A preliminary review of the literature on electronic medical records, EMRs and health information technology (HIT) initiatives raise a couple of doubts.
One is the apparent lack of accommodation for new bio-medical and genomic advances. The lack of a current medical diagnostic database with criteria, frustrates the accommodation for new science. Such a comprehensive medical information database needs to be infinitely scalable, dynamic and freely accessable at least by the providers.
Although stage II envisions decision support, -- such is already the case in the best of the EMRs deployed so far -- stage II does not include differential diagnosis. There again the lack of a current medical information terminology / database frustrates any attempt to correlate patient data with outcome or the genome with medical illness.
Also, the plan underestimates the resistance and distrust that both patients and providers might have in relinquishing their proprietary right to the inherent value of the medical record. The hospitals, insurance companies, drug companies and HMOs will vie for control or at least access to this information. I doubt that the federal government instills more trust. The States with their medical schools and public health departments may be neutral ground, but the level of federal access remains unclear.
Obviously we need to do this. We rank behind most of the Western World in health despite having the best medical schools and high level institutions.
The office of the national coordinator (ONC) clearly defines the issue of trust. However the suggestion that the rewards of stage II will yield to penalties in stage III seems contra-productive. On the contrary studies in human behavior suggest that education and access to information motivate far better than punishment. One might say especially with highly educated and motivated professionals.
Sadly, current medical information is harder and more expensive to come by than classified government information. Journals, books and medical seminars are extraordinarily expensive and archaic compared to the Internet, yet firewalls copyright and exorbitant access fees block that information as well.
It seems illogical to view the medical record database as public information (with privacy safe guards) whilst current medical information remains proprietary.
http://motorcycleguy.blogspot.com/2010/12/language-of-healthit.html
http://ahier.blogspot.com/search/label/Office%20of%20the%20National%20Coordinator
One is the apparent lack of accommodation for new bio-medical and genomic advances. The lack of a current medical diagnostic database with criteria, frustrates the accommodation for new science. Such a comprehensive medical information database needs to be infinitely scalable, dynamic and freely accessable at least by the providers.
Although stage II envisions decision support, -- such is already the case in the best of the EMRs deployed so far -- stage II does not include differential diagnosis. There again the lack of a current medical information terminology / database frustrates any attempt to correlate patient data with outcome or the genome with medical illness.
Also, the plan underestimates the resistance and distrust that both patients and providers might have in relinquishing their proprietary right to the inherent value of the medical record. The hospitals, insurance companies, drug companies and HMOs will vie for control or at least access to this information. I doubt that the federal government instills more trust. The States with their medical schools and public health departments may be neutral ground, but the level of federal access remains unclear.
Obviously we need to do this. We rank behind most of the Western World in health despite having the best medical schools and high level institutions.
The office of the national coordinator (ONC) clearly defines the issue of trust. However the suggestion that the rewards of stage II will yield to penalties in stage III seems contra-productive. On the contrary studies in human behavior suggest that education and access to information motivate far better than punishment. One might say especially with highly educated and motivated professionals.
Sadly, current medical information is harder and more expensive to come by than classified government information. Journals, books and medical seminars are extraordinarily expensive and archaic compared to the Internet, yet firewalls copyright and exorbitant access fees block that information as well.
It seems illogical to view the medical record database as public information (with privacy safe guards) whilst current medical information remains proprietary.
http://motorcycleguy.blogspot.com/2010/12/language-of-healthit.html
http://ahier.blogspot.com/search/label/Office%20of%20the%20National%20Coordinator
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