Paul Eckert says we have going about medical automation backwards.
“We’re turning doctors into clerks,” he says, when it’s just not necessary.
Eckert is CEO of a start-up called United Medical Records LLC. Today he’s launching SharEHR, an Electronic Health Record (EHR) system based on the simple premise that you start sharing what you have and let computers handle the file conversions.
A video explaining the system has been uploaded to YouTube. The illustration is a still from that video.
Every EHR system I have seen in the last three years starts with having doctors complete online forms, which load data into an office system under a format set by the software. This can then be uploaded or transferred to other systems.
“Everyone has taken an ornate, complicated approach like HL7 when it’s as simple as upload, convert to PDF, and then you can selectively share, lock down, collectively share and that’s it,” he says.
The idea is that medical clerks take patient files a doctor already has — word files, jpeg images, scanned papers — then upload them to the SharEHR Web site, which converts them all to PDFs that can be searched, sorted, and shared.
“Rather than sending a fax to a specialist you want to consult with a patient, and telling the patient to call the specialist, why not pass a message to the specialist’s assistant, with a link to the file, who can then call the patient and make the appointment?”
This is handled by unlocking files to an office’s “circle of care,” and tracking file transfers in the background. When a file goes in it’s locked, tied to the PC uploading it. But the file can then be selectively unlocked, although transfers are audited.
“You’re spending a ton of money on information flows. We can save that money. These soft costs are enormous. Patients are harmed, and information does not get where it needs to be.”
Eckert calls his system for transforming files Randomized to Structured Data (R2SD), but the Adobe PDF format is the glue that holds everything together. Folders are filed under the name of the patient, then cross-referenced by the staff as they do today.
The system still needs some maturing, I said during our interview. Any new EHR needs to interface with existing systems, meaning data must be converted to a variety of formats. Eckert says the system will be open to new application program interfaces.
Medical reformers like Dr. David Kibbe of the American Academy of Family Physicians (AAFP) insist that the big hole in health IT policy lies with small offices, for whom present systems are hard to learn and expensive to buy.
SharEHR is based on the economics of Software as a Service (SaaS) — a set monthly fee based on the size of a practice — but abstracts all the computer stuff into its service, taking data from offices as it presently exists. It can be run by medical clerks, while the doctor continues to do what he or she has already done.
It’s a revolution, but can it take off? Will the Department of Health and Human Services offer stimulus cash to practices that install SharEHR?
Eckert admits he hasn’t looked into it. His system pays for itself quickly just in coordinating care among offices. Like file conversion, he’s willing to abstract that complexity to the cloud in favor of just getting done what doctors need to do, share files and make more money.
Besides, just entering the newly created EHR will result in a lot of the old records getting entered anyway, because the way things are done now, there?s a lot of redundancy in health care, i.e. there are a lot of ?re-do?s. 
