PETER PRONOVOST: There is a tension between having our personal medical records “in the cloud”—which has great potential to improve health-care quality—and protecting our privacy. For generations, paper files might have been kept in a hospital’s basement. And even when hospitals began transitioning to electronic medical records, individual patients’ files typically weren’t readily available beyond a hospital’s walls. Outside providers or patients who needed them would have to request those records. Paper records were lost, weren’t available or never made it where they needed to go.
That scenario certainly presents challenges for delivering safe, high-quality care, and it can lead to waste. If a patient goes to the emergency department, physicians typically won’t be able to pull up that person’s medical history from his or her primary-care provider across town. They might order duplicative tests, not knowing that one had been performed just days before in a clinic elsewhere.
So it’s encouraging to see greater prevalence of electronic medical records overall, as well as a growing movement to connect them, so we have a more unified picture of patients’ health histories. For example, health-information exchanges in states such as Indiana are allowing hospitals and other facilities to rapidly see details on the care a patient has received from other providers.
There is also great potential for connecting the electronic patient record to other types of data. This includes readings from in-home health-monitoring devices that measure your glucose, weight, blood pressure or other vital signs. It also could pull in reports about which prescriptions you filled, data from your insurer about where and when you received care, information from physiological monitors in the hospital, and data about your genetics. All of this information could help to predict risk, recommend therapies, and learn what works and how to improve.
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These benefits come with risks, of course. The public revolts if they feel that their information is being misused. Look at the backlash when Facebook changes its privacy statements. Consider the news in August about the theft of data of 4.5 million patients of Community Health Systems, Inc. We’re told that medical data wasn’t stolen, but that’s a real threat.
We need to find a balance between improving health-care efficiency and productivity, and protecting people’s privacy. We need a public conversation how we can minimize the risks through good governance, technology and processes.
Dr. Peter Pronovost is a practicing anesthesiologist, critical-care physician, professor, Johns Hopkins Medicine senior vice president, and director of the Armstrong Institute for Patient Safety and Quality.
Date: September 18, 2014