{Brief US political commentary at the end}
The promise of digital healthcare was a streamlined, integrated experience. Electronic Health Records (EHRs) were supposed to make patient information universally accessible, improve care, and reduce costs. Yet, as highlighted in Laura Landro’s recent Wall Street Journal article, “Your Medical Records Are a Mess, Technology Can Help,” this vision remains largely unfulfilled. Despite advances, our EHR systems remain fragmented, indicating we have decades of work ahead.
I appreciate Jon Krause’s illustration in the article, but it feels overly optimistic. Healthcare records behave less like a herd and more like cats—scattered and unpredictable, with government actions likely complicating matters further. I look forward to a time when the government steps back from imposing new rules, allowing consumers to make choices and markets to determine the winners and losers.
A Look Back: How Did We Get Here?
The roots of modern EHRs date back to the 1960s with Massachusetts General Hospital, but real traction began in the 1990s. A pivotal moment occurred in 1996 when President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA), affirming patient ownership of their data and establishing privacy standards. However, it was the 2009 HITECH Act, part of the American Recovery and Reinvestment Act (ARRA) signed by President Obama, that mandated the widespread adoption of certified EHRs. This era of regulatory changes helped expand EHRs but also introduced complexities and compliance burdens that continue to hinder transformative progress.
Fast-forward to 2023: nearly 500 different EHR systems manage about 3,000 exabytes of patient data. Recent regulations, such as the 21st Century Cures Act signed by President Biden, further complicate matters by expanding data-sharing requirements. While these regulations aim to boost digital record adoption, they often fall short of solving the interoperability issue across systems.
Are We Really “Getting There”?
Landro’s optimism in the WSJ article that “we’re getting there” may seem misplaced for those of us in healthcare technology. The pace of EHR evolution and integration remains slow. A federal survey indicates that nearly half of individuals maintain multiple online medical records across different systems. Despite initiatives to improve this, issues of fragmented data and interoperability persist.
The integration of medical records often requires provider approval and an e-signature, creating bottlenecks. Additionally, hospitals and doctors rely on overlapping data networks that don’t share information seamlessly. Currently, seven federally approved Health Information Networks operate under the Trusted Exchange Framework and Common Agreement (TEFCA), but data duplication means we’re creating multiple databases that fail to provide a comprehensive or consistent picture.
How Fragmentation Affects Patient Care
This fragmentation affects those who need healthcare the most—our aging population. An older patient, like my mother, may see multiple specialists, each maintaining separate records on different EHR platforms. Coordinating her care is challenging and time-consuming. While portals offer some access, they rarely provide a complete, real-time view across providers. As Landro notes, while some EHRs employ AI to suggest follow-up tests or answer queries, this technology often falls short of genuinely improving care.
Despite the proliferation of EHR systems and data-sharing initiatives, healthcare records remain both ubiquitous and inaccessible. The current system is biased toward hospital encounters, often neglecting the more frequent needs of chronic patients. For the average patient, accessing a comprehensive medical record is cumbersome, leading to frustration for both patients and caregivers. Although federal regulations have made strides, the industry still lacks consumer-friendly tools for effective data management.
The Role of AI in Transforming EHRs
As Landro suggests, AI holds promise for navigating this data deluge. However, it’s important to note that the AI used in most EHR systems today is not transformative. It typically involves basic algorithms that assist with limited tasks, such as flagging abnormal results or suggesting additional tests.
For AI to make a meaningful impact, it must evolve beyond these limitations. Currently, AI engines in major EHR systems achieve about 80% accuracy in diagnostics, which is inadequate for critical healthcare decisions. However, AI could play a valuable role by helping patients aggregate their data from various sources, providing a holistic view of their health.
The true potential of AI lies in its ability to enhance—not replace—human healthcare providers.
A Call for Consumer-Centric Solutions
At the core of this discussion is a fundamental truth: EHR systems were not designed with consumers in mind. The burden of data aggregation falls on providers, insurers, and regulators, while patients struggle to access their information.
We need solutions that empower patients and their families to manage their health records seamlessly, regardless of where they receive care. A future where AI integrates multiple EHR systems for a comprehensive view of a patient’s health could revolutionize care. Such an approach would enable patients to manage chronic conditions effectively, using accessible data and AI to guide discussions with their care teams.
