Information Technology Reference
In-Depth Information
Chapter 6
Empowering the Patient
Many years ago I spent an entire day in a crowded hotel room at a world informatics
conference in New Orleans. The topic was who owns the digital medical record or,
more specifically, how and where it should be stored. This was well in advance of
any hope of actually creating such a repository but that didn't keep the conversa-
tions from getting quite lively! I clearly remember one thing in particular: the
Europeans mostly favored giving each patient a “smartcard” on which their record
would be stored and carried around in their possession, while the Americans mostly
favored a “Cheyenne mountain” like approach where everyone's records were stored
in a massive database.
Today, except in a few places, the US has largely discarded a central approach to
electronic record storage in favor of the federated approach in which patient records
are stored in part in each of the EHRs of their multiple providers. This creates many
issues, not the least of which is unambiguously identifying each patient.
The French, who invented the smartcard, recently required that every citizen over
16 have a “
carte vitale
” health insurance card embedded with a microchip and con-
taining social security insurance details (Fig.
6.1
). It does not yet include clinical
information, although some pilot studies are being undertaken.
So, while people may disagree on how to do it, everyone agrees that an integrated
and complete view of each patient's health record is highly desirable. More recently,
with the development of the Internet and mobile technologies, a great deal of dis-
cussion has evolved as to whether and how patients might be actively involved in
making this happen.
There are at least four platforms for patient engagement. We'll discuss them very
roughly in order of increasing involvement on the part of the patient.
