Electronic Medical Records - Potential Benefits of a 'Health Cloud'

In modern society there is a seemingly limitless wealth of data available at the push of a button. From any location around the globe, and even on commercial airline flights, almost anyone can access data and communicate in real time, online, with almost anyone else in the world. A wealth of information – about music, movies, TV shows, books, magazines, and breaking news as well as historical data – is remotely accessible through the use of pocket-size devices that are perpetually connected.

However, electronic medical records (EMRs), which have significant implications for the welfare of the general population, remain a huge and particularly notable omission from this ubiquitous data stream. This is deliberately so, because the security of electronic medical records is an absolute requirement to ensure public trust in and acceptance of these still emerging systems. The downside, of course, is that the ability of healthcare professionals to quickly and effectively provide quality care to their patients is severely hindered by the lack of speedy access to the EMRs.

To date, the use of EMRs in hospitals and private practices is extremely limited. Last year, the New England Journal of Medicine studied the adoption rate of EMRs by U.S. hospitals and found that only 7.6 percent had access to even “basic” EMR systems, and only about 1.5 percent had access to more comprehensive systems. Another study, carried out by the National Center for Health, found that, in private physician offices, the adoption rate of EMRs is much higher – 38.4 percent reported using partial or fully electronic EMR solutions. (However, 20.4 percent of the physicians surveyed reported that these systems were only minimally functional.)

Is VistA CPRS the Solution? Although the overall use of EMRs in the United States remains low, the largest single U.S. medical system – that of the Veterans Health Administration (VA) – has successfully deployed an enterprise-wide EMR system (VistA CPRS) that demonstrates the value that EMRs can provide to both patient and doctor. In 2006, VistA won the Harvard Kennedy School of Government’s prestigious “Innovations in Government” Award.

Physicians who have used VistA CPRS (this somewhat awkward double acronym stands for the Veterans health information system and technological Architecture’s Computerized Patient Recordkeeping System) report that the system allows them to provide a more comprehensive level of care to their patients, particularly when several doctors are involved in treatment of the same patient. One reason for this high approval rating is that VistA CPRS enables doctors to require an “electronic sign-off” on orders – including prescriptions, tests, procedures, etc. – by other doctors who are providing care to the same patient. The system also electronically prompts doctors to review and accept recommendations from other physicians, thereby forcing a degree of collaboration that has become somewhat less common in today’s era of specialty-based medicine.

When doctors themselves do not have easy access to EMRs, it is often the patient who bears the burden of coordinating his or her care, including the collection and distribution of test results from one doctor’s office to another’s. Because of the limitations inherent in traditional paper-based care, combined with the fragmentation of services caused by a lack of integrated patient data, some physicians have found it difficult to transfer information from the VA system to hospitals lacking comprehensive access to EMRs.

A Difficult Deadline – Eased by Funding Assistance The landmark Healthcare Reform Bill enacted into law earlier this year not only sets a 2015 deadline for all hospitals and physicians to acquire and be using comprehensive EMR systems, but also provides some of the funding needed to make that transition. However, because of the unique nature of the “universal care system” provided by the VA, the successes realized by the VistA CPRS will be more difficult to replicate in the private sector.

When all patients are covered by a single healthcare provider, it is easier to standardize information on a single electronic system. Moreover, the VA has spent many years implementing and improving the VistA CPRS system. Nonetheless, most physicians and hospitals will have to quickly invest time and resources in EMRs in order to meet the 2015 healthcare-reform deadline. Moreover, they will have many different commercial solutions from which to choose and thus many important decisions to make.

The competitive EMR market will also present some other challenges, most notably in the area of data exchange. New technical standards that address the need for system interoperability are currently being prepared by the U.S. Centers for Medicare and Medicaid Services. These standards should help minimize data-sharing problems between providers. Nonetheless, it will not be as easy a task as implementing a single system, such as the VistA CPRS, within a single organization.

Maintaining Security While Maximizing EMR Benefits Looking ahead to more widely deployed EMR systems, the benefits may extend well beyond improvements to individual patient care. Interconnected EMR systems may be able, for example, to automaticallyentify trends in clinical symptoms – including the early predictors of a pandemic as well as the success rate of certain types of treatment. EMRs could also link directly into the federal Centers for Disease Control and Prevention (CDC), as well as other existing patient tracking and emergency management systems, to improve situational awareness and response.

As previously noted, though, effective security measures and electronic backup and restoration capabilities must be part of the solutions implemented in order to: (a) continue to ensure both security and patient privacy; (b) build and maintain the public’s trust in these new systems; and (c) ensure that the health data “cloud” does not disappear.  Last year, the Virginia Department of Health Professions’ Prescription Monitoring Program website was “hijacked” by computer hackers – who demanded a $10 million ransom for the restoration and nondisclosure of more than eight million patient records. 

Although secure backups of the data were ultimately restored, Virginia was forced to temporarily shut down the program’s website.  As more and more EMR systems are adopted and begin exchanging data, such hacking attempts will surely increase.  The general public will have little if any tolerance, though, for such security breaches.  To be successful over the long term, therefore, the EMR “industry” as a whole must extend the notion of  “universal care” to the veritable mountain of patient health data entrusted to it.

facebook sharing button
linkedin sharing button
twitter sharing button
email sharing button
sharethis sharing button
Rodrigo (Roddy) Moscoso

Rodrigo (Roddy) Moscoso is the executive director of the Capital Wireless Information Net (CapWIN) Program at the University of Maryland, which provides software and mission-critical data access services to first responders in and across dozens of jurisdictions, disciplines, and levels of government. Formerly with IBM Business Consulting Services, he has more than 20 years of experience supporting large-scale implementation projects for information technology, and extensive experience in several related fields such as change management, business process reengineering, human resources, and communications.



No tags to display


Translate »