Nearly ten years after President Bush’s mandate to provide electronic health records (EHRs) to all citizens within 10 years, EHR adoption is not as high as industry experts would have expected. High costs and a perceived low return on investment have made some healthcare professionals reluctant to implement them.
“It’s not so much the high cost of the technology that’s a problem, but the disparity of who gets the benefits,” says Daniel Castro, a senior analyst with the Information Technology and Innovation Forum (ITIF) public policy think tank.
Furthermore, the lack of a standardized health information infrastructure is playing its part. “We are also seeing issues with interoperability because there are no national standards for health data information, not only for what information should be in an electronic medical record, but how that information should be shared within a network of providers,” Castro tells us.
HRBs: Patient-Controlled Data Repositories
Without national guidance on where and how to store patient information, the push for EHRs has lost some of its initial momentum. However, many believe that the value proposition of EMR systems will increase with the use of health record data banks, more commonly known as health record banks (HRBs).
HRBs are patient-controlled accounts that hold electronic medical information. “It’s a repository that is controlled and paid for by patients,” according to William Yasnoff, MD, PhD. Yasnoff is the founder of the Health Record Banking Alliance, a nonprofit organization that promotes the development and implementation of HRBs.
“It’s a place where each person can deposit all of their medical information from every source and then, at their discretion, make some or all of those records available to the providers they choose,” he says. In many ways, the model is like that of a monetary bank account – medical information is deposited into an account for safekeeping and can be withdrawn by approved parties.
The concept of a one-stop shop for an individual’s medical information benefits all parties involved in healthcare delivery. The individual can control who sees what information and when. The physician has access to a complete medical file when making critical healthcare decisions. Payors, purchasers and public health advocates have a source for accurate data.
Infrastructure Needed to Realize Benefits
Despite these benefits, no health information infrastructure exists to provide it.
“Everyone agrees that we need to have complete patient information at the point of care,” Yasnoff says. “But to do that, we have to first solve certain problems.” Those include making all medical information available in an electronic format, obtaining stakeholder cooperation, creating a sustainable financial model, and gaining the public’s trust.
Healthcare is not yet paperless, but quite a bit of medical data is available electronically. “The big problem is physician offices,” says Yasnoff. “The vast majority do not have electronic medical records.”
Since doctors are key stakeholders, identifying incentives for them will drive the cooperation needed among healthcare entities that will make healthcare information accessible. “Healthcare stakeholders are suspicious. They are often in competition with each other and there is a long history of non-ideal relationships. To think that they will cooperate voluntarily is unreasonably optimistic,” Yasnoff says.
The big question, of course, is who should pay. Continued EHR use must be financially sustainable.
Finally, the health information infrastructure must have the public’s trust. Before committing sensitive medical data to any repository, patients need to know that the information will remain private and secure.
Vendors and hospitals alike have struggled with all four issues as more and more patient information has gone online. However, Yasnoff maintains that the HRB model is the solution to all of them. “Health record banking represents a feasible approach to developing a health information infrastructure in communities that solves all key problems. HRBs address all of those issues simultaneously. There is no other approach to this problem that does that.”
Legislation Needed to Create Regional HRBs
First, key legislation would need to be passed, based on privacy and security standards from the Health Insurance Portability and Accountability Act (HIPAA), to push for HRBs. This, Yasnoff suggests, would guarantee stakeholder buy-in.
That legislation would create the non-profit regional HRBs and provide standards for their operation. Patients would select their own HRB and pay a nominal monthly fee, which would cover the HRB’s costs and provide financial incentives for physicians to go digital and deposit information. Patients would designate the providers who could access all or part of their medical information.
“This creates an incentive structure and gives doctors a reason to have EHRs since you can’t submit without them, “Yasnoff says. “There is going to be a huge customer benefit from that push to digitize, a societal benefit.”
Castro agrees that legislation is the first step to make that push. “Legislation kind of codifies what a health record bank is, gives it federal oversight, and makes it easier for stakeholders to opt into the HRB model.”
And such legislation, like the Independent Health Record Trust Act of 2007 sponsored by Sen. Sam Brownback (R-Kansas) and Congressmen Paul Ryan (R-Wisconsin) and Dennis Moore (D-Kansas), is already on the House floor, pushing health record banking.