This vision can only be realized by recognizing the need for new processes that prioritize consumers’ real-time data needs, aided by AI. Moving from a compliance-focused system to one centered on patient empowerment is essential.
From our perspective, Landro’s article serves as a valuable reminder of the challenges and opportunities that lie ahead. While AI is not a silver bullet, it has a critical role in healthcare. Real change will require a systemic shift that places consumers at the heart of the healthcare data ecosystem, providing them with the tools to navigate their own health.
The path forward is complex, and it may take years to fully realize the potential of EHRs and AI. However, with continued innovation and a focus on consumer empowerment, we can move towards a healthcare system where patients control their data and have the tools to utilize it effectively. This transformation won’t happen overnight, but the journey has begun—and the potential benefits for healthcare, patients, and providers are worth every effort.
About HealthScoreAI™
Healthcare is at a tipping point, and HealthScoreAI aims to revolutionize the industry by giving consumers control over their health data and unlocking its immense value. With U.S. healthcare spending reaching $4.7 trillion annually, outcomes have seen little improvement. Despite technological advances, costs have not decreased, and a staggering 3,000 exabytes of consumer health data remain trapped in fragmented systems, leaving patients and providers without a complete view of care.
HealthScoreAI seeks to bridge this gap by acting as a data surrogate for consumers and providing an unbiased, holistic view of their health. By monetizing de-identified data, we aim to share revenue with consumers, potentially creating a new $100 billion market opportunity. With nearly universal EHR adoption in the U.S. and advancements in technology, now is the time to capitalize on available data and empower consumers—particularly the 13,000 Baby Boomers turning 65 each day and entering Medicare for the first time. Our team, with deep expertise in healthcare and technology, holds U.S. patents and a proven track record of scaling companies to IPO.
U.S. Political Commentary: Election Impact on Healthcare
I hadn’t planned on writing another blog before the U.S. elections, but the Wall Street Journal article above prompted me to share my thoughts.
The intensity of this election is palpable, and it’s natural to wonder how the outcome will shape healthcare policy. While the election’s potential impact on healthcare is uncertain, I believe focusing on consumer-driven healthcare remains promising, regardless of the results.
With over 30 years in healthcare, I’ve witnessed numerous policy changes and their effects on the industry. Interestingly, healthcare hasn’t been a top priority for either candidate this election. One candidate has mentioned expanding Medicare to include more home care, but this likely won’t address core systemic issues. Healthcare represents the largest portion of the U.S. budget, with Medicare spending over $1 trillion annually and Medicaid exceeding $600 billion in federal and state funding combined. Both programs face immense pressure to reduce spending post-COVID, and their current structures are unsustainable.
Key Issues Likely to Receive Attention Post-Election
- Hospital Funding and Consolidation: With provider payments already squeezed, policymakers may scrutinize large healthcare systems that have absorbed smaller practices and profited from outpatient fees, even outside hospital settings. Many of these systems expanded during the ACA era, benefiting from policies that encouraged consolidation, which has reduced competition and increased costs.
- Managed Care and Medicare Advantage: Managed care organizations, which have been acquiring medical practices to control both sides of the healthcare equation, may face stricter regulations. Medicare Advantage, previously viewed as a stable investment, is also under pressure due to cuts in managed care reimbursements. With around 13,000 new Medicare enrollees every day, the financial strain on these programs will only grow, requiring any potential President—whether Harris or Trump—to confront this looming funding crisis.
Potential Policy Shifts and Leadership Dynamics
A possible Trump administration could bring in figures like Robert F. Kennedy Jr., with a strong healthcare focus, or even Elon Musk, who could inject private-sector efficiency into government operations. This blend of perspectives might lead to sweeping changes in government-run healthcare with significant implications for the industry. Regardless of political shifts, consumer-focused innovations, particularly in healthcare records and data access, are likely to be the primary area of improvement.
A Consumer-Driven Future
As emphasized, consumer empowerment holds the greatest promise for transforming healthcare. The Baby Boomer generation, known for driving change across various sectors, is aging into Medicare at unprecedented rates. Given the strain on traditional Medicare and managed care systems, a consumer-driven approach—where individuals have more control over their health data and decisions—may finally be at a tipping point.
Empowering consumers to take charge of their health records and decisions could spark meaningful change in the U.S. healthcare.
-Noel J. Guillama, Chairman