Summary
Objectives:
This paper pursues the challenge of sustaining lifetime electronic health records
(EHRs) based on a comprehensive socio-economic-medico-legal model. The notion of a
lifetime EHR extends the emerging concept of a longitudinal and cross-institutional
EHR and is invaluable information for increasing patient safety and quality of care.
Methods:
The challenge is how to compile and sustain a coherent EHR across the lifetime of
an individual. Several existing and hypothetical models are described, analyzed and
compared in an attempt to suggest a preferred approach.
Results:
The vision is that lifetime EHRs should be sustained by new players in the healthcare
arena, who will function as independent health record banks (IHRBs). Multiple competing
IHRBs would be established and regulated following preemptive legislation. They should
be neither owned by healthcare providers nor by health insurer/payers or government
agencies. The new legislation should also stipulate that the records located in these
banks be considered the medico-legal copies of an individual’s records, and that healthcare
providers no longer serve as the legal record keepers.
Conclusions:
The proposed model is not centered on any of the current players in the field; instead,
it is focussed on the objective service of sustaining individual EHRs, much like financial
banks maintain and manage financial assets. This revolutionary structure provides
two main benefits: 1) Healthcare organizations will be able to cut the costs of long-term
record keeping, and 2) healthcare providers will be able to provide better care based
on the availability of a lifelong EHR of their new patients.
Keywords
Social change - ethics - politics - economics - information medical record linkage
