fbpx
 +1 386-243-9402 MON – FRI : 09:00 AM – 05:00 PM

Electronic Medical RecordsIt is 11PM. Do you know where your medical records are? Most likely they are scattered across multiple doctors’ offices in manila folders. The most information about our healthcare encounters is with "payers", the insurance companies which pay for care if we are lucky enough to have the coverage. Most of their information is about medical codes and money — not much about the actual "healthcare" that we experience. Pharmacies have tons of information on what we were prescribed but not why it was prescribed. Specialists have notes about our visits that our primary care physicians often have not seen. Meanwhile, a very large number of people — some studies put it at 100,000 per year — die from medical errors.
Patient safety, ballooning costs, and government budget pressures are accelerating the move toward electronic medical records. There are many variations on the theme. EMR’s in the hospital, Personal Health Records on a smartcard, and Personally Controllable Medical Records on the web. EMR’s are emerging from insurance companies, pharmacies, community doctors, hospitals, regional health information organizations, employers and software companies. It is not yet clear which EMR or combination will prevail. Personally, I will be glad when all my medical information is encrypted and stored on the Internet where I will know that at last it will be safe and under my control.
One thing I know for sure is that it is time to make major strides. There will be many participants in making it happen. Government and non-profit organizations such as HL7 must play a key role in establishing standards so that the various kinds of EMR’s can be compatible. Most experts agree that Personal Health Records sponsored by healthcare providers have the best chance of success in the short term. Longer term "cloud-based" PHR’s such as proposed by Google, Microsoft, and others have great potential but need to overcome trust and privacy concerns of consumers.
One provider pilot program that I think has potential is the "SmartCard" at Danbury Hospital in Connecticut. Five-hundred patients in the trial program can insert their smartcard in a kiosk (very similar to an ATM), confirm the identity displayed, and then receive a "ticket" — just like at the deli — to await being called for their test or procedure. The patients like it because they don’t have to use the "clipboard" and the staff like it because they don’t have to ask patients to use the clipboard. The potential goes well beyond just automating the check-in process. The smartcard can be the "carrier" for our electronic personal health record. At some point our mobile phones may take over the task but in the short to medium term the smartcard may prove to be a very effective aid to empowering consumers to manage their own our healthcare.
The potential is huge. Upon entering the office of our primary care physician the office system could recognize our smartcard and an exchange could begin which updates the hospital with the latest information on the card, updates the card with any updated test results the hospital may have, and updates the primary care physician with the latest test results plus notes from any specialist consultations. If the primary care physician "writes" a script on his or her system it could be automatically transferred to the smartcard and to the pharmacy system and when the patient gets to the pharmacy the card could be recognized and the prescription would be filled. All the information on the smartcard would be encrypted and accessible only after authentication by the smartcard holder. This could be done using a password or a biometric such as an iris scan or fingerprints. This may sound futuristic to some but similar things are already being done. Denmark began a drive toward paperless hospitals more than a decade ago and is achieving much success. Verified Identity Pass, Inc. has a vision of using smartcards to enable us to breeze through airport security lines. The Fly Clear smartcard contains digitized versions of both your iris scans and fingerprints.
There are numerous technical and financial challenges inhibiting the rollout of a smartcard system in a pervasive way. The biggest challenge is that the benefits are "shared" — neither patient, provider, or payer can justify the cost but collectively everyone wins. It reminds me of the UPC challenge of the 1970’s. In spite of large benefits from knowing what got sold and when, the grocery stores were hesitant to invest in UPC scanners because there were no products that had UPC symbols on them (the first product to have a code was a packet of Wrigley’s Gum in 1974). The stores found it difficult to justify the cost even though there would be labor savings from scanning versus "ringing up". The package goods manufacturers were also skeptical, despite the benefit of knowing exactly how their products were doing at retail on a timely basis. I remember visiting the M&M Mars candy factory in Hackettstown, NJ in the early 1970’s and discussing UPC scanning with the director of product packaging. She said there were not enough benefits to offset giving up the "real estate" on the candy bag to place a symbol for which there were hardly any scanners to scan them. (The first UPC scanner was installed at a Marsh’s supermarket in Troy, Ohio in June, 1974). It took strong leadership, competition among retailers, and perseverance to get us to the ubiquitous scanning which we enjoy today.
Likewise with personal healthcare records. The benefits are huge — increased accuracy of information leading to better outcomes and reduction in duplicative procedures, and ultimately personalized healthcare. Physicians will spend less time ordering procedures and medications, liability costs should go down due to fewer errors, increased collaboration will improve caregiving, patients will be able to relocate and take their healthcare data with them, and patients will be able to take a more proactive role in their own health and selection of providers. All it takes is strong leadership, competition among healthcare providers, and perseverance. The glass is half-full, not half-empty. It is likely that in the next five years we will see more progress toward electronic medical records than we have seen in the last twenty.