Up at 5AM: The 5AM Solutions Blog

Many feet, many paths to EHR

Posted on Sat, Feb 27, 2010 @ 01:03 PM

When Bill Clinton had stents placed in one of his arteries a few weeks ago, our colleague Christine Quern (Feinstein Kean Healthcare) mentioned that she’d heard a physician commentator on the local newscast state that Clinton went to Columbia Presbyterian Hospital for treatment “because that’s where his medical records were.”

I’ll forgive a news commentator for inaccuracy under fire. But in this era of “health IT,” with intense focus and funding for creating electronic medical records, is this kind of thinking old fashioned? Is it acceptable to state that someone should seek treatment where their medical records reside? Even a former president?

Well… yes. Many strident cases are made for “digitizing” medical records through the wounded warrior stories, in which families of injured veterans cart around suitcases of medical records from doctor to doctor, seeking treatment and answers. This is one of the business cases that drives the Nationwide Health Information Network (NHIN), which seeks to provide the trust fabric for secure electronic health information exchange. One of the promises of the NHIN is that you can leave your folder/binder/suitcase at home, because Dr. Smith can obtain the test results taken by Dr. Joshi. It's a fantastic vision of a primary benefit of electronic health records.

I work with the wonderful people behind the NHIN; I work to create the testing and validation processes that will ensure that the systems exchanging health information across this network are capable of doing so. I’ll write more about the work being done, but I work on the NHIN and had to be my own personal NHIN at my doctor’s office last week – Dr. S---  faxed my test results to me, and the e-fax rendered a pdf on my laptop, which I showed to Dr. P--- in his office. I work on the NHIN and realize we’ve got a long way to go before its promise can be realized – we’ve got a long way to go before it would be considered absurd that Bill Clinton would get treatment at a hospital just because his medical records were there.

Why aren’t we there yet? Government, and businesses big and small, are attempting to clear the path to make the sharing of health information simpler – everyone from Dell to seemingly Pizza Hut is getting into the effort. We’d like to hear your thoughts on the largest challenges – time, money, technical hurdles, privacy concerns, workflow modifications, access consent, human nature? – how will conditions unfold so that Bill Clinton can access his medical records anywhere? What will that look like – will Clinton own his information (in a chip in his arm, in his iPhone, in HealthVault or Google Health et al, or in his suitcase full of medical records), or will the data reside where it originated, shareable with others? Is our first step defining standards for machines to exchange data, or defining up a way for people to share information? We’re heading to the Health Information Management Systems Society conference (HIMSS) next week and will report on our conversations, musings, and discoveries. In the meantime, please share your own comments and ideas.

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