There are big technical hurdles standing in the way. I think the buzz word is interoperability, but basically we need a way for your doctor's computer to be able to read records from the hospital and other doctors, and vice versa. I'm no techie, but I understand that's a huge challenge.
VIRGINIA POSTREL: Whenever the idea comes up, privacy groups always raise concerns. I'm not sure patients worry as much as organized groups, but that's an issue.
And interoperability is, in any computer system, a huge challenge. Bank of America's California computers can't interface with the rest of the bank's computers—years after the merger.
SHANNON BROWNLEE: It's funny, but people are more worried about somebody looking at their medical records than at their bank records. We seem perfectly happy to have electronic banking.
That's pretty depressing about Bank of America!
VIRGINIA POSTREL: When I moved from Dallas back to L.A., I had to close the accounts we'd opened in Texas to get one the banks here could access—even though it was all B of A.
SHANNON BROWNLEE: And banking is pretty simple compared to the information contained in a medical record. We may need the federal gov't to simply set a standard platform—everybody has to be interoperable with Kaiser's system, or UCLA's. Assuming UCLA Medical Center even has electronic records.
VIRGINIA POSTREL: UCLA Medical Center has excellent electronic records. In fact, my internist, whose office is in Beverly Hills, can access my hospital records, including radiology reports, from his office, because he's part of the UCLA system.
SHANNON BROWNLEE: But here's the problem with hanging our hopes on EMR—they can't create order out of the chaos of our current system on their own.
VIRGINIA POSTREL: But it would be tremendously costly, not just in dollars but in lost information and transitional errors, to try to start from scratch. It's certainly a difficult problem, though one that everyone in medicine seems to agree needs addressing.
SHANNON BROWNLEE: So maybe UCLA's standard could be used in Southern California. The point is, somebody may have to say this is the standard, live with it.
Starting from scratch is what many hospitals have been doing.
VIRGINIA POSTREL: As a stimulus, my economist husband jokes that maybe they should just hire lots of people to do data entry. After all, laid-off retail clerks and journalists can't design computer systems.
But, of course, you need a system first.
SHANNON BROWNLEE: What's interesting is the fact that the federal gov't has to get involved in stimulating EMRs in the first place. I can't think of another major industry that has not decided to invest in computerized records. Why not health care? Because you don't get rewarded for doing a better job of caring for patients, or doing it more economically, two things that EMRs could help providers do.