Today, most medical organizations have gotten away from paper medical records and use computerized electronic medical record systems (EMRs). The U.S. government has encouraged the use of such systems, no matter how large or small these systems are.

A current problem is that a patient may be seen in different medical organizations and have medical records in different EMRs. This has promoted the concept of “interoperability,” allowing one EMR system to retrieve the medical records from another EMR system.

There are a number of problems with interoperability:

• Instead of one pile of basically unreadable medical records, you have multiple piles.
• There is unlikely to be a complete summary of important medical information, such as current medications, past visits, preventive care, allergies, etc., that can be trusted.
• There may be limited ability to have interoperability for smaller-scale EMR systems.
• There are security concerns with such transfers.

I propose that large medical organizations could have their own EMRs, especially organizations that have connecting software systems for medical organization ancillary systems, such as for their pharmacies and clinical laboratories. Other medical organizations, especially smaller ones, would share a “utility” EMR system, which provides EMR services to many medical organizations, keeping each medical organization’s medical information separate from other medical organizations. I call the former “dedicated EMR systems” and the latter “utility EMR systems.”

In my proposal, connecting the EMR systems would be a “secure health care network” only available to these EMR systems that collect summary health care information for each patient, combining information from all the medical organizations where a patient is seen.

This summary information would include a list of encounters (outpatient visits and inpatient stays), current medications, allergies, outside organization referrals, current orders, and other information. The EMR systems would be limited to very large EMR systems with validation that the system eliminates any security holes that allow hackers to get network information.

The secure health care information, including the patient summary, would only be available to physicians caring for the patient. A patient would be assigned to a home medical organization, allowing health care network information for the patient to be available to physicians at that medical organization. During a patient encounter outside the patient’s medical organization, the patient would need to provide biometric information that would allow the physician caring for the patient to see information in the health care network. Outside medical organization referrals would enable health care network information to be available to other physicians on a limited basis.

Within the secure health care network for a patient would be a list of the patient’s encounters. A physician could select an encounter to see the underlying associated medical records, which would be retrieved from the medical organization where the encounter occurred via the associated EMR system.

It is expected that most of the time, the summary in the health care network for the patient would supply most of the useful medical information, and a physician looking at the medical records for an encounter would not be necessary.

Using a utility EMR system, a medical organization could choose to offload their administrative functions of insurance, billing, and payment to the utility, allowing the medical organization to concentrate on patient care.

Additional information could be included for a patient in the secure health care network, which could include:

1. Genetic information: The patient’s genome.
2. Significant health problems: A list of the patient’s significant health problems.
3. Longitudinal histories: For a particular significant health problem, a timeline listing encounters treating the medical condition along with associated procedures and medical conditions.
4. Continuing care: Information for a physician to assist in continuing care of a patient over multiple encounters.
5. “Virtual organizations”: Information to identify multiple physicians working together to care for a patient.
6. Care across medical organizations: Information to support care across medical organizations. This could include virtual organizations across medical organizations.
7. Rural medical care: Support for rural areas where there are few hospitals, enabling rural physicians to work for large medical organizations, thus enhancing career moves.
8. “Early treatment diseases”: Individualized support for treatment of some predicted serious medical conditions before there are obvious symptoms.

Michael R. McGuire is the author of A Blueprint for Medicine.

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