Tuesday, March 10, 2009

Electronic Heatlh Record

An idea that is getting more attention is the electronic health records. I received an email today about a study suggesting that these are being "underused" in comparison with their potential. The authors raised four points, and I will focus on two: portability and who has control.

I have been with one employer long enough and my family has been satisfied with our health insurance long enough to say that we have been with the same health plan for 13 years and don't plan on changing any time soon. That situation is not unusual historically in the United States but may be more unusual in the future. If electronic health records are to be useful, there will need to be a degree of portability introduced. Even if not every insurer or health system uses exactly the same form, some way of exporting data from one system and importing it into another system would seem to be a necessity. As with many things in the health care system, this would require coordination. Either each insurer or system would have to find it profitable to provide portability or there would have to be regulation imposing portability. While all insurers and systems would presumably like portability into their systems they would seem to have little use for providing portability out of their system--unless they would see it as useful to attract people who might value potential portability--while always hoping to keep people in their own system. So, there may be a need for regulation in order to provide the impetus which self-interested incentives do not.

For the control over the data, many would argue that the consumer should have control of information about themselves. The key is to figure out what having control of their data means. Does it mean having control over who gets access? Does it mean having access oneself? Does it mean being responsible for keeping the data? While there are many problems that we have with data security as provided by (or failing to be provided by) commercial firms, it is easy to imagine that a person put in charge of their own data could be even more problematic. It could be lost. For password protection, people often make poor choices.

The key would seem to be to provide insurers, health systems, and individuals with economic incentives to collect, make transferable, and protect health information.

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