Friday, July 3, 2009

Health Record Banks

The government is working to develop a nationwide health information network (NHIN), but it will require a system that can deliver a patient’s record completely, privately, and securely when requested. Much of that task rests on the health information exchange (HIE) model behind the NHIN.

The discussion of HIE models has barely begun, and the health record banking model is becoming a big part of the conversation. This model, based generally on financial banking, is the simplest solution to most data exchange problems. Health record banks centrally store copies of consumer’s health records, which providers deposit into the accounts. Consumers control which providers can contribute information and which providers and individuals can view their records.

The concept of a health record bank is simple: it would offer comprehensive information to providers about an individual, controlled by that individual, and stored in one secure location. Having patients control their health data is critical to the development of a NHIN. Patient-centered control is a central feature of the health record bank model. Patients would decide which healthcare organizations can access their records, and they could limit access to specific records.

There are many details that will still need to be worked out. The problem of establishing interoperability between different healthcare providers still exists for health record banks. Standardization needs to occur on a national level so that regional and state health record banks can communicate.

States that are planning health record banks may be ahead of the curve on developing true interoperability and ‘meaningful use’ of an electronic health records (EHR). Washington State’s experiment in consumer-controlled health records has begun a pilot phase, transforming the health record banking model from theoretical to actual testing. Earlier this year the Washington State Health Care Authority (HCA) announced the launch of three pilot sites that will try out the feasibility of a permanent statewide health record bank network. The Louisville (Kentucky) Health Information Exchange used a health record bank as the way to exchange patient information in building their HIE.

I think the health record bank model is an excellent idea. The Health Record Banking Alliance is a great place to get more information about how we can work together to create community repositories of electronic health records that are controlled by the patients. I can go to Montreal and pay for my dinner instantly with a swipe of my debit card, yet if I go the hospital twenty miles away, they need to make phone calls and burn up the fax lines to access my records. The records are printed, faxed, printed again and scanned into the receiving health information system (not very green is it). Technology has advanced tremendously in the last twenty years, yet we are still using these old methods for health information. We need to apply the same technology to our health information that we use for our financial information.