Ken Flegel, MDCM MSc Senior Associate Editor, CMAJ has written a very thougtful editorial on the Electronic Medical Record in terms of patient safety and the ownership and stewardship of the clinical data.
"By custom, the medical record has been stored as a paper file in the physician's office. The keeper of the record has been the physician — a banality in which lie 2 deeper concepts: one of ownership and one of access. Lately, it has come to be understood that the physician and the patient own the information in the record jointly and that each is entitled to control the access by third parties, though normally for different reasons. But now, driven by need and abetted by technology, much about the medical record is changing, raising new questions about how ownership and access are affected.
Obviously, the only way to restore coherence is by moving from the paper record to electronic storage and linkage. The essential quality of the electronic record is that it can allow all significant information to be accessible in one place at the same time. It can be searchable. It can possess a kind of algorithmic intelligence. If well designed and efficient, it can be organized and user-friendly.
There is a clinical need — one might say imperative — to proceed. Patient safety is the principal reason. For example, an electronic record could inform a physician not to prescribe a drug that is contraindicated by the patient's history. Emergency visits are another standout circumstance where access to the complete record will avoid harm, to say nothing of time and money. The question, then, is who shall keep the records and who shall own them? Although the keeper is likely to change to encompass a virtual network of health care providers, ownership should remain with the patient.1 But ownership here means the ability to grant privilege to others to contribute to or gain access to the information. It does not mean the patient can change the record (although there could be a place for him or her to add comments).
Who will have the ability to make or alter an entry? Are we each about to become holders of our own somatic Wikipedia?
Click here to read the full article: Getting to the electronic medical record -- Flegel 178 (5): 531 -- Canadian Medical Association Journal
What I read into this is a growing acceptance of the need for a transition from the old ways to the new and a change of thinking in terms of how we share information in a much more fractured environment. Technology and EMRs are some of the important keys to this puzzle.
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