The Bigger Promise of Electronic Medical Records
An article detailing the benefits of national registries for articifial joints appears in the New York Times today. The article lays out a rational and well-articulated argument for creating a national registry in the United States to track performance of artificial joints.
However, joint replacements are only a small piece of patient care. The article completely misses the bigger picture. A computerized national registry is simply a smaller, less comprehensive electronic medical record. Why settle for only collecting data on artificial joint performance when we could implement a system to evaluate the effectiveness of virtually any medical procedure? A standardized, national electronic medical record system has the potential to make this a reality.
With a standardized electronic medical record system in every doctor’s office throughout the country, we could readily collect data on anything from adverse drug events to surgical outcomes. Universities and the National Institutes of Health, through their own scholarly work, could develop and disseminate protocols for private physicians to evaluate their own practice. Doctors could go into their own electronic medical record system, look up all patients taking Drug X, and see if there a pattern of adverse events or particularly positive outcomes. They could then immediately adjust their own practice to optimize patient outcomes. When new devices or drugs come on to the market, tracking of adverse events would be quick and simple. Drug companies would not have to spend millions of dollars enrolling patients into ongoing safety trials after a drug’s initial approval. The FDA could simply monitor drug safety on an ongoing basis by periodically searching for patterns of adverse events.
Real-time evaluation of patient outcomes–this is the bigger promise of electronic medical records.
In addition to providing an excellent rationale for a national registry for artificial joints (and electronic medical records by extension), this article also gives some great reasons why developing such a system is unlikely to occur in the United States. One sentence perfectly captures the biggest barrier to a national registry or a standardized national electronic medical record system:
The American health care system is sprawling and fragmented, compared with the highly centralized systems in countries that do have the databases.
This is perhaps the most difficult thing to understand about the American healthcare system. It is, in fact, not a system at all. There is no systematic way in which healthcare is provided in our country. Individual hospitals or networks of providers or health insurance companies or physicians’ professional associations may develop standardized methods for treating various illnesses, but no single entity exists to unify all of our healthcare institutions and providers. Thus, in order to gain widespread adoption of something like a standardized electronic medical record system, considerable time, energy, and money must be spent convincing providers they will benefit from being a part of the record system.
However, as the article points out, such a system will decrease adverse events through quick collection and analysis of data. Not only does this save money, but it brings us closer to our ultimate goal–healthier people.