Tuesday, April 28, 2009

Technology for a Single-Record System

Technology to deliver a single patient record system and better alignment of incentives for preventive care are two of the provisions cited in the April 27 edition of the Annals of Internal Medicine about The Change We Need in Healthcare.

Drs. David Goff and Philip Greenland highlight the possibilities for a single-payer system to deliver better preventive care. "At present, there is little incentive for private insurers to pay for prevention services when the enrollee (patient) may be covered by another insurer in just a few years. In this example of misaligned incentives, the insurers have little likelihood of realizing a return on their investments in prevention. We have known for several years that risk factors present in middle-aged men and women are predictive of health care costs and disability many years later under Medicare, but Medicare cannot pay for preventive services in middle age because the program is restricted to covering the elderly (and disabled). In a single payer system, the government could cover preventive services and realize the return on that investment, as governments do in many other countries."

Focusing in on healthcare technology, Goff and Greenland advocate for the creation of a single patient record system. "The government should insist on, and assist with, implementation of electronic health records with decision support and other informatics capabilities that enhance quality. Perhaps even more than a single-payer system, we need a single-record system (as in banking). It is striking that bank customers can access their bank accounts across the nation at different financial institutions, yet patients have unnecessary and wasteful repeated tests in different locations owing to our inability to share medical records in an efficient manner. Care is fragmented, which impairs quality and cost, when records cannot be shared. Government incentives are likely to be the only way to accomplish this critically important innovation in health care across multiple, unconnected providers."

News Analysis

The importance of a single-record system cannot be overstated. However, the analogy to the banking system understates the challenge in healthcare. Unlike banking whose ATMs deliver anywhere access to customer information from a single institution's records, the healthcare single-record system implies anywhere access to patient information from diverse organizations with the attendant issues of person identification and selective security. The healthcare single-record system must also overcome a tower of babel across organizations to deliver on semantic interoperability.

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