Electronic Health Record (EHR) II draft

It is easier for a doctor, not connected with a major institution, to obtain government secrets than to access current medical information. The funding for electronic health records (EHR) affords an opportunity to advance education and channel that, difficult to obtain medical information, to the medical student, the practicing doctor and the point of patient care.

Translational medicine makes an issue of researching and implementing new knowledge into clinically applicable substance. That substance has little merit until it becomes a part of clinical practice. The flood of new bio-medical information overwhelms the process of translating and delivering relevant advances to the clinician. Many EMR proposals contain substantial decision support capabilities, but neglect to feed current and changing medical information.

Vender centric programs meet the economic needs of the client and the vender. Government centric strategies stress avoiding errors, reducing cost, meeting fixed quality criteria[1] and quantifying the benefit. Drug centric solutions attempt to aid in selection of medical treatment and prevent adverse drug reactions. Hospital centric EHRs must deal with pooled data with other institutions, confidentiality, their own institutional review boards (IRB) and somehow collate data from divergent sources.[2] Hospitals and insurance companies seek control of the data as an administrative and economic strategy. Drug companies have a similar motive.

Make patient needs the first priority by centering the EMR in the computer of the individual provider while linking that database with a secure cloud database. Supply the provider with total access to total medical information. Include the decision and support capabilities. Generate a continuous differential diagnosis. Include a self-correcting statistical element. Compare and analyze the relationship between patient data and outcome.

Impediments in developing meaningful EMRs

·         Battle over final ownership of the data

·         Divergent priorities in function and goal of the EMR

·         Colossal challenge in meeting every bodies demands

Proposing that these electronic patient records (EPR) belong jointly to the patient and the primary care provider resolves a number of the impediments and problems.

·         Eliminates incompatible database problems among various institutions

·         Individual providers work with off the shelf database linked to major database provider.

·         Clinician can modify the reports and add criteria at will without upsetting the core software schema.

·         Medical school and institutional researchers can access accumulated patient data anonymously.

·         Patient genetic data correlates with clinical pathology in real-time

·         Enhances medical student education by learning the database in clinical years

·         Gains acceptance among private practice physicians by its sponsorship in the medical school and by its use among graduating physicians

·         Puts the medical school in control of the patient database

·         Puts a regional and environmental spin on the relevance of medical information

·         Promotes competition between medical schools in developing the best medical information database and operating system

·         Frees the decision support function and diagnosis from the distortion created by arbitrary regulation and economic motivation

·         Maintains political neutrality

·         Data accessible:

o   1. because in standard and widely used database program  

o   2. Because all information recorded as specific data entries and thus retrievable  

·         Informed consent no longer an issue for cohort studies

·         Use and cooperation become ubiquitous – spreads voluntarily

·         Free use provides an unwitting contract to use the information wisely

·         Errors and misdirection become immediately transparent to the medical school and a pointed direction for CME

·         Gives medical students much more of a vision of the totality of medical knowledge and a more organized way to store it.

Requirements

·         Open source and free to all providers

·         All patents and copyright in the  public domain

·         A database purchase from Major database provider, probably Oracle or IBM, unlimited users

·         Medical information in database form provided by medical school, free of copyright and cost! As an educational and CME function

·         Enough federal and state financial support

·         Initial programming of the database schema and the statistical relational rules

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[1] J Am Med Inform Assoc. 2009 Sep–Oct; 16(5): 637–644 Decision Support Capabilities

[2] J Am Med Inform Assoc. 2009 Sep–Oct; 16(5): 624–630 The Shared Health Research Information Network (SHRINE)