The following editorial appeared a few days ago - and as the PCEHR was mentioned I thought it was worth a careful read.
Solving the right health IT problem
September 20, 2011 | William Yasnoff, MD, PhD, President, Health Record Banking Alliance
Twenty years have passed since the Institute of Medicine identified electronic health records (EHRs) as "an essential technology for patient care." However, despite much activity, and some progress, comprehensive electronic patient records are still not available to providers of care.
Most of our efforts thus far have been focused on automating our current record retrieval process: When a patient presents for care and has records elsewhere, a manual request is made to the outside provider and the records, if available, are typically faxed to where they are needed. We have mistakenly believed that if we could just automate this process with electronic health information exchange (HIE), all would be well. This provider-centric approach addresses the wrong problem. Each provider’s records, even if electronic, are not complete patient records.
Treating the symptoms of missing records by automating our current manual "fetch the records" process will not fix this. The locations of all the records for a given patient are not generally known or recorded. Every provider must have an EHR system able to respond immediately to a record request from any other provider (a combinatorial explosion of potential connections). Provider sharing of records is totally voluntary. Records from multiple sources must be correctly identified and integrated in real time. Protecting privacy is very difficult since patient information is located in many different systems. The scattered patient records cannot be feasibly searched for public health, public policy or medical research purposes, eliminating our opportunities to use this information to detect patterns and improve care. Finally, there is no clear business model for sustainability.
Last year's report from the President’s Council of Advisors on Science and Technology concluded that current HIE efforts through the states "will not solve the fundamental need for data to be universally accessed, integrated, and understood while also being protected." Findings of a recent survey of HIEs "call into question whether RHIOs [Regional Health Information Organizations] in their current form can be self-sustaining and effective."
The right problem is ensuring the availability of comprehensive electronic patient records. Solving it requires a patient-centric approach. Imagine each patient having their own secure and private electronic "checking account" for their medical records.
.....
William Yasnoff, MD, PhD, FACMI, is a health IT consultant and President of the Health Record Banking Alliance. His prior work at HHS resulted in the creation of ONC in 2004. He is the author of the Health Information Infrastructure chapter in the textbook Biomedical Informatics (Shortliffe & Cimino, eds.). This post appeared at NHINWatch.com.
Read the full article here:
The following paragraph provides some links to some examples.
“This approach, known as a health record bank (HRB) or "patient-controlled EHR" (PCEHR) is already in use in Singapore and Denmark, and is being implemented in the Netherlands. Australia just awarded a large contract to build a PCEHR system by mid-2012. Aided by seed funding from Washington State starting in 2009, several small HRBs are now operational there.”
Here is the announcement from Singapore:
Accenture Implements Nationwide Electronic Health Record System in Singapore
June 20, 2011
Accenture Implements Nationwide Electronic Health Record System in Singapore
Phase One Launch Provides Single Patient Record for Healthcare Professionals
SINGAPORE; June, 21 2011 - Accenture (NYSE: ACN) and MOH Holdings Singapore have launched one of the world’s first national electronic health record (NEHR) systems. Aligned to Singapore’s “one patient, one record” vision, the NEHR enables a single patient health record for clinicians to access across the healthcare continuum.
As patients visit providers – including primary care clinics, acute and community hospitals – healthcare professionals will be able to access a single patient record for medical information. The NEHR captures medical data, including patient demographics, diagnosis, medications, tests, procedures and discharge summaries, for exchange among clinicians.
“Our goal is for all Singapore health organizations to have real-time clinical information for treating patients,” said Dr. Sarah Muttitt, Chief Information Officer, MOH Holdings. “This milestone represents a significant step towards achieving our vision.”
“The NEHR will enable insight driven health through the timely access to holistic patient information,” said John Vidas, who leads Accenture’s health business in Asia Pacific. “Singapore’s vision, leadership and innovation will establish standards and best practices for other regions to follow.”
The Singapore NEHR go-live is the first phase of the effort and was deployed in 10 months.
Full release here:
From Denmark we see a really interesting approach.
Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study
March 11, 2010
Authors: Denis Protti and Ib Johansen
Overview
Denmark is one of the world's leading countries in the use of health care technology. Virtually all primary care physicians have electronic medical records with full clinical functionality. Their systems are also connected to a national network, which allows them to electronically send and receive clinical data to and from consultant specialists, hospitals, pharmacies, and other health care providers. Under the auspices of a nonprofit organization called MedCom, over 5 million clinical messages are transferred monthly. One of the most important innovations has been the "one-letter solution," which allows one electronic form to be used for all types of letters to and from primary care physicians; it is used in over 5,000 health institutions with 50 different technology vendor systems.Citation
D. Protti and I. Johansen, Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study, The Commonwealth Fund, March 2010.Full text of issue brief is found here:
I can’t vouch for the third link but it seems to rather double Dutch to me!
Go here if you read the language:
My take is that the guts of the Health Bank concept has some merit. The implementations in the US look nice and simple and are obviously reasonably practical:
See here:
and of course here:
What is happening in Denmark looks like a clever way to skin the Health Information Exchange approach and the Singapore model is still emerging.
Had our powers that be decided to go with Danish simplicity and elements of the Singapore and US approaches we might have had a workable system without all the issues to suit those patients who wanted one and still have been able to enhance our present clinical systems.
I still struggle to know how any of these concepts can make complex long term collections of information easily accessible and useable - so there does seem to be a role for curation of a health summary if a sensible balance between patient desire and clinician time and effort can be struck.
I have to say having a look at what is going on elsewhere is really worthwhile. Comments welcome.
David.
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