Inverting the pyramid: An alternative conceptual construct for electronic capture, control, distribution and use of health information

Current electronic health records (EHR) capture literally billions of “encounters” between individual consumers and some element of the clinical provider, regulatory, of fiscal management infrastructure. These separately captured encounters are then sub-aggregated into millions of discrete (duplicative and overlapping) files, and distributed to thousands of information users. The IT infrastructure required to support this operation is costly and we are just beginning to deal with the issues of interoperability and system security. *[ONC, HNIN, Hammond summary] This amalgam of information serves a number of key purposes in our health care system: support of delivery of clinical services; training of health professionals; billing and other fiscal management functions; secondary public health requirements, such as (?) epidemiological study of incidence and prevalence and adverse event reporting (Biosense, VAERS); and is the informational basis for provision of personal health records (PHR) to individual consumers.

This paradigm has produced a number of significant problems and functional limitations: it is costly to assemble; awkward and costly to share; does little to empower the consumer or engage him/her in individual health management; limits the consumers ability to control access to his/her health information; does not provide concurrent information for the secondary public health needs outlined above.

Panel members will discuss various aspects of the functional and cost implications of a theoretical alternative construct in which the consumer is the point of capture and the basis of system organization. IT feasibility/cost of implementing such a system will be considered, along with public health education potential and empowerment of individual consumers in the management of their own health and wellbeing.