NOEL KING, HOST:
Why is it so hard to get a COVID-19 vaccine? Well, there are many reasons, but here's a big one that you probably haven't heard about - your personal electronic health record and the fact that your health care provider doesn't want to share it with other providers, including possibly your current doctor. Dr. Bob Kocher is a partner at the venture capital firm Venrock, and he was a member of California Governor Gavin Newsom's testing task force.
BOB KOCHER: Electronic health records are the tools that doctors use to take notes on patient care, to share information with other doctors, to track your lab results, to order prescriptions. They're really the workflow software that health care providers use.
KING: You heard him say it - to share information. You'd assume electronic health records - or EHRs - should and would be shared across hospital systems, but they are mostly not. And that siloing of information slows a lot of things down. Kocher has been banging the drum on this problem since back when he was working to shape the Affordable Care Act.
KOCHER: Electronic health records are designed to be able to share information. It's not done very often, and it's only done really when a patient requests for it to happen.
KING: Why would that be? It would seem unreasonable to me for hospitals to not be sharing data about patients.
KOCHER: Many people share that concern, that it is surprising that information doesn't flow like liquid across all the people that might care for a patient. In reality, hospitals are a lot more like banks or retail stores where they don't want to share information because they're worried that patients might actually go to another location to get their care. So while they can share the information, many of them don't like to share the data because actually it might make it easier for you to move your care to another location.
KING: How does the lack of connection between EHR systems affect at this moment when people can schedule vaccines?
KOCHER: Yeah. So today what we're seeing are some of the unintended consequences of this. Everybody in America is hoping that they can get a vaccine soon. Today, to get a vaccine, instead of going to one place and being able to see all the appointment slots and then schedule at the most convenient one that's soonest, you actually have to go to every different provider and form an account and then check and see if they might have an appointment for you. Also right now, because eligibility is a little bit different, each of these systems has different gating questions to decide if they're even going to let you see the scheduling. Another problem is after you get your first shot, it might be the place you went is really crowded. And it's hard to get your second appointment and it would be easier to go somewhere else. But there's no way today to share across the system easily that you got your first shot of a vaccine at one location and you're going to get the second one at another location.
KING: Tell me what an ideal system would look like, one that would allow people to quickly get vaccinated wherever is easy and convenient for them.
KOCHER: An ideal system would be allowing scheduling to occur across multiple health systems, much like you do for airline tickets, where you can go to one website and see all the planes and then choose the one you want. The second thing would be after you get a vaccination, it would be much better if there was a registry where the next provider knows which vaccine you got. Did you get the Pfizer one or the Moderna one? And so they can give you the correct second dose and you can get it anywhere, not just the same place you got the first one. The last thing that would be very helpful is we don't know how long protection lasts from the vaccines until we had a national database of everybody who was vaccinated. We could then see if they got infected later, you know, what happened - if the vaccine wore off, was it a different strain, and did they have any side effects?
KING: If I am a health official at the state level, in what ways is this impeding my job?
KOCHER: Well, first, your job is a lot harder because you're probably calling a lot of the different places that are giving out vaccines to check on things like do you have open appointments, do you have enough vaccine? And so that's making it harder for states to give people information about where to go to get vaccines. So what we have today is like a Taylor Swift concert ticket rush, where every day people log in to lots of different websites to see if there's any new appointments. And that's a very inefficient system and really frustrating. And it also, like, makes it hard for states to even know where to set up new sites because they don't have great data on what's schedule look like, how many shots were given, what are the inventories? And so there's a lot of manual process today to try to connect those dots.
KING: What types of data that might be important when it comes to getting a COVID-19 vaccine are not in EHR systems?
KOCHER: EHR systems do not always capture race or ethnicity data. And that's been one of the important details that we'd like to track for COVID-19 since the impact of the virus has been much greater on certain race and ethnicities.
KING: How hard would it be to change that?
KOCHER: Yeah, it's harder than you might think because there's more than a thousand different electronic health systems used today, and most of them actually exist uniquely on each different computer. And so it's hard and slow to update the systems.
KING: Sorry, say again, uniquely on each different computer - it's that disparate?
KOCHER: Yeah. So this - electronic health records are much like old-fashioned software that exist on your, you know, local computer. They're not in the cloud. And so you can't just update them overnight. You actually have to go to each different health care location and open up the back door where the server is and install it manually.
KING: When you worked on the Affordable Care Act, I know that you were worried about issues that disconnected EHR systems would pose. At the time, did you try to do anything about it? Did you try to streamline this?
KOCHER: Yeah. So we created standards for data sharing so that you can securely share information across the records. The challenge has been that the doctors and hospitals who use them haven't had great reasons to turn on those features. And so while their records can be shared, it's not done routinely. And partly out of privacy and security, it's not done without the permission of a patient. And so there are several steps to get the information shared, which makes it slow.
KING: As you look to the future of COVID-19 vaccinations in the next few months, does it seem to you that any of the problems posed by this system might start to change? Is there anybody really advocating for a fix here?
KOCHER: Well, I think that we're going to see the CDC make really compelling arguments that we have to get better at at least sharing important elements of the electronic health record, so maybe not everything, but it's going to be critical for our national security and safety to know how long are these vaccines providing protection? When are people starting to get COVID again? Are there adverse events? And so being able to extract and share data like what shot you got and when I think will be a priority. I also think capturing, you know, race and ethnicity data is going to become a priority because we have to work on unequal outcomes in our health care system. And so while I don't think it's going to necessarily lead to complete data sharing, I think we will see critical aspects of the electronic health record much more easily shared with people trying to track COVID-19.
KING: Dr. Bob Kocher is a former Obama administration official who helped shape the Affordable Care Act, currently a partner at the venture capital firm Venrock and a member of California Governor Gavin Newsom's testing task force. Thank you so much for being with us.
KOCHER: Thank you for having me.
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