This week, blogger and consultant William Bryson of Innovative IT for Healthcare outlined an approach which seems may solve some of the key issues dogging the emergence of RHIOs. As I see it the idea, EHR/EMR "banking," certainly has some flaws, but is definitely worthy of further discussion.
In his article, Bryson describes the concept, under which a third-party organization would collect and host clinical on behalf of the states. This approach works around thorny HIPAA privacy issues, as well as making it simpler for patients to control who gets their data and when. (After all, establishing multiple levels of access is much easier with one database than with data living in five, six or even dozens across several organizations.)
Under this model, doctors and other clinicians make "deposits" of clinical information--and are paid to do so. Patients establish and pay for the EMR "account," which then gives them control over any and all withdrawals of medical information. Effectively, the patient's EMR is held in trust by the third party.
I can understand why Bryson was interested in this model. It's easy to see how EMR banking vendors like eHealthTrust could play an important role in calming the fears of competing regional health systems, stifling at the outset the question of how much control each side would have to give up. And it's a very neat trick to place patient info into their own "account," as just about every version of RHIO we've heard of is struggling with how to handle the scores of permissions they'd need to get whenever they share information across the network. This approach blows many of these concerns out of the water.
Honestly, I'm a bit skeptical that patients are sophisticated enough, yet, to see the need to establish a medical bank account. It's sort of a chicken-and-egg problem; so few actually see their PCP using electronic records, it's just not a concept that will resonate with enough to reach critical mass.
Another issue is that the groups most likely to benefit from such an approach--senior citizens on Medicare and poor people on Medicaid--would not be prone to be the most computer-savvy types. I think that taking control of, much less paying for, a computerized medical record would be a hard sell for both groups.
But even if the effort would take patient education, serious security protections and a possible re-structuring of the business model (get, say, the pharmas to underwrite the EMR cost?) I think the idea makes a lot of sense. I'm eager to see whether states take this path in some form, rather than paying for a lot of iron and software and hoping regional health systems can run with the ball. (Do you think this approach can work? I'd love to get your opinion.) -Anne
P.S. I'm sure most of you are going to HIMSS '07 next week. I will be to cover the show in depth, and look forward to meeting as many of you as I can, especially at our hot networking party On The Rocks on Monday the 26th. See you there!