Web-based approach shifts medical record burden to patients

The current healthcare delivery system produces enough pain that a change to an electronic medical record (EMR) makes sense, according to an e-session presented at the Healthcare Information and Management Systems Society meeting in Dallas.

"Current estimates place the administration of healthcare delivery at $350 billion a year," said Wendy Thomson, principal consultant for EDS, and David Townsend, owner of Bold Strategy.

Thomson and Townsend propose an EMR process based on the notion that patients own their own medical records. This would be achieved by an insurance card-driven Web-based browser-accessed application. The process would not require physicians to maintain special software.

"This is critically different from most of the EMR solutions that are being implemented today. Most of them assume that each medical provider maintains records on patients and shares those records when necessary," Townsend said.

With the Web system, providers are given read-write access at the point of service by the patient.

The patient can also store Health Insurace Portability and Accountability Act designations on the card, relieving practitioners of the requirement of maintaining HIPAA designation records.

"If a provider doesn't own the record and has limited access as directed by the patient, a large portion of HIPAA requirements become mute to the provider," Thomson said.

Townsend and Thomson recommend that access be limited to medical specialty via diagnosis code, ensuring that medical providers have access only to that information that pertains to their core provision.

"This will address concerns that an optometrist could view psychiatric records," Townsend said.

The insurance card would be embedded with basic data - name, carrier, plan ID, and which databases to access - as well as static medical data such as blood type, allergies, and any chronic conditions.

The system recognizes that a workaround will be necessary in emergency situations. The Web application includes referral logic that automatically approves or rejects referrals to the extent practicable. For example, if x-rays are positive, then referral to an orthopedist is automatic.

To date, healthcare cost containment efforts have focused on cuts to available care options and adoption of plan changes that pass larger percentages of the existing cost burden to subscribers. These cost mitigation approaches assume the current cost structure is a given, Thomson said.

"We believe the current cost structure is not a given and can be greatly simplified and reduced," she said.

Thomson and Townsend formulated their Web idea by first mapping the current administrative practices and then seeing what could be done to improve the process by applying existing, proven technology.

"We set out to automate everywhere possible and remove redundant activities and record-keeping," Thomson said.

They also wanted to eliminate as much of the administrative fragmentation as possible, instituting instead point of service account approval and settlement, so that the transaction would be complete when a patient left the office.