Single EMR - How far are we?

A unique medical record for each person is considered to be the Holy Grail in the world of healthcare IT – especially when applied to a country like India. When is this going to happen? To begin with a unique medical record would not have to be electronic, but logically speaking it needs to be. A physical record has constraints of sharing and updating, so let’s accept that this unique medical record needs technology to create it. This is a challenge – and a unique opportunity as well, as we do not have any legacy issues; and can piggy back onto the UID initiative started by the Govt of India and spearheaded by Nandan Nilekani.

What will this unique medical record contain? Simple - every piece of your medical history. From your birth, all your medical reports, your changing demographic biological profile, your health information, details about your insurance and your doctors, allergies and medications. It is a time-map of your health, created over time by a range of different people, and owned by you. It will be a combination of your EMR and PHR.

How will this help ? Any doctor you give permission to will be able to see your entire history, thus helping him to make better medical decisions. Today hiring companies and insurance companies are two corporate entities which constantly ask for health check-ups, which means a huge amount of time and money will be saved by giving them permission based access to the required part of the record. For the patients, a continuous record gives them the tool to manage their health better; having a constant record of the test gives a clear indication of what is stable and what is not. Many of us here in India rarely have more than even two previous reports stored properly ! On a much more global scale, statistical and empirical studies on medical data gleaned from these reports provides fodder for research. Predicting disease outbreaks, health hazards, improving living conditions - all require solid data to make proper decisions, all coming from the same source, your medical record. After all – all this data should benefit you !

The challenges to getting a unique medical record are plenty:

a. Lack of technology infrastructure. As PCs get smaller and cheaper (not to mention the entry of ubiquitous smart phones which can compute) and internet penetration scales progressively, this will slowly cease to matter.

b. Lack of cohesiveness in IT solutions . A hundred providers provide a multitude of solutions that look, act and store things differently, so how does one make a unique record, forget about integrating the paper records ? The technology itself is providing an answer , using clever new methods to interface and exchange information.

c. Lack of initiative. Patients and doctors have survived for many years without a unique medical record, and unless appropriate incentives are provided, the situation will remain as it is. Educating the public, providing low cost effective solutions; and providing competitive benefits to those that embrace this technology as early adopters it are a few things that can be done to fast track the change in mindset.

The challenges are vast, but the rewards are too big to not give it a good shot. I think we should also be realistic in what we can achieve. Even once the pieces are in place, entering data for even 10% of the population is going to be a massive task. Also the focus should at first solely be on getting people into the system and capturing all that happens after this point, rather than worrying about the past. The past information can be slowly entered later on. I think we need to move forward, rather than waste time thinking about how to get all the past records of a patient on board.

The ambitious UID scheme only provides the identification mechanism. Now it will be up to healthcare IT firms like Plus91 to integrate this UID mechanism into the software they sell and portals they start, using the UID system to tag each record to a unique person. Over time all providers can then either pool the information or provide access across their databases using this UID. I think a cloud like structure where your record is spread across multiple databases of various providers , but with the same unique tag , is a definite short term possibility. So for you accessing your record using a unique interface will feel like it’s a unique record, but in reality it is but 100 pieces of a jig-saw spread all over the Internet.

This is a challenge – and a huge opportunity !