Electronic medical records-a rant

I went to China on business trip two Summers ago, and while there put my bank card into a teller machine and got $200 worth of Chinese currency. A few minutes later my wife texted me and asked if I had done so. I replied yes, and she noted that she was just checking because she saw the transaction posted to our bank account (she gets a text anytime there is a cash withdraw, etc.). A very efficient transaction, with many moving parts across different continents, that occurred seamlessly (you even get the wholesale exchange rate doing it via teller).

There is no way people care more about medical privacy than they do their money. There is no way it is more complex to translate ICD-9 codes than currencies (on the fly!) and to post it within minutes. The never ending drive toward electronic medical records seems like running in the deep sand on the beach as compared to the story above. Why? It cannot be technical reasons?

There is likely an infrastructure story (how banks talk to one another), perhaps a regulation story (requiring banks to keep up with transactions, especially of certain sizes), but there must also be a part of the story driven by the fact that banks want to be able to converse with one another and that they derive some benefit(s) from this.

Who is it that doesn’t want Electronic medical records? Is there a missing infrastructure piece that must be routinized to make it happen? I really don’t get it, and can see no technical reason for electronic medical records to not be as seamless as getting Chinese currency with my bank card. Am I missing something?

update: here is a RWJF funded report on HIT adoption that was being tweeted around this morning. I haven’t read it.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

4 Responses to Electronic medical records-a rant

  1. SteveH says:

    I saw TR Reid speak several years ago about his documentary, Sick Around the World. He mentioned the health insurance card the French carry. If they lose it, anyone can just drop it in a mail box and it will get sent back to the central office. Someone asked about losing the card and what if someone used it to look at the health records stored on the card. Reid said he hadn’t thought about that and would try to see what kind of security was built into the card.

    Later I asked him, but why do people here worry so much about medical privacy? Do they not worry in France? The answer, in part, is that people worry about losing their health insurance or job if they’re at risk, have a pre-existing condition, etc. Medical privacy wouldn’t be as big a deal here if coverage really was universal. Hopefully some of the resistance to EMRs will dissipate if the threat of losing health insurance is reduced or eliminated. On the other hand, there is a paranoid streak in American politics that will never disappear.

  2. Chris Connor says:

    I would suggest you have someone sit with you and compare the SWIFT data format used by financial institutions and the many, many varieties and versions and message types that constitute HL7. Work with someone knowledgable on both, then after understanding them I would suspect your statement of “There is no way it is more complex to translate ICD9 codes than currencies on the fly”

    Unfortunately (and I wish it were different) the complexity of moving and translating clinical data compared to a financial transaction is about a thousand fold more complex. If it were just the single diagnosis code were working with, maybe, but those who know, understand it is much, much more than that.

  3. Don Taylor says:

    @Chris Connor
    Is there anything written up somewhere that lays this out?

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