The Debate Over Electronic Medical Records

Posted on Jul 20, 2010 in Records Management News

Forbes.com Ed Sper­ling, 07.19.10, 06:00 AM EDT by Ed Sperling

How the rules about elec­tronic med­ical records will change our per­cep­tions about all infor­ma­tion technology.

After more than a year of review, the fed­eral gov­ern­ment has finally released its “mean­ing­ful use” guide­lines for elec­tronic med­ical records. For the health care field this is par­tic­u­larly mean­ing­ful because it’s the first step taken toward adding the kinds of con­sis­tency and effi­ciency through IT that most cor­po­ra­tions take for granted.

Elec­tronic records can elim­i­nate dupli­ca­tion in test­ing, bring together com­plete med­ical his­to­ries, dis­close adverse drug inter­ac­tions, reduce errors in patient care, add trans­parency into a sys­tem that has been largely closed to review, and set forth best prac­tices for treat­ing ill­nesses. The mean­ing­ful use reg­u­la­tions allow hos­pi­tals and physi­cians to recoup their IT invest­ments toward this end, at once both mod­ern­iz­ing an anti­quated health care sys­tem and help­ing to reduce the over­head asso­ci­ated with med­ical care.

All of this makes sense on paper. The whole pur­pose of IT is to improve effi­ciency and make infor­ma­tion more read­ily avail­able to those who are qual­i­fied to receive it. But it’s also about to set off a debate that will likely last years, if not decades, about the trade-offs between effi­ciency and patient care, patients’ rights and what con­sti­tutes ade­quate care. This is the kind of debate that hasn’t taken place out­side of groups like the Amer­i­can Hos­pi­tal Asso­ci­a­tion and the Amer­i­can Med­ical Asso­ci­a­tion; it’s now wide open for pub­lic review.

The play­ers in this debate will include lawyers, health care providers, insur­ance com­pa­nies, chief infor­ma­tion offi­cers, chief med­ical infor­ma­tion offi­cers, chief secu­rity offi­cers, tech­nol­ogy com­pa­nies, drug com­pa­nies, lob­by­ists and gov­ern­ment and pri­vate over­sight agen­cies and com­mit­tees. They will define the types of records that need to be kept, how that infor­ma­tion is used and by whom, how it should be stored and new ways to uti­lize that infor­ma­tion for improv­ing treat­ment and iden­ti­fy­ing trends.

What’s not read­ily appar­ent, though, is the effect this will have on the rest of the tech­nol­ogy world. Through­out the his­tory of IT there has never been a national debate on how tech­nol­ogy gets applied to prob­lems. Deci­sions typ­i­cally have been made based upon the needs of a par­tic­u­lar com­pany and the capa­bil­i­ties of tech­nol­ogy pro­duc­ers to meet those needs. One size doesn’t fit all, and best prac­tices often are closely guarded secrets.

To be sure, these best prac­tices can be a com­pet­i­tive advan­tage or dis­ad­van­tage, depend­ing upon both short-term and long-term out­comes and how effec­tively tech­nol­ogy is applied. Some com­pa­nies have scored big with tech­nol­ogy. Oth­ers have not. Wit­ness the wide­spread use of com­mod­ity Intel ( IN TC — news — peo­ple )-based servers in the 1990s, which cre­ated mas­sive inte­gra­tion headaches and caused energy use to spike unnec­es­sar­ily. Those prob­lems are only now being addressed through vir­tu­al­iza­tion and out­sourc­ing into clouds.

I’ve seen far too many mis­takes by doc­tors in e.g. send­ing let­ters to other doc­tors. Have had to cor­rect many of these to make sure I would not be dis­ad­van­taged in my own health. So frankly I don’t t.…

While the mean­ing­ful use rules are vague about the exact tech­nol­ogy, over time they’re going to become very clear about the processes involved in stan­dard­iz­ing records so that when a patient vis­its one hos­pi­tal the records can be trans­ferred from another hos­pi­tal or doctor’s office. This will fos­ter debate about tech­nol­ogy prac­tices that have never been out in the open, includ­ing the costs of this tech­nol­ogy, accept­able times for imple­men­ta­tion, upgrade sched­ules, as well as what works best with what and for what purpose.

In the end, mean­ing­ful use will fos­ter mean­ing­ful debate, and that debate will reach well beyond the med­ical field to expose some other closely guarded secrets.

Ed Sper­ling is the edi­tor of sev­eral tech­nol­ogy trade pub­li­ca­tions and has cov­ered tech­nol­ogy for more than 20 years. Con­tact him at esperlin@yahoo.com.