What About Electronic Health Record Portability?

President Obama gave a press conference last night about his proposed health care reform. The one thing we seem to all agree is that health care is well overdue for an overhaul. How to overhaul health care, however, is where consessus is lacking.

One piece of this debate that brings people together is this whole idea of electronic records. My dad’s medical practice was recently acquired by a large health care outfit, and he is going through the pang of converting 20+ years of paper charts into an electronic format. Before his practice was acquired, he had been going through the process but was told to stop because the system his group purchased was not compaitble with the system of the health care outfit.

This issue of compatibility has avoided the spotlight, which is problematic. How exactly does the use of electronic records cut costs if those records have to be printed and then faxed/mailed to a different hospital or doctors’ office because that hospital or doctors’ office uses a different system? The answer given: privacy protection. Granted, no one wants his or her medical records publically viewable, but I don’t see why it has to be all or nothing. I would rather have important information like allergies and medications I’m taking made readily available so that if I were to need emergency surgey, say, the surgeons and staff will be able to provide appropriate care and not kill me, mangle me or face a malpractice or wrongful death lawsuit.

So it’s not so much a question of electronic records to cut costs, but a question of balancing accessibility with privacy. Again, electronic records that have to be printed and faxed creates the same kind of “waste” Obama wants to eliminate.

A simple solution is to require every company making electronic health care record applications make the code open source. Or better yet, make the entire concept of electronic health records open source. Companies that support open source, like Google, Red Hat, the Linux Foundation, etc. will participate. And yes I know Google is building its own health care dashboard. But think of the resources available, worldwide, if health record applications are open sourced. And talk about cost savings!

Granted, the government will have to come up with specific guidelines (and they may have already), and such things as HIPPA compliance need to happen, which may be a foreign concept to those not familiar with US health care. Source code would have to be vetted. All the various steps of application development would still have to occur, but at least we’d all know what we’re getting. And if there are features that seem obvious to patients but not so obvious to doctors, there would be an easier way to address them and find a solution.

The few companies that already build and deploy health record apps are not going to like the idea of making the code open source. I can understand that. They need to make money, and selling the app is how they make money.

So why not allow a public API? That way, the companies can still keep their software, but if I need emergency surgey in Arizona, at least the Arizona hospital system will be able to communicate with the Illinois hospital system, increasing my chances of successful treatment and decreasing Arizona’s chances of malpractice lawsuits.

I don’t pretend to have all the answers, and I’m all for electronic health records. But if the ultimate goal is easier exchange of information in order to eliminate waste and poor decisions, then make the systems compatible.

I don’t see why there can’t be an OpenOffice-type health record system. By that I mean, I can open up a WordPerfect document, or .doc or .docx or any number of different extentions to get the information I need. I can save it with the original file extension, too, and all is good.

So why can’t electronic health records work the same way?


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