photo by Dougww (http://doug.aqueo.us/)
By Sven Larsen
With all the *ahem* “spirited debate” surrounding healthcare reform it’s clear that there is one part of Obama’s plan that everyone agrees with. Medical records need to be digitized in order to save money, improve communications between care facilities, and improve patient access.
Perhaps both sides are so ready to agree because the task is so daunting that it may take years to accomplish.
Apart from the obvious security concerns there are several other obstacles to digital conversion. One of the biggest is something library scientists call “maintaining the integrity of the metadata”. In plain English that means making sure that all of the information in a profile or history is correct. Ever log in to an online profile or read an article about yourself and found some errors? That’s bad metadata. It’s a concern when your online reputation is at stake. But it’s critical when it’s your medical treatment that can be impacted by bad information.
So the question becomes, who should be responsible for maintaining that data?
The most obvious choice is the patient. But is this really a realistic expectation? Think about all the online profiles you may have created for yourself (Facebook, Linked In, MySpace, etc.). How many of those do you keep updated? This also assumes that you have regular access to a computer, something that is a major issue for many of the most frequent users of our healthcare system, particularly seniors and the poor. And, of course, the patient would have to be trusted to accurately capture all the information provided by healthcare providers. Can you imagine the liability issues this would create?
But if patients can’t be trusted then the burden falls on healthcare providers. Not so bad, right? Aren’t HCP’s already responsible for maintaining accurate patient records? This is just a change in the method of capturing this information, right? But what if a nurse is trained on the healthcare equivalent of Windows and then switches to a hospital that uses the healthcare equivalent of a Mac OS. This could cost institutions a fortune in staff training (in addition to the costs of installing these systems in the first place). If your company has ever implemented a new enterprise application like SAP or Oracle, then you know the kind of pain I’m talking about. In addition to user facility there could be issues with hardware compatibility, applications sharing data in a common file format and more. And how often would underfunded institutions upgrade their systems? I think back to a presentation I saw from the guys running New York State’s government website where they showed us the 20 year old computers Albany was using to run their sites. I could easily picture the same scenario at public hospitals in inner cities.
Perhaps the ideal scenario would be a third party provider providing a web based solution? Putting aside security concerns, they would be able to create a business around compiling patient databases, tracking their medical histories and ensuring that all the information on file was correct. Come to think of it, there are a bunch of businesses that do this already. They’re called Health Insurance Companies.
Maybe this whole reform thing won’t be such a bad deal for them after all?