The pandemic has brought another wave of innovation into space. As health centers began adopting telemedicine and virtual visits, it suddenly became important to put everything that happens in a doctor’s office online – scheduling appointments, filling out hiring forms, billing. Doctors turned to their EHR.

According to data from Crunchbase, funding for EHR tech startups increased from $ 98 million in 2020 to a whopping $ 751 million the following year, a 666% increase. Meanwhile, a second wave of companies are looking to better integrate with existing electronic health records by adopting FHIR standards in 2020. FHIR, or Fast Healthcare Interoperability Resources, is a set of standards aimed at facilitating the sharing of data from part of the companies.

One of them, Redox, has raised $ 95 million since it started in 2014, according to Crunchbase. The platform connects suppliers with a number of different billing platforms, remote patient monitoring systems and telemedicine startups to create a customized administrative solution for physicians. Other, Health gorillaraised $ 50 million in March to improve the flow of patient information between providers and payers.

While many of these new companies are promising and intuitive, they aren’t as useful for the country’s largest hospital systems without the consensus of the big EHR players.

“Even if you got the buy-in from [hospital] CFO or corporate leadership, that integration work in the hospital is a nightmare and is quite tailor-made every time. That’s why it’s so complicated, ”Zhang said. “And they have low margins in the beginning, so they can’t take on giant projects all the time.”

This is ultimately the crux of all investments in health care: Health markets revolve around patients, providers or insurance companies. Without buy-in from those markets, regardless of how good the technology is, startups are doomed.

“This is the fun of investing in health care,” Effron said. “What can make it so complex is that it has to work for a lot of different people in the system.”

Illustration: Dom Guzman

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