The Winds of Change

There is a growing debate emerging in many countries about the value of regional and national electronic health record systems, most of which are still in the development stage.  Recently, high profile criticism has emerged suggesting that national EHR initiatives in the US and the UK are going in the wrong direction.

In the US ( Eric Schmidt, Google CEO and member of the President’s Council on Science and Technology (PCAST) stated during a PCAST sessions that “the national health IT system should be based on Web records that patients can control”.  When David Blumenthal, national coordinator for health information technology, suggested that his office is working on plans that will allow certain kinds of communications with personal health records, Schmidt responded that “Giving me a summary … is not the same thing as giving me the record.”

During the same meeting, Craig Mundie, Microsoft’s chieft research and strategy officer said that “the administration also should focus more on how to manage medical data — including metadata to locate key pieces of information quickly — rather than on the specifics of the electronic health records”.  Richard Levin, president of Yale University, pointed out the current electronic health record systems are proprietary and don’t interoperate.  He stated “What is out there is not very good” and that “the reality is dismal”.

In the UK, a similar attack on their current eHealth architecture is raging.  The opposition Conservative party is proposing use of personal health record services such as those offered by Google and Microsoft in place of the current architecture deployed by the NHS National Programme for IT.

The Conservatives state that, if elected they would  “stop imposing central IT systems on the NHS” and instead “allow healthcare providers to use and develop the IT they have already purchased and developed, within a rigorous framework of interoperability”.  The Conservatives propose that “Patient records should be stored locally rather than on a national database, with the capability of transferring the information when necessary”.

What elements of these two debates are relative to Canada?


US and UK suggestions re: PHR vs. legacy EMR/EHR

2 responses to “The Winds of Change

  1. Mike,

    You and I have always differed in our views on PHRs in the Canadian market. I think a system like Canada’s (70% public vs 30% private funding) does not have enough incentive for patients to act as consumers.

    After attending the old Revolution health talk at HIMSS a couple of years ago, I still sit and wonder “where is the impetus” in Canada. I still cannot figure out what I’m missing, but maybe someone can enlighten me, as to how the business model is going to work 🙂


  2. Mark, why do you seem to assume that the consumer will have to pay in order to the PHR model espoused by the Conservatives in the UK (which, by the way, has a publicly funded healthcare system) and the senior technology executives in the US? There are other business models. All that both groups are trying to say is that the existing, legacy EMR/EHR software simply doesn’t interoperate sufficiently to realize many stated eHealth goals.

    Earlier this year I attended a session on Microsoft Healthvault. I asked the Microsoft representative how they planned to make money. He replied that they didn’t expect to do so in the US but did expect to generate revenue from governments in countries with publicly funded healthcare systems to buy Healthvaults for each citizen.

    By the way, I contend that the best way to build a sustainable, publicly funded healthcare system is to have people take responsibility for their own health. Consumer eHealth applications are an inexpensive means to help them to do so and I argue that governments across Canada should be aggressively promoting consumer eHealth.


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