Global advances in electronic medical records: India, UK and US

In 2009, Ontario’s efforts to create an electronic medical records system continued to experience problems of mismanagement. Many in the local media focused on the misbehaviour of people that worked on the project. That said, I think there is still a great opportunity to build systems and standards for electronic medical records. Some case studies from other parts of the world are worth considering. As I see it, there are two types of benefits to such records; individual and social. The individual benefits are numerous including easy of transfer (i.e. a patient moves, transfer to a specialist etc) and persistence (i.e. many different professionals could update and add to a single records that would provide a unified picture of health at one moment). The social benefits include improved medical research and lowered transaction costs in transferring records and having to work through many different medical record formats. Without further ado, let’s look at some global trends in digital medical records

1. Madras Medical College introduces Diploma in Medical Records Science program

This one year program trains technicians to code diseases and report health information in a standardized fashion. The program has several objectives including effectively providing medical records in legal cases, satisfying Right to Information requests and improved epidemiological research. What surprised me in reading about this program is the fact that the program had existed prior to 1988 but closed down when it failed to meet regulatory requirements. I find it particularly interesting that access to information is cited as a reason to improve medical records. That’s a whole new and very much valid argument in favour of improving such records. Further, I find it interesting that India is placing greater emphasis on training staff rather than building IT systems, the latter being the preferred approach in the Western world.

2. Scotland and Wales outdo England in digitizing medical records

Wales has launched a system called My Health Online which is designed to, “let people order repeat prescriptions and book appointments with their GP. Other features of the site will include advice and information to help patients manage health conditions. It will link to the existing NHS Direct Wales website.” That’s quite impressive. I like the degree of centralization implied in this but I hope that other modes of access (e.g. phone access to a centre of some kind) continue to be provided for those that do not know how or wish to use a website. Scotland, meanwhile, has focused its medical records effort on standardizing emergency medical incidents: “In Scotland, however, the country’s independent NHS has shown it is possible to set up electronic records for all patients. Almost all of its 5.2 million ­population now have emergency care summary (ECS) records, which provide basic demographic data and information on patients’ prescribed medication to A&E wards, out-of-hours medical providers, and NHS24, Scotland’s version of NHS Direct,” reports the Guardian (“Online health records can save lives.“). The same article also discusses other efforts in the UK to build a record system that have not met with as much success. Scotland is onto something with its focus on emergency medical records.

3. U.S. Veterans Affairs Department seeks to share medical records with other organizations

I’m not deeply informed about the medical record situation in the United States, so this article was enlightening (this lengthy 20008 blog post at ArsTechnica offers a great introduction to US digital medical records though). After a decade of effort to share records between the Defense and Veterans Affairs departments of the federal government, some progress has been made in standardizing the records. The U.S. federal government has developed a system called the Nationwide Health Information Network (NHIN). This month, the government announced its first effort to share its records with a private insurance company. Given the influence that the U.S. military has in developing technology and even records systems, the NHIN may end up being adapted all over the world.

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