By Ewing, Lydia M.
Searcher , Vol. 15, No. 5
Good news? In a word: yes. Although there are real security and privacy concerns. Your personal medical information could end up someplace you didn't intend, and, unfortunately, there have been recent unsettling examples of this. (1) Nevertheless, the current mode of delivery of American medical care exposes people to significant risk, a risk that electronic health records could help reduce. At present, it is altogether too easy to receive the wrong medication or to be treated at a hospital emergency department where providers lack important information about your medical history, sometimes with tragic consequences. Given a choice between a possible privacy breach and greater safety in the provision of medical care, many people would opt for greater safety.
What is the current state of affairs for personal health information? Healthcare delivery is extremely complex, with many providers operating in different settings. Patients flow between delivery environments as they recover from an acute illness. Those with chronic conditions may see several physicians to care for different aspects of their illnesses. For optimal safe care, clear communication must take place between care providers. When care is "handed off" to another nursing shift, for example, the next set of caregivers need important patient information conveyed to them.
In fact, health records currently reside in many different places for a single patient. The primary care physician has one, usually paper, record. The ophthalmologist has another paper record. The ob/gyn has another record, as does the hospital where the patient's babies were born. The pharmacy has a record of all the prescriptions that the patient has had filled, but the corner pharmacy is not the hospital pharmacy. Those in the field call these "silos" of information, tall but narrow. Currently, there is little systematic sharing of that information. Given the number of patients, the volume of information on each patient, and human nature, details fall through the cracks. According to the Institute of Medicine, between 44,000 and 98,000 Americans die every year because of medical errors. (2) One reason for so many errors is the fact that the right information isn't in the right place at the right time. Another reason is that systematic double-checking of medical and prescription orders doesn't occur.
The upshot? Much better information about your money is available through the electronic banking industry than is available about your health through the healthcare system.
Clearly, the system needs some help. Electronic health records (EHRs) can be one significant antidote to the problem of sharing patient information among caregivers. An electronic health record would make it possible for the ophthalmologist to see the blood work information from the patient's latest physical exam or for the primary-care physician to see what medications other doctors may have prescribed. Once the system gets rolling, the doctor may even get an email alert that the patient has received a prescription from another physician in time for the primary-care physician to review the patient's situation and make sure that there are no unsafe interactions with other prescriptions. And then there's new research to consider. Medical information grows exponentially. MEDLINE added 623,000 records in 2006. (3) Clinicaltrials.gov lists approximately 35,400 clinical studies, most of which are currently active trials. (4) In time, EHRs may help to handle the explosion of new medical information, even as it creates new types of patient information for researchers.
Aside from the immediate benefits to the individual patient, the aggregate information from all the records in the system could become a gold mine for medical research. Data mining of the data could detect patterns of disease (especially epidemics, bioterrorism, etc.) for public health services. It could also lead to more effective treatment of illness through early detection and intervention. …