From the U.S. Government Accountability Office, www.gao.gov Transcript for: Electronic Health Records Description: Audio interview by GAO staff with Linda Kohn, Director, Health Care Related GAO Work: GAO Work: GAO-14-242 Electronic Health Records: HHS Strategy to Address Information Exchange Challenges Lacks Specific Prioritized Actions and Milestones AND GAO-14-207: Electronic Health Record Programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care Released: March 2014 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report; your source for news and information from the U.S. Government Accountability Office. It's March, 2014. The use and exchange of electronic health records among health care providers could potentially improve outcomes and quality of care for patients. Two teams led by Linda Kohn, a director in GAO's Health Care team, recently examined the use and exchange of electronic health records. GAO's Sarah Kaczmarek sat down with Linda to talk about what they found. [Sarah Kaczmarek:] How does exchanging electronic health records work, and what are the potential benefits for patients? [Linda Kohn:] Exchanging health information means sharing and accessing health information across multiple settings in organizations. It means that providers can request and receive information about patients from other providers' records. So, for example, what medications was the patient on? What are laboratory results? Previous diagnoses, prior hospitalizations. So, for example, you go to an internist. Your internist sends you to a lab to get some blood work done, then sends you to a specialist who does an outpatient procedure in a hospital, then you go back to your internist for continuing care. Today, you could have to explain your problem first to the internist, then the surgeon, potentially the hospital again as to what medications you're on, what treatments were already done, you may have tests repeated because your surgeon doesn't have all the information on you that your internist has, and the same thing may happen at the hospital. If the providers exchanged health information, the information from your internist could be shared with the surgeon, potentially the hospital, and then vice versa after the procedure. So communication can be improved, care can be better coordinated, duplicate tests may be avoided. Those are some of the benefits of exchanging information. So there's lots of potential for better care, but it's really, really hard to do. [Sarah Kaczmarek:] Let me ask you then, what are the key challenges to exchanging electronic health records? [Linda Kohn:] When we did this work, we went to four states and we talked with providers and other organizations to hear about the challenges to exchanging health information. We wanted to talk to providers on the front line of care and hear what the challenges were, and we heard about four key challenges. The first challenge we heard about that makes exchange difficult relates to insufficient health data standards to support exchange, so for example, one area we heard about related to allergies. Some EHRs classify an allergic reaction as a side effect. Other EHRs classify it as an allergy. If the information is recorded differently in different EHRs, it can be difficult for a physician to locate and use the information when it's exchanged among providers. It's like having a smartphone, and only being able to text to people who have the exact same smartphone as you do. So standards help address some of those concerns. Another challenge we heard about was variation in privacy rules across states. The third area we heard about was difficulties in matching patients to their records when information is exchanged. People can have the same name and live in the same area. The fourth area we heard about related to the cost associated with exchanging information. Providers we talked to identified additional costs of exchanging information beyond the cost of the EHR itself. For example, we heard some providers say that they were charged per-transaction fees when they exchanged information. [Sarah Kaczmarek:] Given these challenges, what recommendations is GAO making? [Linda Kohn:] GAO showed two reports related to electronic health records. One at the beginning of March 2014 about the EHR programs generally, and one at the end of March 2014 that focused specifically on health information exchange. We made recommendations to HHS in each of those reports, and a common theme across both reports are recommendations for HHS to add more specificity to the ways they are monitoring the programs and measuring progress to make sure the ultimate outcomes desired are achieved. [Sarah Kaczmarek:] Finally, for patients, what's the bottom line here? [Linda Kohn:] We're all patients at some point, aren't we? What you'll see as a patient is more providers using EHRs in their offices, and using them in meaningful ways to provide care. Not all providers are there yet, that's going to take more time, but patients should increasingly see their physicians using EHRs in their offices. Exchanging health information is hard to do, and still faces a lot of challenges, so while you may see your physician using an EHR in the office, it will likely take longer for them to easily share information with another provider. 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