Link: Challenges with EMR and EHR Data Sharing
John Lynn presents another aspect of EMRs and sharing data across providers and facilities.
In his post, on EHR and HIPPA, John discussed the difficulties of obtaining consensus among providers and facilities for a unified EHR. In technology, we call this a "system of record." A system of record becomes the de facto standard of the core system that contains all the information needed for the process and is the source of data for information and decisions that come about as a result of access to that information.
I agree with John that a "unified system" is probably unlikely in my lifetime due to the different needs of providers and facilities, the politics involved, and the unrealistic expectation that we can "all get along" with only one EHR software system. But in his post, (and in most current EHR/EMR discussions) the implied premise is that a doctor or a facility must be the "owner" of the data and the system of record.
Let's try another scenario. What if the Patient was the "owner" of the data and the patient selected a system of record for his or her PHR?
As far as I know, there are only a few choices out there for individuals who want to establish their personal health records (e.g. Microsoft HealthVault and Google Health) but there could be more as long as the patient's selected PHR provider/vendor supports "the standard."
As my husband and I were discussing this potential scenario (he's a lawyer and a veteran of the technology industry who is interested in these and other privacy and confidentiality issues), he proposed the idea of a patient "owning" the "system of record" (the PHR). In this scenario the patient's providers, labs, radiology and others, update the PHR with appropriate information from their EHR when it becomes available (with secure authorization, of course). He wrote about this idea on his blog the other day.
As I began to contemplate his proposal, a few ideas came to mind...
1) Since there are a limited number of software tools available for PHRs, decisions for providers and facilities related to their choices of EHRs becomes moot. They don't have to have the "same" system, they only need to be able to share data to update a patient's record on their PHR. Both Microsoft and Google have application programming interfaces that can be used for this purpose (or should - pharmacies already do this).
2) Yes, we're still in "standards-land" and the interoperability required to send data to and from a system of record is still evolving. But I'll just say that if we wait for everyone to agree on a standard, assuming the Government doesn't mandate one, we could be waiting for a long while. In the meantime, nothing may get done.
3) We're still in our "infancy" mode regarding electronic records. OK, this can be good. As a "late adopter" of enabling technologies, we should be able to leverage the failures of other industries and bypass the same problems with healthcare data exchange standards and software reliability.
OK, I'm stepping out on a limb here, but often "wicked problems" are easier to solve if we make different assumptions. Any thoughts?
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