I have been a strong proponent of the creation of a National Health Record (NHR), but will it increase the quality of care for each citizen? Without 100 percent compliance by all healthcare providers the establishment of the NHR will bear little fruit for its expense. Proponents of a NHR site the achievements of the VHA. VHA patients include highly mobile active and inactive soldiers. Ubiquitous methods for viewing clinical data are critical, however Joe Outpatient doesn’t move around in this manner nor does he stray far from the facilities where he receives care.
For Joe, the benefits of an HIE and NHR can be achieved through the interfacing of the PHR and EHR The benefits of being able to record drug, patient and administrator are not confined to a NHR but are accomplished each day at any hospital utilizing barcodes and secure drug administration techniques. Prevention of medical errors is more reasonably achieved in an environment where citizens take charge of healthcare data. Financial incentives designed to promote patient ownership and maintenance of healthcare data will provide more benefit than a complex national network of interoperable clinical messages.
Proponents of a NHR will argue its benefits towards Bio-terrorism alerts. Hospital staff can easily notify a CDC hotline when their EMR indicates a suspicious number of specific diagnoses. This can be achieved now.
So unless my dermatologist, podiatrist, primary physician, pharmacy, local hospital, the hospital in Toronto where I had my heart attack and every care provider with data about me is participating in this national exchange, the benefits and our tax dollars will be lost.
Oh, did I mention that I self prescribe a regimen of natural herbs that could potentially have adverse reactions with commonly used over the counter drugs? No, I didn’t because they are illegal and I don’t want big brother knowing my personal habits and potentially using it against me.
Here is a simplistic approach:
1. Keep encrypted PHR data on a USB device that is always with me.
2. Update the PHR data with a standardized CCR format every time we visit a healthcare provider. This can be given to us at discharge, or emailed to us and integrated with our PHR.
3. Update the PHR with personal data, diet information, exercise activity and other personal habits
4. Update the data kept on the USB device.
5. Reward citizens who maintains their PHR; they cost the system less and should be incentivized through lower premiums or reduced co-pays.
I could be way off here, and if you think I am then sound off and become part of the process.
Gregory Park is a 25 year HIT veteran, who currently works as National Account and Product Manager for DB Technology. You can read more from Gregory Park at his blog, Challenging Assumptions, where this post first appeared.