City State Health Care Systems and their EHRs

Dr. Lesitsky is a community-based primary care physician who practices in rural northeastern Pennsylvania. He's not only a buddy of the Disease Management Care Blog, but someone with a working knowledge of life in the trenches of primary care. When docs like him talk, the rest of us should listen.

By Neil Lesitsky, MD

I am a busy solo family physician located 25 miles from the nearest hospital but within 50 miles of at least 9 separate healthcare institutions. My patients may frequent any one of these or their ancillary branches. In addition, there are literally hundreds of providers within the same radius who are not aligned with any system.

As I see it, each one of these institutions is run as its own City-State, each of which has their own unique monarchs, deities, moats, armies and, most importantly, its own electronic health record (EHR). Each institution treats their EHR as their coin of the realm. This coinage functions well within its own borders but lacks infrastructure to be recognized or connect outside its sponsors’ sphere of influence. The information is locked away in the City-States’ treasuries and inter-treasury transfers continue to require a byzantine process.

One City-State in my area, Geisinger has published a paper demonstrating how its coin has become the gold standard in its region. It makes a compelling case from the viewpoint of that King's Court. From my vantage point, however, the other institutions in my area haven’t necessarily agreed.

Our Government has addressed this issue by suggesting that there be a common language for EHRs, so these City-State realms can communicate with a common diplomatic tongue. However this is not the same as a central treasury. This perspective has also been noted by Rick Peters of the HealthCareBlog in an excellent article noting the difference between standards and interoperability.

In my view, a major barrier to the adoption of an EHR by my primary care colleagues is the lack of a common treasury that aligns the City States in a global infrastructure. In primary care, the attraction of an EHR has more to do with data transfer and preventive care prompts than documentation of care (although my back office may disagree).

There is much more data flow into a primary care office than out of it. In my situation, until such a central treasury exists, and the city states easily transfer their deposits, it is not prudent for me to align myself with any of the monarchs.