Any future changes to Electronic Health Data Management which does not approximate true DATA MANAGEMENT is doomed to produce nothing but cost and expense.
The primary issue, in my opinion, with health data management systems, is the approach to the organization and structure of the health data being managed. In medicine unlike any other industry, the management of the data does not follow the rules for good data management. As a result we have disjointed and fragmented, difficult to transfer patient data.
In well designed data management systems there is only a single copy of a record for a particular "thing." It does not matter whether that "thing" is a widget, a person, or a car.
In health care, where a patient will see multiple providers, each provider holds, maintains, and manages a portion of the patient's health data. Records, which exist in electronic form with one physician, are transferred to another physician as PAPER RECORDS. As a result, unless the patient is only seeing a single doctor, there is no provider who can produce a comprehensive and complete electronic medical record for a patient.
To fix this there must be a single standard medical record data format for a patient. Suffice it to say that this medical record should not reside with any provider or entity but in an electronic file over which the patient has the ability to grant access.
The record can exist either on a portable drive/device or online.
Digital signatures should be used to ensure authenticity, and non-repudiation of each entry to the record.
EHR systems can interface with this Health Record by reading from and writing to it. EHR vendors will be free to write their software to PRESENT the patient data in as fancy a way as they want to. They will be able to write to the record in the pre-defined way.
The structure of the RECORD cannot be left to private industry, as we see with Google and MS today. Each will try to leverage their own BUSINESS interests in the creation of the RECORD, this will again lead to a fractured system, where a lot of time and money will be spent trying to achieve compatibility.
From a health care perspective, the provider will be able to see the entire patient record, WITHOUT the need to transfer records from one doctor to the next.
"The window is not the view, the window allows the view" ~ Hugh Prather
The interface (EHR Software) is not the data, it only allows us to see the data. Tinted glasses do not change the substance of view, they only reduce the glare.
That being said, everyone knows TODAY, from a database perspective, what comprises a patient record. For example: First Name, Middle Name, Last Name, Date of birth, Sex, SSN, compose the identification of the patient.
However, if you look across multiple EHRs at how the data columns are represented (column name and length) you will see The "First Name" column as FName, FirstName, F_Name, First_Name, NameFirst or any other designation. The length of this column(number of characters) will also be wildly different.
The problem then is how do you transfer your FirstName column to another system that identifies the same column as First_Name, so that the transfer is seamless?
If however, there were a "single defined medical record format" (in terms of tables and columns), the physician's EHR would only have to UPDATE that system in a manner that insures the integrity of the data.
There seems to be this apprehension about "the government" managing data...yet look around you, government manages your data every day, electricity, water, driver's licenses, property taxes, vehicle registration. Who builds those systems for the government? PRIVATE INDUSTRY. But the government owns and manages it. So the retort that "private entities" can do it better is a canard. When private entities do it their goal is to perpetuate the financial interests of their companies.
What I am proposing does not require the record to be KEPT by any state. If the format is universal, an individual can carry his/her medical record around on a smart card, USB device, or host it with MS-Health or Google Health.
When I go to see the cardiologist, I present my card the cardiologist and his/her system can read the card and write to the card. The cardiologist can also make a snapshot copy of the record. When I return to my PCP and she puts the card in her system. The data entered by the Cardiologist is there.
Let me throw in another scenario. I know a doctor rounds at 4 hospitals in a 20 mile radius. 3 of the 4 hospitals are owned by different entities: Iasis, Banner and Catholic Hospitals. Now even though she can get online and see patient information from all the hospitals, imagine what happens when PatientA is discharged from a Banner hospital on Friday and shows up in the ER of the Iasis Hospital a week later. She now has to use TWO DIFFERENT SYSTEMS, in addition to her own, to see the patient's history over the past 3 weeks.
If there is a universal health record data format, and the data is written to a single place, be it the Microsoft Health, Google Health or a USB Drive, she will be able to access all the information in one place with one system.
Let's look at phones and the telephone system:
There are at least 20 different phone carriers in the country, yet you can buy ANY KIND of phone you want, with any carrier: iPhone, Windows Phone, VOIP, Vonage. whatever. Yet all of these phones are able to complete a call to one another irrespective of which network you are on.
Because there is a standardized protocol for making and receiving a phone call and, the government is involved in that process. Believe it or not EVERY PHONE on the market today, has to go through FCC testing, and it does not stifle innovation because there are newer better phones being marketed every week.