[LINK] Electronic medical records: why we should seek a second opinion

[David Boxall]

It seems to me that electronic medical records will most benefit the 
disadvantaged, such as itinerants and the chronically ill. Those of us 
who are more comfortable will quibble about privacy and such, but do the 
risks outweigh the benefits?

From: 
<http://www.smh.com.au/opinion/politics/electronic-medical-records-why-we-should-seek-a-second-opinion-20111218-1p0o3.html>

December 19, 2011
Dr Tanveer Ahmed

There are fears that the US's overreach in Iraq and Afghanistan, in 
combination with its tenuous financial state, may spell the end of its 
global hegemony. But the superpower's downfall is just as likely to be 
caused by the cost of MRI scans as it is by defence spending.

Health remains the greatest non-security challenge Western governments 
face. The task of managing an ageing population, whizbang technologies 
and a demanding public is awesome.

Australia is not quite in the budget quagmire on health, but there is 
every chance its proportion of gross domestic product costs will 
continue to rise above the current 10 per cent. One of the great 
potential contributors to efficiency in what is notoriously the most 
inefficient of sectors is the electronic patient record. By allowing for 
more efficient sharing of information, health records stored as a 
transferable entity in digital form could transform the entire sector.
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The electronics and computing revolutions of the past several decades 
have reshaped much of medicine, giving us advanced imaging techniques, 
microchips for monitoring and regulating heart function, and countless 
new diagnostic tools.

But the information infrastructure of healthcare lags behind. Patient 
records and the data needed for determining effective medical practice 
remain decidedly low-tech.

Every week I have frustrating conversations with colleagues who refuse 
to use email for correspondence about patients, instead directing me to 
send them a fax.

As a junior doctor, I spent countless hours looking for forms, patient 
files and important X-rays. I wasn't alone, as a 2001 study by 
management consultants in Britain confirmed that medical officers there 
spent an hour a day looking for data instead of applying their scarce 
skills.

Just about every other industry - financial services, travel, 
entertainment, communication, you name it - has been radically remade by 
information technology in the past two decades. But not healthcare.

Entrepreneurs have harnessed science and technology to make dramatic 
advances in the practice of medicine but the health information system 
remains archaic and paper-bound. This paradox gets to the heart of why 
healthcare is simultaneously so impressive and so frustrating. The 
opportunity cost of inaccessible and unused data is particularly high 
for the millions of Australians suffering from conditions such as 
diabetes, mental illness and heart disease. This type of chronic disease 
increasingly forms the bulk of sickness and relies on team co-ordination 
to deliver high-quality care.

Such sufferers would benefit enormously from regular, systematic 
analyses of their condition based on automated reviews of their key 
health indicators. It would also save taxpayers billions of dollars.

One of the key concerns from consumers is about the privacy and security 
of the data. This is a particular concern among mental health sufferers 
who worry that sensitive information will become available to other 
health providers or even employers. But we have been willing to accept 
some risk to our privacy in exchange for convenience in the wide use of 
the internet banking, shopping and other services involving personal 
information. If patients could make greater use of the internet to 
improve their interactions with their doctors, they would quickly see 
the benefits and accept the risk, knowing there are appropriate safeguards.

The government's plan to introduce the electronic patient record is on a 
tight schedule with the rollout to begin in July. The push will almost 
certainly need to come from consumers and governments, given such 
investments in technology do not produce a financial return for doctors 
and hospitals.

The main beneficiaries are the patients who will gain new and more 
convenient access to their medical records and the healthcare system at 
large, which will operate more efficiently. The physicians and hospital 
administrators stand to lose their monopoly control over clinical 
information and get paid nothing more for their efforts.

Indeed, many experts believe it will reduce demand for doctors and cut 
hospital admissions, as better information improves prevention and 
discourages the ineffective use of medical services.

But there is a real risk that democratisation may go too far, with plans 
to give greater powers to consumers to alter their own records without 
medical input, which instil understandable fear in both doctors and 
their insurers.

Equivalent attempts have fallen over in Britain due to a combination of 
financial turmoil, a change of government and poor clinician 
involvement. Our government has learnt from these mistakes but the risk 
remains that the issue may not be given due weight by the community. Its 
appearance seems to be limited to the IT sections of newspapers. But it 
could be a transformative event, for it will limit the potential of 
future health expenses to strain our economy, and it will make us healthier.

-- 
David Boxall                    |  When a distinguished but elderly
                                |  scientist states that something is
http://david.boxall.id.au       |  possible, he is almost certainly
                                |  right. When he states that
                                |  something is impossible, he is
                                |  very probably wrong.
                                                  --Arthur C. Clarke