NEW YORK — Medieval physicians devoted centuries to the search for the elixir of life, a universal panacea for bodily ills.
During the 19th century, doctors touted the all-purpose healing properties of patent medications.
Today, a consensus is emerging that electronic medical records will prove the solution to many, if not all, of our health-care system’s ills — from rising costs to dosing errors.
Former House Speaker Newt Gingrich and Sen. Hillary Clinton have teamed up since 2005 to advocate for the computerization of personal health information and the establishment of a national database that can be used for such varied purposes as billing and emergency care.
Advocates envision a system in which an ambulance arrives to assist an incapacitated patient, and by plugging basic identifying details into a console, the providers on the scene will have access to the patient’s entire medical history.
They will know, for example, if this particular patient is allergic to penicillin or has suffered a prior heart attack.
Sounds great, doesn’t it? Yet so did Dr. Sibley’s Solar Tincture, a Georgian-era remedy that promised to “restore life in the event of sudden death.” The problem common to both patent remedies and EMRs is that some ingredients may turn out to be poisonous.
The key element in any electronic medical system is what bioinformaticians call interoperability. This refers to the capability of repositories of EMRs (e.g. hospitals, doctors offices, nursing homes) to access and exchange data through the same system.
Currently, the largest such system in the United States is administered by the Department of Veterans Affairs. A patient can walk into any VA facility with confidence that his doctors will be able to examine the medical records from his past visits to other VA sites. Such a system affords our retired servicemen a degree of medical mobility not yet available to the vast majority of health-care consumers.
Unfortunately, a system that grants easy access to large numbers of legitimate users is also an invitation to abuse.
For a nationwide network to function effectively, the data will have to be accessible to many of the more than 12 million individuals employed in the health-care industry.
Physicians and nurses, dieticians and social workers, physical therapists and X-ray technicians all will have valid reasons for viewing their patients’ records. The same system will enable rogue providers to access the records of innocent third parties (e.g. ex-spouses, co-workers).
While both federal and state laws prohibit such snooping, obstacles to enforcing these rules on a national scale are prohibitive. We have already witnessed that nosey hospital employees have leaked the medical records of celebrities — from Farah Fawcett to Bill Clinton — to the media.
Fortunately, hospitals keep careful tabs on who accesses the charts of VIP patients. In contrast, when a meddlesome pharmacist in Alaska looks up the urine toxicology on his daughter’s fianc e in Florida, to check if the fellow has a cocaine habit, no red flags will alert the hospital.
Safeguards are available to limit opportunities for misuse. Credit-card companies already rely upon tracking algorithms to detect unusual patterns of individual spending, often an indication of ongoing fraud.
A similar system might be used to alert providers to unlikely patterns of access. Another precaution entails sending each patient in the database a quarterly list of all the individuals who have accessed his records.
Yet who will administer — and pay for — such measures remains unclear. Moreover, after-the-fact enforcement offers little solace to the victim who does not wish to press criminal charges against his colleagues or relatives.
Finally, there exists the real threat of an outside party, such as a computer-savvy terrorist, breaching the system’s security and laying bare our intimate medical secrets for the eyes of the world.
In the rush toward EMRs, we may be losing sight of the cardinal rule of the medical profession: First, do no harm.
Jacob M. Appel, a health care attorney, teaches at New York University.