EMRs can't solve management problems

In theory, the following couldn't happen if we had a complete, interoperable national electronic medical records system.

Patients who were seen at a Brooklyn imaging center have been struggling for months to get their records back after a group of imaging center closed abruptly last summer. The firm, based in Brooklyn's Bay Ridge area, has taken a public beating for storing--and allegedly abandoning--hundreds of X-rays and mammograms in New Jersey.

Wouldn't it be much easier if those images had been stored digitally and could be retrieved with a few keystrokes by their next imaging provider? Sure. That's what everyone wants to see.

Unfortunately, though, even a 100 percent connected national EMR infrastructure may not cover problems like these. Why? Because while establishing a national platform for sharing patient data is hugely important, it can't solve operational problems by itself.

In this case, for example, let's assume that Bay Imaging had full-on digital imaging and was connected to providers across the state. That's a realistic scenario, right? Well, even in that case, as RHIOs are finding, questions arise as to who could access the information, when, and where it would be stored.

Now throw in the fact that Bay Imaging has gone out of business. Who owns the data? If it's housed on servers that Bay took down when it closed, have any of its partners or referring facilities received copies, or are all of those patients just out of luck? If the data is housed in some sort of state-wide neutral databank, does it have to scrub the data if Bay wants to take it elsewhere? How can Bay administer access permissions if it's not in operations? And if someone else does it for Bay, who will? I realize that existing medical records law may cover some of this, but it's still a thorny set of issues.

Admittedly, the Bay Imaging collapse is a bit of an unusual situation, but it's certainly not unheard of. So how will we handle these kinds of gaps in the system?  Nobody knows yet. Sure, we'll figure it out, but that will take years above and beyond the point at which most facilities are wired.

So, can we have the nation's providers largely connected to EMRs by 2012? Maybe, if the government will pay for it. But will it solve all our health data access problems? Not likely. - Anne

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