Understanding interoperability issue in America's electronic health systems

In this post, I would like to discuss one of the issues in America’s
healthcare which I have been involved in addressing the solution. As a
rising nation, Myanmar could learn from the mistakes made by developed
nations and build better health information systems.

Electronic health records (EHR) are digital records of health
information. They store all the patients’ medical history
digitally. As of 2017, approximately 90% of office-based physicians in
United States use electronic health records (EHRs). This adoption rate
is pretty high given that 90% of physicians in United States updated
their patients’ records by hand and stored them in paper files not
more than a decade ago. (This is still true for Myanmar). However,
having high adoption rate of EHR does not necessary means that data
are not easily exchangeable among different EHR systems where EHRs are
mostly run by private health companies in United States. This is due
to the fact that each electronic health systems do and store things
very differently. And electronic health systems rarely comminicate with
another due to economic incentives to keep patients’ within their own
system. This leads to the lack of standardization in exchanging data
and thus the health interoperability issue. Few hospitals can see
patients’ data from external systems integrated into their own EHR. In
fact, only 30 percent of hospitals were reported to achieve this data
exchange interoperability as of 2015.

American medicine still runs on fax machines and traditional mails

Unable to share patient medical record using the electronic system,
hospitals have to rely on very outdated technology. With the current
state of health systems, if a patient wants to request his or her
medical records from the patient’s old provider, the patient would
need to go though long and confusing process of making the request to
the provider for the release of patient health information. The
request process normally includes calling the right office and
submitting the forms via fax since every health provider has its own
way of processing the release of patients’ data. Believe it or not,
even the font size matters when filling out the request forms in some
cases. Otherwise, the request will be denied. Then, the providers will
take days mailing your medical records. This adds up a lot of burdens
not only for clinicians who need to quickly review patient medical
history but also for patients who may be in dire situations with

In the medical sector, the fax is as dominant as ever. It is the
cockroach of American medicine: hated by doctors and medical
professionals but able to survive — even thrive — in a hostile
environment. By one private firm’s estimate, the fax accounts for
about 75 percent of all medical communication. It frustrates
doctors, nurses, researchers, and entire hospitals, but a solution
is evasive. (Why American medicine still runs on fax machines - Vox

You are responsible for managing your medical history

Most states in United States, by state law, mandate the destruction of
medical records for patients inactive for more than 5-10 years
depending on the state. If you want to get your immunization records
from ten years ago, it would be very difficult to get if not
impossible. With America’s advancement in technology and widespread
use of electronic health system, it is natural to expect that your
entire timeline of medical history would be recorded and organized
somewhere in the system. But in reality, it is not the case. Patients
are responsible for keeping their own medical history. Due to the
nature of business, hospitals are interested in keeping your data as
long as there is a financial incentive to do so.

Addressing the interoperability problem

In 2015, the office of the National Coordinator for Health Information
Technology (ONC) released a roadmap to address this issue.

Milestones for an Industry-wide Testing and Certification Infrastructure (source:

Shared Nationwide Interoperability Roadmap

At the heart of achieving interoperability is data standardization.
Policy makers are responsible for enforcing standardization of data
exchanges and giving vendors and private companies incentives to
achieve health interoperability. Without data interoperability, it is
impossible to have access to the entire history of patient medical
records. Achieving this will improves the quality of treatments by
enabling more efficient and accurate health assessments and treatments.


EHR adoption rates

The fax of life

Few U.S. hospitals can fully share electronic medical records

The 5 Most Frustrating Aspects of Healthcare