Also, the focus on small practices is critical. The adoption of EHRs will force small providers to pay attention to the HIPAA Security Rule in a way that will overwhelm them by an order of magnitude vis-a-vis there attempts at compliance with HIPAA Privacy Rule.

Rob, you raise a good point on what is meant by complete and you are correct in assuming that with the exception of some psych notes, I am referring to the complete record available to the patient/consumer. 2011 may be too aggressive of a schedule for a complete record in light of the cultural challenges that such a move presents, but ultimately this is a goal to strive for. So for 2011, lets strive for labs, meds, immunizations, allergies and summary record.

As to who actually pays for the PHR, eg is this a cost borne by a practice to create and support such? No, see two paths here: For those with the resources, they can create/host a PHR for their customers which does have benefits. For smaller entities, they can facilitate customer’s use of a PHR by providing portability of the record.

And Jan, while you state that providing the patient their own complete record could lead to greater confusion due to multiple records, is that not what we have today? A cousin of mine with a couple of serious illnesses has 1 GP and 5 specialists. She must compile the complete longitudinal record, carries the stack of clinical notes, etc. to each appt to share with the various clinicians for they do not share the info amongst themselves. Now that is a mess.

What I am suggesting is to take that mess we have today and put it into a digital construct that the patient has complete rights of ownership to and allow them to lead the care effort. After all, do they not have the most to gain or lose?

That being said, do agree with you that certain safeguards/policies need to be put in place to insure overall public health & safety, e.g., a citizen who has a history of drug abuse, suicidal tendencies, etc.

Again, thank you both for your thoughtful and insightful comments. It will require discussions such as this to reach a comment ground of understanding to indeed move from defensive medicine to one that is inclusive and proactive.

I also agree with Dr. Rob that we have to figure out how to have a meaningful dialogue about both doctor’s needs to have a medical record that they can control and attest to and consumers’ desire to own and control their medical record. Without careful and thoughtful dialogue about what the balance is between those two poles, we run the risk of creating a mess, where we have multiple digital records of an individual’s care, all claiming to have “the truth” about one person’s medical history. We run the risk of too much noise and not enough clarity.

It may be helpful for all of us to spend time thinking about the use cases in a future world. Imagine that I get a copy of my record from my doctor’s EHR and place it into a stand-alone PHR, then change, delete, or hide a diagnosis on that record. Following the Markle Foundation’s principles, there is no indication that I have deleted anything when I present my PHR to my next physician. Will he/she trust it enough to act on it without verifying everything through costly testing? In that situation, wouldn’t good medicine indeed be defensive medicine?

It’s certainly true today that doctors never assume that their patients are telling them the whole truth, and that records received from another provider may have HIPAA-authorized omissions, but aren’t we trying to create a future where there’s accurate data and defensive medicine doesn’t need to be standard practice?

I’m hoping that these are some of the issues being explored at the various Health Camps that are taking place.

Truthfully, this seems daunting to me. If that is the case, it probably would seem impossible for the average doc.

I personally think the debate over ownership of the record could be extremely divisive. It’s going to be a hard transition for doctors to EMR. If the perceive that loss of control of their records will be at the end of this road, many if not most will quit. I am a strongly patient-oriented doc, and I feel the patient advocates don’t really try to understand the doctors’ position here.