E-health: A matter of life and death

I was standing in the security line at Dallas International airport some months ago when I was approached by a worried-looking gentleman who was carrying a large envelope with papers. He asked if I was travelling to Chennai (I was stopping over at London).

It seems that a family member on holiday in India was undergoing emergency medical surgery and the medical records were needed faster than a courier could get them there. I was struck by the irony of the situation.

Consider this: you can travel anywhere on the planet or pay for your hotel or other purchases by the swipe of a credit card, where the payee authenticates your credit limit.

In essence, your financial information can and is transmitted to wherever it is required in the bat of an eyelid. And yet, the thing that matters most to us, our health and our health records, is pretty much stuck in the Stone Age.

Your medical information, history of medical treatment, surgeries, allergies and so on are recorded on paper and all this stays where it is recorded. If this information is not made available to doctors when and where it is needed, it is pretty useless and could mean the difference between life and death.

An estimated 80,000 people die in the US alone each year due to medical errors. Alarmed by the situation, public health administrators in developed and developing countries have started focusing on this area.

The National Health Service has embarked on a 10-year programme in the UK to provide electronic medical records to all its citizens, while President Bush has called for a programme to cover everyone from "the cradle to the grave" by 2014.

Interestingly, the technology already exists to do this and, therefore, is not really an issue. Hospitals around the world have been using EMRs for several decades now.

The question is how do you connect the disparate systems, or how do you collect the same clinical information. The issue is one of adoption of common standards and interoperability. The second issue is that of privacy.

Some people would not want their personal medical history made available to strangers. A way to resolve this would be to make it voluntary, where patients give their consent.  Creating and maintaining EMRs for a whole country or even a region is an expensive affair.

Who should bear the burden -- the taxpayer as in the UK, the insurance companies, the hospitals, the patients or some combination thereof?  Finally, adopting EMRs would entail a huge change management exercise.

Doctors are very comfortable using plain old paper and may resist having to input and retrieve data from computers. This means that an investment in re-training as well as an effective communication programme outlining the benefits of EMRs is essential.

One may argue that given the current state of hospitals, India can ill afford to spend on EMRs.  However, we must view EMRs not as a luxury but as a vital part of the health infrastructure.

While the lack of a national ID and the fledgling nature of the hospital accreditation programme may be an issue, the key driver towards EMR adoption is likely to be the pressure exercised by the insurance industry.

The defence forces, large organisations like the railways or the Employees' State Insurance Scheme are likely to be early adopters because of the "captive" nature of their large workforce. For the others, a kind of public-private partnership is likely to fund the initiative.

I hope a day is not far when we will be able to access crucial medical information anytime, anywhere, just as we do with money from ATMs. And may you never have to approach strangers at airports with a bag of medical records ever again.