Today's Debate: Who should control the medical record database?

A 2006 Rand Corporation report estimates that the Regenstrief system accounts for nearly half of the gains in quality of health care in the United States that can be attributed to the use of information technology.

Regenstrieff Institute buildings in IndianapolisMost databases are controlled by their owners.

Medicine is currently in a non-stop arms race among HMOs, insurers, and hospitals, with each hoping to control medical decisions through their control of medical record databases.  Even pharmacists are in on it.

But who should control that database, and whom it should serve?

In a recent review of John Seely Brown's book The Social Life of Information, Simon Head of The New York Review of Books finds an interesting factoid:

A 2006 Rand Corporation report estimates that the Regenstrief system accounts for nearly half of the gains in quality of health care in the United States that can be attributed to the use of information technology.

Think about it. Nearly half of all our nation's gains in health care quality, attributed to IT, are coming from one system in one city. The Regenstrief system, it turns out, is a nearly 35 year old medical database solely for Indianapolis, which now covers over 600 million patient observations.

The key to its success, as the blog Pacific Views notes, is that the Regenstrieff system was built by doctors and is controlled by doctors. It is used to help make decisions as they're being made.

Most HMO and insurer databases, by contrast, swing into action after-the-fact, and their second-guessing means many doctors need a full-time assistant just to manage payments.

Before rushing to build a gigantic national database based on the VA's system or anyone else's, I think it's vital we get this right.

A medical records database is most useful before and during a patient interaction. When it is used solely to second-guess decisions after the fact, it's a waste.

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