Thursday, March 12, 2009

Better Records


Our medical records system has to change. In this one area, I actually agree with Mr. Obama, but only in part.

I went to the Dr. recently and spent the majority of my time there writing dow
n my medical information. Very little time was actually spent with the doctor. Then he spent 2 minutes reviewing my medical history and then talked to us. When I go to another doctor for something else, I will need to repeat the procedure, but he won't see the information that the previous doctor wrote because the records are separate. I might even leave something off by mistake (or intentionally). This has got to change. In an age where information is so easily stored and accessed from anywhere in the world through a simple web browser, there is no reason not to have one source for all my information.

We have to move to a single record per person for all medical issues and history. I don't mean a single repository for all records, but one place for my records and possibly another for yours. Read on...

If all my records were in one place, then any doctor that I give approval to can view them and see all my history immediately and without duplication or error. He will have accurate and current info on my history, conditions, treatments, prescriptions, etc. I don't have to worry about forgetting something or worry about him not understanding something because it will all be in one place.

However, I do have some caveats about this.
  • This must be developed privately and not by the government. Have you ever accessed a government web site? They are difficult to use and not as good as most corporate sites. The government should not attempt to develop this technology but instead should simply reward the company(s) who do. Set up a development competition so that whoever meets all the requirements within the time frame will be rewarded nicely. Even if a $100 million reward was posted, this would still cost far less than the current estimates for the government to develop.
  • There must be open competition so that there might be 2 or 3 good records storage providers competing for our business. This is critical to keeping the quality high and costs low. A government built technology will be stale and never keep up with technology.
  • The records must be portable so that if I want to switch providers, I simply export/import to a new record provider.
  • The records belong to the person (owner) only. No one else can access the information except those to whom permission is granted. When a doctor needs to see the records, he/she must be granted access permission from the owner. Same for family members.
  • Neither the government nor the insurance industry will have access to these records unless granted by the individual.
  • When access is granted, it will only be for a limited time (maybe a week or month). This goes for Doctors as well.
  • All access to the information will be traced and recorded - visible to the owner so that he/she knows who and when their records were accessed.
  • The providers will need to keep a subset of our records for their records. This is simply a legal CYA for them but it could be used for research if permission is granted by the owner.
  • The owner will not be able to modify a doctor's notes, comments, or prescriptions. This will prevent the patient from hiding something, like getting duplicate prescriptions or conflicting medicines.
  • Security must be at the top of the list. Lots of people are concerned about this, but this is not an insolvable problem. Easy - no, but it is doable.
  • It must store images (MRI's, xrays, etc), prescriptions, doctor's notes, nurses notes, owner notes, questions, scans of older records, etc.
  • It must not store billing information. If someone is having trouble paying, then that must be handled separately and not be visible by the provider.
  • It must be easy to use and intuitive. This is a good reason to keep the government out of it.
  • The monthly cost can be paid by the owner/individual through subscription fees. However, someone will probably be able to be profitable through advertising or some other means.
  • HIPAA laws must change to support and adjust to storing information this way.
The list of requirements will surely grow since I am no expert here, but do have an opinion. Did you know that Google is currently running a beta of health records? I poked around there and didn't get the sense that their first go around will be life changing. I think that IBM is also working on a solution and probably a few other big players. This is good - let the competition begin.

However, do not let Uncle Sam develop it or think they own it. That would be horrible! Let it be done privately on the open market. This is a better way.
 
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