Institute For The Future

An open source electronic health record platform

As much as I am in favor of electronic health records (EHR), I recognize that compatibility is a problem. For example, my EHR at the Palo Alto Medical Foundation, which I access regularly, does not link to my records at Stanford Hospital. The efforts of companies like Google to provide online personal health records (PHRs) would allow me to aggregate all of my health information from any number of sources and control access to that data (hopefully in a secure and private way).^*

 

But it seems like it would still be a good idea if electronic health records--which reside with health care providers and have not yet been universally adopted--were interoperable or connected in some. What if a national health information infrastructure existed that provided standards and policies for information accessibility and individual privacy?

 

It turns out that there is such a thing. It is called VistA, and it is the Veteran Administration’s electronic health records system. VistA allows health professionals in the VA to search for "'patients around the country with similar diseases and lists the physicians’ treatments and successes, grouped by the most common treatments.'" I learned this from a entry entitled " A Lesson in Health Care Innovation...from the Government?," which was posted on a blog supported by the Century Foundation. The post goes on to describe why the VA has been well-situated to successfully undertake a large-scale IT paradigm shift to the use of EHRs.

 

On the subject of EHR compatibility, the blogger explains,

In the VA model all electronic records speak the same “language,” i.e. they are compatible and can speak to each other. One system of records is managed by a single authority that covers a wide array of health care needs.

 

By contrast, more market-driven innovation runs the risk of incompatibility: different providers will create different platforms and data formats in order to protect their market share. The result is an electronic tower of Babel.

 

Indeed, two of the biggest issues with current efforts at creating regional electronic networks are consistency and accuracy. Too often, it is difficult to match patients to records that might be incomplete or incorrectly linked. Juggling various systems means more opportunities for hiccups.

 

Unfortunately, in a market-based situation—where various electronic network providers are competing to contract with hospitals, or even the government—the incentive to maintain this fragmentation is high. Competitors want to protect their proprietary platform and “beat out” competitors in order to consolidate their market share. Competitive advantage demands a certain degree of secrecy.

As open source software, VistA has been able to avoid the downside of the competitive marketplace.

 

In conclusion,

. . . Electronic medical records are an innovation that will produce important long-term benefits—but only after high short-term costs. This makes the IT transition a real bear for most health care providers—but not the VA. It just goes to show: progress isn’t always synonymous with markets.

 

 

 

^{* For more on the use of EHRs and PHRs, see this interview with David Lansky, senior director for health programs at the Markle Foundation.}