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Our Brave New World: EMR and The “Ownership” of Health Information

by Dan Orenstein, Senior VP and General Counsel of Legal

At the HIMSS 2012 conference in Las Vegas this past February, Dr. Farzad Mostashari, National Coordinator of Health Information Technology, observed that while there is still a lot of work to do on the adoption and use of electronic medical records (EMR), the majority of physicians in the US will be using an EMR within the next two years.

And we like that. It shows progress.

It also means we are experiencing an acceleration of the paradigm shift from the “Old World” of paper-based health records to the “New World” of EMRs.

None of it feels like a small adjustment; more like a tectonic paradigm shift for the health care industry. Even as the Old World recedes around us and the New World emerges, Old World concepts of health records and record ownership do persist. They manifest themselves in some unusual ways, too, and with surprising staying power, persisting in laws, regulations, the way we think about records, the way we do business and, often, even in EMR offerings themselves.

EMR systems that have not fully transitioned to the new paradigm represent a “Middle Path” that slows down change and innovation. To move forward successfully from the Middle Path to the New World, we will ultimately need to resolve the conflicts between the paradigms.

Ownership vs. Use

So, what about these conflicts? In the Old World, records are regarded principally as physical items--paper files that contain information. Therefore, the Old World focuses on custodianship of the record, which then translates into the question of who “owns” the record and, therefore, the items (information/data) contained within the record. This is a property-based approach to health information. In the New World, the interest is the data itself and, more important, aggregated data across multiple records that:

  • provides meaningful insight about what care protocols work
  • enables caregivers to communicate better with patients
  • enables researchers to more expediently identify patients to participate in studies
  • achieves better public health reporting and analysis, among other uses…

Therefore, in the New World, how the data can be used and how it can be leveraged is more relevant than who owns it.

Are you still living in the Old World? Did you make the leap to the New World? Tell us about it.

Next week, we will explore static records vs. real-time records and ways that software-based EMR systems often represent the inertia of the Old World paradigm.

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