EMRs

Information, M.D.

By Douglas Page

A Michigan initiative seeks to create a standardized electronic medical record

Information technology, full of so much promise, has disappointed so many times--both on cost and on outcomes improvement. It's bewildering to clinicians. "There's been an enormous investment in health care IT, yet as a specialist I still see patients where crucial medical information is carried in their wallet on an index card," said Charles Shanley, M.D., associate chair of surgery at William Beaumont Hospital, Royal Oak, Mich.

The state of Michigan is attempting to change that. Shanley chairs a statewide electronic medical record initiative, believed to be unique, to use available technology to allow clinicians real-time, secure access to medical records and images. The initiative, the Michigan Electronic Medical Record Initiative (MEMRI), is a coalition of physicians, health care professionals, hospitals, insurance and technology companies, working to make individual medical records available anywhere in the state via the Internet.

The system connects information already in electronic form scattered on computers across the state, and makes it available wherever patients visit. A pilot implementation is scheduled this summer, pending funding.

Under MEMRI, Michigan physicians will get immediate access to patient records, including digital images, nearly eliminating errors, duplication and delays inherent in legacy paper systems. MEMRI uses a standardized data reporting format, already used by many providers, so databases can communicate via the Internet. "We believe MEMRI is a first in terms of technological approach, using a dynamic, distributed database, and a federated network identity solution to the privacy issue," says David Ellis, MEMRI's executive director.

One concern: privacy. It's a particularly sensitive issue in Michigan, where medical records were accidentally posted on the Web in 1999. Ellis says that's no problem with the statewide EMR. "With this technology, the patient controls who has access and who doesn't," he says. "We think we can keep records private and secure." It helps that MEMRI does not support central storage of the EMR. The data remain stored permanently where they originated, and can only be accessed by patient approval.

MEMRI's goal is to demonstrate that with current technology and with some agreement on data standards, medical records can be shared with what's already been invested in broadband. "Given the current cost crisis in health care, it's inconceivable that we can continue without such an information-sharing system," Shanley says. "It's good medicine, it's good economics, it's a no-brainer."

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