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John Coppola

Interesting idea Alan. The challenge I would find is based on a simple difference. In the iCloud concept the automatic updates are of information "I" control on various devices. In the EMR/shared health information concept there may be other contributors to the information (eg other providers, prescribers, etc. I would like to be in control of my patient records and be able to update the information based on a personal verification and practical usefulness of that information. As you indicate meds prescribed by multiple providers might not be the best example. A simple sync when desired, needed and expected for continuity of care would be best. Very discrete and unequivocal data such as lab, DI would be useful to synchronize automatically in EMR and in the "cloud" which I presume would function as an EHR. Of course all of our challenges of privacy and security of shared information would need looking at.

Jonathan Marcus

This is the way of the future. Your example of medication is a good one even though you indicate it might not be. IMO a medication list should primarily be what the patient is actually taking. If some of that is prescribed by another physician, IMO that should instantly be reflected in the electronic record. Perhaps it should be graphically laid out in the records of individual doctors differently than the meds that these doctors prescribed.

I spoke to an entrepreneur in the US at Heath 2.0 2009 who had a device that replaced pill bottle caps. It could document every time a patient took meds and which meds were taken. It had a wifi chip to transfer that info to a computer and online, which allowed for patient self monitoring and compliance monitoring by health care professionals. This info could also could be in the electronic record.

Perhaps the problem is that we view electronic records as silos that ideally will 'communicate' with each other. I wonder if we should be trying to looking to totally unify records as one. The view onto these records would be different depending on who one is; patient, doctor, government. Privacy controls, filters, etc. In this way an EMR would be nothing more than a operating system for a user (doctor, patient, pharmacist, ?goverment). The EMR would feed data to and from the unified record and be a context dependent view onto such a record.

Yes this would pose many questions such as what info a doctor is responsible to look at and when. But I think it's hard to deny that the way of the future is a single health record for patients.

Dennis Giokas

Alan, I am totally on side with you. Multiple systems, providers and devices need to speak to each other. As you indicate, it is important to reconcile medications and to make that information accessible. I imagine as a clinician you would want other key data reconciled and available to you such as laboratory results. As you say, that is the “great concept we need to aspire to”. What you described are systems with requisite functionality and interoperability of a Drug Information System (DIS) interoperating with an EMR.

The most unique aspect of “cloud” is that it is a novel hosting strategy that has shown it can optimize the use of computing resources and thus reduce the capital expense to host systems, and ongoing operations and maintenance expenses. However, you still need systems in the cloud to provide essential business and clinical services, and interoperability services to enable the capabilities you describe.

Interestingly, the functionality and interoperability you describe is totally consistent with the interoperable electronic health record (iEHR) approach that Infoway has been investing in. The functionality you seek is in the DIS of the iEHR. What is different? How it is hosted – in the cloud or in more traditional data centres. From the iEHR your EMR can get the current medication list in real time and make it viewable to you as a clinician. From your EMR you can also invoke advanced services in the iEHR such as drug utilization review on that medication list. Optionally, your EMR can download and process that medication list locally. That same medication list in the iEHR can be viewed and processed via an app on your smart phone or tablet device. See my post related to this topic ( )

Today the provinces and territories are hosting the iEHR capability in their own data centres. In the future they could use cloud-based strategies in what is known as a private cloud in order to be compliant with the privacy and security requirements for personal health information.

To sum up, the cloud only changes how we host systems. You still need to deploy the DIS with the desired functionality and interoperability to support clinicians using EMRs. The good news, we are doing just that in Canada.

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