How a Coordinated Medical Record system could be implemented.
Editor’s note: This article is the ninth in an ongoing series by James McGauley, M.D., on the idea of a Coordinated Medical Record system, which produces a single comprehensive medical record for every patient. The record contains all of the patient’s clinical and financial healthcare information over space and time. The credit card industry is the model. This type of information system will do more to increase the quality and decrease the cost of healthcare simultaneously than any other single initiative.
A Coordinated Medical Record system that produces a single, comprehensive, privacy-protected, automatically-updated patient record that is continuously available to the patient and to all authorized caregivers essentially defines a “Holy Grail” type of IT system.
Single, comprehensive medical records are the ultimate patient-focused records. The continuous availability of those records to all caregivers means that everyone is working with the same patient information all the time, and that is the core principle that leads to a significant increase in the quality of healthcare. And, it is the documentable increase in the quality of care that ultimately determines the appropriate cost of care.
A Coordinated Medical Record system is modeled after the credit card industry, which has proven that it is both technically and logistically feasible to establish a customer-centric data management system that captures and organizes billions of random transactions every day.
Groups of bankers founded the companies that developed and deployed the credit card systems. Currently, there is no comparable entity in the healthcare industry, so one needs to be established. It needs to be a new corporation in the middle of the healthcare industry whose sole purpose is the neutral management of medical records.
As described in a previous article, the founding members would be a handful of activist physicians and representatives of major national corporations. These potential founders are currently sitting on the boards of national physician and employer organizations that are looking for ways to improve the quality and decrease the cost of healthcare.
The employers can easily fund the start-up of this entity and can subsequently use their collective power as the ultimate source of most healthcare dollars. These individuals can redirect insurance premium and healthcare tax dollars to fund the ongoing functioning of this information system.
Physicians are the ones who need to use this type of system and will only do so if they are the ones who can write the rules regarding the functionality of the system. This includes the rules regarding access to and ultimate uses of the data in the system.
Ideally, this new corporate entity should be not-for-profit. The business of moving information around the healthcare industry obviously can be, but does not need to be, a profit center in itself.
The new entity only needs a thin corporate structure. The intellectual property and the IT team that maintains and enhances the system remain in the corporate entity, but nearly all of the data processing and communications operations can be outsourced to a first-tier, enterprise-capable, national data processing company.
In our team’s second pilot project, we outsourced the data processing, communications and Service Center staffing functions to Electronic Data Systems Corporation (EDS, now DXC Technology). Four first-tier national data processing companies showed interest in providing these services, including IBM, which later provided a letter of intent indicating its interest.
The level of interest that these companies demonstrated shows that a Coordinated Medical Record type of system can meet the highest levels of data and system security, stability and scalability.
Our pilot projects showed us that physicians, patients and employers are all strongly supportive of a Coordinated Medical Record system. The pilots demonstrated the ideal size and configuration of a healthcare community that make it both logistically and financially feasible to establish the system in that community.
The projects showed us that primary care physicians are the key to establishing the system in any community because they are the only entities in the healthcare industry that care for a consistent group of patients. The pilots documented specifically how the system improves the quality of care and how that quality improvement is the driver for multi-billion dollars’ worth of cost savings.
The central database of Coordinated Medical Records is capable of generating real-time, comprehensive, clinical and financial, standard and customized statistics and reports that are unparalleled in the industry. The comprehensiveness and real-time nature of the information in the database make it a uniquely powerful foundation for producing artificial intelligence analyses and risk management protocols that fragmented EHR systems cannot produce.
It is critically important that this type of database be neutrally managed with strict adherence to access and use criteria that are primarily patient-, physician- and quality-focused.
If a Coordinated Medical Record system, as described, does not fit the criteria of the healthcare industry’s IT Holy Grail, then what are the criteria? Admittedly, many might argue that it would be very difficult to get this type of information system established, but no one can say that it’s impossible.
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