Medical Records Need Improvement

Medical Records Need Updating

By Tim Holland

Yes, it’s the twenty-first century but why are our medical record keeping practices mired in the nineteenth century? It would appear that the major technology advances adopted by the medical industry are the photo copy machine and the telephone answering system.

Of course there are computers in the doctor’s office but they are dedicated to individualized software packages designed for scheduling patients and billing and accounting record keeping processing. Why hasn’t computer technology made it to medical records; why aren’t medical histories portable; why aren’t medical systems “talking” to one another?

In an age where Microsoft wants to control the way you write every word and Google wants to digitize every word ever written and e-mail and text messaging control the airwaves, why do walls of file cabinets, manila folders and reams of paper dominate every physicians office? If you are referred to a specialist do you take along your records from your primary care physician to the specialist on a CD or do you try to recreate your family and medical history from memory on a new set of forms provided by the new doctor, the hospital, the laboratory? If this all appears to be extremely inefficient, tedious, time consuming and, of course, error prone, you’re right.

If truth be told, your doctor isn’t too happy either. While your records are still in the 19^th century, your doctor may be one of the most technically savvy people you will run into, in fact, a number of doctors, on their own, have begun to computerize their patient’s records. The problem is not with the medical profession but with technology itself. There isn’t a doctor I’ve spoken with that wouldn’t love to see a patient’s records digitized; to be able to bring up test results from a variety of labs and specialists from anyplace in the country; to sit in his or her office and review MRIs, X-rays, CAT scans, EKGs, and a whole host of other material and then be able to send them on to another party for further review and consultation. The trick to making all this happen is something called standards and compatibility.

The solution is inhibited by the size of the task. The number of commercial entities that have a stake in how the solution is achieved is enormous. There are software companies, telecommunications companies, hardware companies and then there are the most important parties – the insurance companies. In fact, without the largest insurance company leading the charge and determining how the integration and security issues will be handled, the desired development and implementation of medical information standards will not occur. Who is the largest insurance company with all this power? Why Medicare and the United States Government, of course.

Just consider the task: millions of millions of records, tens of thousands of doctors, thousands of hospitals and clinics, insurance companies of all sizes and shapes and, of course not only the federal government but also city, county and state governments as well. The security issues alone are daunting. No industry association or groups of associations is capable of addressing what would be needed.

It would be difficult to find a medical professional anywhere who would not endorse digital medical records but trying to “bottom up” the process is cumbersome and extremely expensive in the long run. “Bottoming up” would involve a single physician computerizing a patients records and then having the local medical group follow suit. Next in line would be for all the hospitals they deal with agree to accept the records and for all the doctors and hospitals agree to the same software standards and formats so that information and reports can be moved from one to the other.

To an extent, this is what is happening, unfortunately, on a small scale. The real answer is an internet based medical interchange, where the standards are set by a governing body of which the U. S. Government must be the marshalling force but need not be the managing one. The governing body must consist of medical professionals (no insurance companies, software companies or medical technology companies allowed); the focus must remain on the patient and not the process.

A need does exist and it is crying for leadership. As a model, I often look back at the international banking industry and how they came together during the 1970s in creating the Society for Worldwide Interbank Financial Telecommunication (S. W. I. F. T.) which moves, in a fully encrypted secure environment, following a standard agreed to by all parties, financial transaction information from one end of the world to the other, downloaded into each financial institutions database management systems and then made available to customers in their own offices and homes.

The talent, capability, technology and infrastructure are all there – all we need is leadership.

Note:

This opinion/essay is the property of the author. It is offered for use by individuals who are also free to copy and make it available to other individuals as they wish. Anyone wishing to make use of the material for commercial purposes must seek permission of the author, who can be reached at Impressions@Tim-Holland.com. Such permission will not be unreasonably refused.