Thanks for the input (and check your email).

RHIOs is one of the provisions that was included in HITECH when the ONC-HIT was established.

As to the standards halsted mentions in the diary…those have already been established via HL7, IEEE, and ASTM.

Some of the information gathered in a hybrid EMRs can’t be accessed via SQL even if the record was included in a centralized database. Part of the information is entered via computer systems and part of it is simply scanned into an electronic format (like vanghossister describes below).

Even with large providers, they’ve been hesitant about investing significant funds into setting up a broad scale system that could be used until the transition to ICD-10 takes place because it will alter the data sets that will be used and change user screen formats (along with changing cost centers)

SMART cards are another option, with patients having downloadable medical records on WORM devices.

But even if we get to the point of having totally electronic systems, unless CMS changes their rules, there will still be information that doesn’t get recorded in the centralized system.

My understanding of how an EMR works is within one healthcare system, such as the one I work for, patient records will be available for any physician or their proxy to view immediately. Upon receipt of a release of information request from a healthcare provider outside our system, I believe the pertinent records will be sent as an encrypted file via an e-mail type program. I am not positive about how that works.

As for creating lots of high paying jobs, while that might be true for those involved in the software part of conversion, it is not true after implementation is near completion. All of our old records have been scanned and converted to an electronic format. We have now entered the phase of physician order sets being entered electronically rather than handwritten and scanned in later. We have also entered into the phase of any “real” paper documents being scanned in by unit clerks or nurses on each floor. Our department head is now trying to find enough positions to fill with those who used to scan in paper documents all day so no one loses their job. The more efficient you become, the fewer people are needed.

I can’t think of anything worse than a centralized bank of medical records “guarded” by our government! What a disaster that would be.

I would suggest anyone reading this should obtain copies of their personal records and go over them carefully, with your family physician if necessary, to make sure there are no mistakes. The advent of speech “wreckognition” makes this especially important! Mistakes can live in your record for a very long time unless someone thinks to question an entry.

The problem with distributed is the latency.

Let’s suppose Dave Average, who we’ll say lives in Bucks County PA, receives a minor injury. Let’s suppose Dave Average steps on a rusty nail while cleaning out the garage.

Dave doesn’t remember his last tetanus shot so the hospital looks it up while they’re cleaning out his foot. Dave’s last shot was at his physician’s office 3 years ago, Dave’s physician is on the same network service provider as the hospital – since this is all in Bucks County – so the E.R. tells Dave he’s good very quickly.

Now, let’s introduce some latency. Suppose that, instead of Dave’s garage, it’s his friend Bill’s garage .. and further suppose the garage isn’t in Bucks County, but Hershey.

The Hershey ER sends the query, but they’re on a different network that only send queries to Dave’s physicians’ network in batches, 4 times a day. The last batch just completed when Dave came in, so now Dave has to wait around for 6 hours to find out that he doesn’t need a tetanus shot.

Okay, let’s introduce even more latency. Dave is now outside the U.S., specifically he’s on vacation in Ixtapa, Mexico. Now, Ixtapa is a resort town, and their doctors are pretty darn good, but the local E.R. subscribes to a data service that sends their queries in batches, and receives answers the next day. Most days. Dave now has to wait over 24 hours to find out he doesn’t need a tetanus shot.

This is the problem with distributed .. while it’s possible to do the whole thing in realtime, that’s much less efficient, especially as the distance increases and international borders get in the way… so the inevitable service providers.

Yes, hospitals and medical groups and even some doctors offices have an I.T. staff but if the ones near me are an example, they do largely break/fix for the specialized hardware needed, as well as common Windows desktop issues.

Like businesses with EDI, they’re much more likely to contract this kind of data storage and retrieval out … and the service provider is going to do whatever they can to lower their costs.

Mew

The RIGHT way to do it, is to standardize a file-format for health-records, and then make each person’s records transmittable or request-able between medical facilities.

Think something similar to the Web, but for health records, not a centralized database…