Total Recall - C. Gordon Bell [41]
One significant hurdle is demonstrating the value of EHRs to physicians. Fewer than a third of American doctors currently use electronic records. They rightly worry that promised savings may accrue in other parts of the health-care system, leaving them with no reward for their investment. And without an agreed-upon or even a de facto national standard, they may have to scrap or retool their electronic health records if they end up betting on the wrong format.
Worse, when different systems use different standards, it is difficult, and even dangerous, to share information. For example, the code “DPT” may stand for Demerol-Phenergan-Thorazine in one system but the Diptheria-Pertussis-Tetanus vaccine in another. Imagine being admitted to an emergency room and being dosed with a drug you’re allergic to because they misinterpreted the code in your record. And yet there are some twenty or thirty commercial electronic health records on the market, most of which use proprietary data formats. Many health-care providers have watched cagily from the sidelines, waiting for a standard to be set. Fortunately, it appears that waiting will soon end, as recent years have seen spreading standardization as well as software coming to market that translates between standards.
At the same time, some health professionals are exploiting unorthodox tools for organizing and sharing medical information right now. In a recent bit of serendipity, radiologists realized that they could use iTunes, Macintosh’s popular music-management program, to manage and organize PDF files just as easily as music files. For example, radiologists generally save medical reports as PDF files in folders on their PCs. If they want to compare images from several articles, they have to pull each one out “by hand,” so to speak, and lay them side by side. But iTunes can search, describe, and rate PDFs just like music files. The physicians can search and sort PDFs according to any desired criteria and publish their “play-lists” for other doctors to see, just like music lovers do with their MP3 songs. Bring up all X-rays of fractured tibias within the past year. Show me all herniated discs in people over age seventy-five stored in my PDF files.
Health-care providers employing PHRs will have decreased costs and better service. This will bring them more business, and force their competitors to adopt PHRs as well. All signs indicate we have already reached the critical mass needed to see personal health records become universal.
OWNING YOUR HEALTH MEMORIES
The typical American can access her bank account from ATMs around the world, check her e-mail from anywhere there’s a Wi-Fi signal, and go online to see charts breaking down exactly how energy is used in her home. But if she wants to look at her own health records, she’s out of luck. The little she can view online is incomplete and spread among many sites, and in any case, most of the relevant information exists only on hand-scribbled forms and printouts stuffed into a dozen manila file folders in a dozen far-flung offices around the country.
No one institution has the full picture of her health. The hospital has one piece of the puzzle, the specialist another, and the family doctor yet another. Her insurer knows everything that has been billed but lacks most of the details, and it has no idea about her out-of-pocket visit to the naturopath, the chiropractor, and the cosmetic surgeon. Factor in the dentist, the pharmacist, the gyne cologist, the dermatologist, and the therapist. Her current general practitioner keeps his own file on her, but everything he knows about her prior medical history consists of whatever she happened to remember (or misremember) on her first visit.
American health care has been fragmenting. Driven partly by technological advances and partly by the bottom-line focus of our system, hospital alternatives