Universal accessibility to personal medical data: issues for future development of health services

Jorge Martinez de Hurtado
FUNDACION HOSPITAL ALCORCON, Alcordon, Spain

Objectives: Understand the benefits of an Electronic Health record (EHR) distributed through the Internet or its relkated technologies, so that it is readibly accesible independently of location. However, important ethical, legal and security issues must be solved not only from the technology point of view, but also from that of the different actors oh health care systems.

Abstract: Medicine has been considered for many authors one of the last activity sectors in which paper based transactions take place. Nonetheless, surprise arises when one learns that health organizations are information intensive and information dependent in their daily routines. Reducing medical errors and improving accessibility to medical information is used by many as the main reasons to computerize medical activities. Predictions from years ago stated that, by now, EHRs would be fully deployed in healthcare. However, up to date, only 5-10% of doctors fully use this tool. Advantages as multipoint access to clinical record, introduction of relevant clinical information by provider/patient, and personalization of general medical advice, must be ensured by good design, using preferably open standards that include concepts as integrity, interoperability, accessibility, security, traceability and flexibility. Using the Internet (or related technologies) to transmit and exchange information, allows to use it at the point of care. Several barriers to the deployment of an efficient tool arise, related to identification of users, security requirements, contents, format, language and cost. Deployment of an Internet distributed, secure and transversal EHR, with partial control by the patient, can be simple and practical enough for it to show all its benefit. The components of such tool must include, at least, a connectivity engine, a unique identification system, master patient index, electronic document manager, workflow processor and image management capability. According to recent surveys, the reasons for health care systems to use EHR are the following: Need to share comparable patient data among different sites within a multi-entity healthcare delivery system 75.7% Need to improve clinical documentation to support appropriate billing service levels 75,3% Contain or reduced healthcare delivery costs 66,3% Need to establish a more efficient and effective information infrastructure as a competitive advantage 64,3% Need to meet the requirements of legal, regulatory, or accreditation standards 60,4% Need to manage capitation contracts 21,8% Other reasons 3.5% Source: Medical Records Institute If we just analyse the clinical issues towards the use of EHR Systems, the results are: Improve the ability to share patient record information among healthcare practitioners and professionals within the enterprise 90% Improve quality of care 85.3% Improve clinical processes or workflow efficiency 83.6% Improve clinical data capture 82.4% Reduce medical errors 81.7% Provide access to patient records at remote locations 70.7% Facilitate clinical decision support 70% Improve employee/physician satisfaction 63% Improve patient satisfaction 60.4% Improve efficiency via pre-visit health assessments and post-visit patient education 40.2% Support and integrate patient healthcare information from Web-based personal health records 30.4% Other 0.3% Source: Medical Records Institute EHR systems are, in fact, quite complex. Considering every potential option, ten dimensions can be analysed: 1. Information capture 2. Information representation 3. Data flow 4. Clinical practice 5. Decission making support 6. Trust and security 7. Activity indicators 8. Interoperability 9. Quality control 10. Content selection In a too high percentage of cases, nowadays doctors lack necessary and precise information at the point of care, so that unnecessary ancillary diagnostic methods are blindly repeated, and previously detected conditions are unknowingly ignored. A policy of integration of EHR systems and the Internet can solve many of the dilemmas and challenges to which health care systems are faced during the 21st century