No More CDC Vaccine Cards, Please

February 28, 2022

You might expect that by the 21st century, we would no longer be storing important health records on flimsy, impractical strips of unlaminated construction paper. Yet, the unfortunate reality is that we keep our health information scattered across CDC vaccine cards, faxes, blood donation cards, driver’s licenses, and more. Beyond the immediate impracticality of it all, there is a larger problem at play: we don’t have a centralized, digital place to store medical records.

Currently, our electronic health record (EHR) systems are segmented across specific hospital networks and private providers. While providers can customize their EHRs to field-specific needs, this also means EHR systems are not interoperable. Each EHR system has a different language, rendering it nearly impossible to “talk” across systems and exchange patient information. In practice, this means it will take you several costly rounds of paperwork to communicate your vaccination status from doctor to employer or the results of a cancer biopsy from primary care physician to breast cancer specialist.

The COVID-19 pandemic showed us the more hazardous consequences of our flawed EHR systems. The lack of interoperability contributes to delayed response and communication regarding confirmed infections, which puts frontline workers’ lives at risk. Physicians and nurses are reporting high rates of burnout, in part because of the difficulties in navigating EHRs. On the patient end, our segmented EHRs are not always reliable, usually leaving impoverished patients to fall through the cracks. For example, if a homeless or uninsured person was severely injured in a car accident, it may be impossible for hospital staff to find out in time if that individual was eligible for a blood transfusion.

The tragedy is that these problems are completely avoidable. A federal mandate to centralize our electronic medical record systems across the nation would eliminate many technological hiccups and reduce crucial emergency response times. Hospital administration, billing personnel, and all levels of healthcare providers, from paramedics to physicians, could access patients’ healthcare records, regardless of location, time, etc. Even more importantly, patients would have a portable and accessible copy of their health records at all times. In emergencies, patients could instantly show a healthcare provider their medical history, cutting out precious time of conferring and faxing health records.

That being said, significant barriers lie between successful implementation of a universal EHR system, including security concerns around private data, equitable uptake of the system, and standardization of data fields across patient records. Moreover, the diversity of stakeholder perspectives, including that of pharmaceutical companies, hospital systems, and patients themselves, present a huge challenge to implementing a system where everyone is satisfied.

However, resistance can be overcome with adequate financial incentives and strong federal support. In 2004, President Bush heralded a new era of healthcare digitization with his Health Information Technology Plan, and in 2009, President Obama implemented a bold experiment, called the HITECH Act, that incentivized physicians to adopt EHRs across the nation. The scheme led to a significant jump in nationwide EHR utilization, from 12 percent in 2009 to 96 percent by 2016. Yet, having adopted EHRs, healthcare providers are now struggling to navigate systems whose whole purpose is to make healthcare easier. We need strong federal support, like a federal mandate to standardize EHRs, to help providers serve their patients.

Success is not only possible, but within sight. Take Taiwan, for example, where citizens receive an electronic ID card that permits access to healthcare facilities. The ID card contains insurance data, recent medical visits, drug prescriptions, advance directive information, and other essential medical information. Moreover, Taiwan’s EHR system uses a complex digital architecture to ensure that patient data is both secure and transferrable. Beyond the immediate clinical benefit of having these data easily on hand, the uniform digitization of health records has created opportunities for technological leaps in medicine, such as automated insurance claims and personalized precision medicine, where artificial intelligence can process clinical recommendations based on each individual’s unique genome and medical history. Evidently, not only can interoperability coexist with functionality and security but also a universal EHR seems to be crucial to medical innovation.

Undoubtedly, a universal EHR system has incredible potential to integrate interdisciplinary teams and improve equitable healthcare provision for patients around the nation. Yet, in the last ten years, we have grown complacent with the state of healthcare communication in the United States, and efforts to implement efficient communication tools are stagnant. Australia, China, and France are already making strides towards adopting universal EHRs. With a federal mandate for a consolidated EHR system, we can close the gap between our status quo and the technological future. It is time for the United States to step onto the international stage of healthcare reform and implement meaningful change in our electronic healthcare system.

Sandra Yu is an MPH student in the Department of Health Policy and Management.