There is widespread agreement that it’s beneficial and that it could improve all aspects of medicine, but there is also much standing in the way of electronic medical records.
Computerizing medical data is an old and obvious idea. The upsides in terms of efficiency and cost have always been enormous. And yet mountains of paper and other non-electronic records continue to be generated. And those records that are electronic live on incompatible islands.
Now a series of efforts is underway across the developed world to create central databases with standardized formats for medical records. The potential advantages make some observers salivate:
– Cost reductions – Medical care in the U.S. now costs $1.9 trillion, about 16% of GDP
– A dynamic lifetime view of a patient’s medical history, available to any authorized provider
– Easier epidemiological studies to compare of the incidence of symptoms and the effectiveness of medications and other treatments.
– Easier surveillance for epidemics, pandemics, and bioterror.
Many argue that such a system could allow doctors to focus more on preventive care rather than a reactive approach of treating diseases as they appear.
Many of the advantages are more mundane. When you go to a doctor or emergency room out of town, they need to take a long history and lack access to records which could be helpful — and that’s just if you’re conscious. Central and standardized storage of medical records would make it easier for patients to switch providers, thus enhancing competition.
It would also provide a cost advantage for providers, who spend a fair amount of money managing paper records, especially in the face of new regulations to protect the privacy of those records.
The problem of doctors and hospitals not wanting, out of old habits, to enter data electronically is still a major one, but one that will pass with time. The real problems are cost-related.
Consider the X-ray. Only in recent years have digital X-rays begun to appear, and the machines are still quite expensive. Electronics being what they are, the cost will come down and eventually traditional X-rays, which rely on expensive materials, will become uncompetitive. But in the meantime, the average orthopedist office still has a conventional X-ray system.
Such physical records are a major hole in any attempt to make records electronic. And they are not the only ones. Even simpler devices like electrocardiographs still often generate paper records because there’s no incentive to the provider to spend the money on electronic hardware.
And then there’s the format question: Just because you have an electronic X-ray or EKG doesn’t mean all medical software can read it. There needs to be agreement on the data formats of these items.
XML has emerged as the obvious general format for holding medical data, as it excels at interoperability between systems. Much work has been done with respect to specific formats; consider this FDA document on XML medical formats, including EKG data.
But there is no widespread agreement on such standards. Even easier standards which involve only data, such as a CBC (complete blood count), aren’t clearly standardized. This is ironic because any doctor could look at any paper version and read it.
There is also the problem of privacy. In the long term, making records electronic should make it easier for them to be secured, but it also opens up new and powerful avenues for the compromise of data. People are justifiably concerned that personal information could be used to prejudice them in employment or pursuit of insurance.
Technology like electronic patient records is necessarily disruptive. It will save a lot of money and enable a lot of benefit. But it will also cost a lot of people a lot of money in the form of new software and hardware that they will need to acquire, as well as old systems they will need to leave behind. Long-honed skills and habits will also be challenged. Who can blame people for resisting? But it’s just a delay. Eventually, all such records will be electronic.