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E-PATIENTS AND ELECTRONIC PERSONAL HEALTH RECORDS (?EPHR?)

By Greg Piche'

 The cost of health care is an enormous drag on the productivity of American business. When the cost of health care for employers rises to 20% of the cost of doing business in some industries, the structural handcuffs of health care costs can make the difference in economic survival or not.  The advent of electronic medical records (?EMR?) has been received in some quarters as a panacea for the achievement of improved quality of health care delivery and reduction of the crushing runaway costs of the system.

 The problem is that the various stakeholder interests in the control of medical health records portend enormous resistance to the effective, meaningful utilization of electronic medical records. The control of medical records has had and still retains an economic value to hospitals and physicians. Physicians value them because they represent a direct and ongoing connection with patients who tend to remain connected with physicians and medical practices which are repositories of their medical history. Moving to a new provider is often wrenching for a patient, because of the complexity and uncertainty in the process.

It is no surprise that hospitals are in the advance of the development of digital medical records systems for their and needs and for proselytizing the benefits connectivity with the physicians on their medical staff in nice, tiny, closed systems. After all, it is a direct link and a potentially important investment that a physician undertakes with a particular hospital. The idea is that the inertia created by connectivity will keep the patients connected to the physicians and the physicians connected to the hospital.

Even within a closed system there are obvious efficiencies and upgrades in the quality and cost of health care. There is, however, a much larger potential return by moving control of and responsibility for electronic health records to the consumer ? a major tenet of the so called ?e-patient? movement in the world of Health 2.0.

An open system of health care records is one that permits patient control and possession of his or her medical records and the easy transfer or portability of the patient?s health information to any treating physician or provider of care that the patient selects. It is not a mere adjunct to a closed system that is being provided by most PHR vendors. Those merely permit a patient access to closed system records through a designated portal, but otherwise restrict the transfer of information to destinations outside of the closed system. An open system  permits a patient or care giver a critical health care management tool ? fast, accurate and accessible health care information to assist in the treatment of patient with a complex, chronic or emergent health condition.

A number of high level organizations have been meeting in an attempt to resolve the interoperability issue between EMR systems to permit the easy interchange o electronic health information across closed systems. Ultimately they are stymied by the economic threat posed by the potential conversion of comfortable, balkanized, closed systems into a larger, open, internet system. The only realistic way of achieving a truly open system is to empower the patients or patient caregivers to manage their conditions through portable and accessible electronic patient .medical records. Business should foster and encourage their employees to accept responsibility for understanding and maintaining their own personal health. Encouraging the development and proliferation of patient owned and controlled health information systems would be a wonderful place to start a new paradigm health care system.

You energize patients by actually giving them responsibility. This needs to be done thoughtfully, but it needs to be done. The patient?s job is to take care of themselves ? to work with their caregivers to be as healthy as possible given their conditions. Just like any other job, they need the tools and the knowledge to do this.

Bill Fox, Director of the National Center for Patient interactive Research, a nonprofit organization founded on the belief that the patient must be a hard-wired participant the transformation of medical technology. In interview in The Kru Report: e-Patient Connections, December, 2009.  See www.KruResearch.com.

Full post as published by Healthcare Law Blog on December 10, 2009 (boomark / email).