State EMR project tackles missing image problem

Michigan has taken the lead in establishing a statewide electronic medical record. An initiative conceived by a coalition of physicians, healthcare professionals, hospitals, and insurance and technology companies will make individual medical records available over the Internet.

The Michigan Electronic Medical Record Initiative, or MEMRI ( http://www.memri.us ), provides a system in which Michigan residents have their own private, secure, and complete EMR available across the state. The system will connect information already in electronic form, residing on computers wherever patients happen to visit.

A pilot implementation is scheduled next summer. Physicians anywhere in Michigan will have immediate access to critical patient information, including digital diagnostic images, thereby eliminating the errors, duplication, and delays inherent in legacy paper systems.

MEMRI will use a standardized data reporting format already used by many of the state's major providers so individual databases can talk to each other, linked by the Internet.

"We believe MEMRI is a first in terms of technological approach, using a dynamic, distributed database, and a federated network identity solution to the privacy issue," said David Ellis, MEMRI's Executive Director.

Privacy is a sensitive issue, especially in Michigan, where medical records were accidentally posted on the Web in February 1999.

"We have the technology that makes it so the patient controls who has access and who doesn't," Ellis said. "We think we can keep the records private and secure."

It helps that MEMRI does not support central storage of the EMR. Permanent storage of images and records will remain distributed among the providers whence the data originates and can only be accessed by patient approval.

Imaging will be a critical component of the Michigan EMR.

"In an increasingly specialized healthcare delivery environment, it will be absolutely crucial that diagnostic imaging be part of a truly functional EMR," said Dr. Charles Shanley, an assistant professor of surgery at the University of Michigan and chair of the MEMRI board.

Real-time availability of diagnostic imaging is frequently the missing link from the clinician's perspective, especially when complex procedures are being planned, Shanley said.

"It is here where costly redundancy frequently occurs," he said. "Given the current cost crisis in healthcare, it's inconceivable that we can continue without such an information-sharing system. It's good medicine, it's good economics, it's a no-brainer."

Imaging implies the need for broadband connectivity. Internet2 is one possible solution.

"The recent display of hepatic 3D medical images at RSNA via Internet2 is an indication how close we are to such images becoming widespread, and how what is currently considered broadband will not be nearly enough to meet the transmission needs of these images and the EMR that contain them," Ellis said.