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Your medical records probably consist of fragmented notes—paper documents and computer files—scattered among the various clinics, hospitals and doctor’s offices that you may have visited in the past few years. If you happen to need afterhours attention at a clinic you haven’t visited before, your new provider cannot access those records, and you may be in no condition to provide the information. That limitation may change, however, with the recent trend in Western countries to nationalize patient records.
If you’re wondering what that might be like, consider the Netherlands. In July 2009, many general practitioners, pharmacists and medical specialists began taking part in a national electronic health record (EHR) system provided by the Dutch government. Each patient’s EHR lists his or her medical conditions, prescribed medications and possible allergies.
In the Dutch system, the patient’s EHR is not saved at a central location but is instead kept by the original healthcare provider. Other providers who are treating the patient can retrieve the EHR through a national information infrastructure—called AORTA—designed for the exchange of data between healthcare providers. Imagine a hub-and-spoke system, where the “hub” server routes data requests and replies between healthcare providers on the “spokes,” who do not have direct contact with each other.
Advocates believe that the EHR will improve patient care in the Netherlands. In principle, they say, it should reduce errors caused by inaccurate or ambiguous medical records, reduce the duplication of tests, cut down on delays in treatment and keep patients well informed so they can make better healthcare decisions.
Dutch healthcare providers currently participate on a voluntary basis, but patients are automatically incorporated into the EHR unless they opt out of the system. In February 2009, the House of Representatives of the Dutch Parliament passed a bill that would make it mandatory for providers to link their patient records to the national EHR. As this issue went to press, the bill was stalled in the Dutch Senate amid concerns that the national EHR may compromise patient privacy.
“A lot of people will get access to data that are often kept private, including people who are not medical doctors, such as secretaries,” says Albert de Roos, a consultant who advised the government on the infrastructure of the Dutch EHR. “Also, doctors are reluctant to share information they are not sure of, or that could reveal their ignorance, or for which they could be sued.”
Concerns about the security of the new ID cards (required for the EHR), about liability issues with respect to the information in the records, and about the new responsibilities of health professionals are also delaying the full implementation of the EHR system.
The amount of genetic data available, since the dawn of the biotechnology era, has vastly expanded from just 606 base pairs and 680,338 sequences in 1982. The biggest challenge for health technologies will be to process and make sense of the ever-growing banks of information.
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