Yasnoff: Wisconsin should invest in health record bank

Milwaukee, Wis. – Dr. William Yasnoff agreed that $30 million is a relatively small sum for state government to invest in the adoption of electronic health records, but not too small to make some headway on what he considers a better idea.

Yasnoff, founder of the eHealth Trust Initiative, continues to advocate that states or regions create a central repository, or bank, for all electronic health records. He views a bank, which would be financed with small monthly fees charged to consumers, as the best way to get healthcare organizations to share information, get more doctors to invest in electronic health records, and get around interoperability issues.

He also thinks it would be a more effective way to spend the $30 million that Gov. Jim Doyle has proposed to help healthcare providers convert to electronic health records.

Under the banking approach, consumers would elect to have copies of key elements of their medical records, from all sources, deposited in a health record bank. The banks in turn would allow aggregated copies of each consumer’s medical information to be shared when and where needed, with the consumer’s consent.

The current system, he noted, does not provide for availability of complete patient information at the point of care. Since the majority of people receive their care in multiple places, and each facility maintains its own records, there is no entity in the healthcare system responsible for keeping each person's lifetime health record. Yasnoff, who compared the system to that of a legal trust, said it’s important to provide a single access point, and he views it as the best way to establish regional health information organizations (RHIOs). Healthcare organizations would interface with the banking system, not with each other.

Establishing the trust necessary for such a system is easier to do among health systems in a community or region, rather than in a national system, which would pose scalability problems.

“You set up a legal agreement between the consumer and the entity holding the record, and it’s a legal trust relationship, much like a financial trust that’s enlisted to act in the interest of the consumer,” he explained.

Wisconsin Health Information Exchange

Enter the Wisconsin Health Information Exchange, which is attempting to create localized systems in which clinics, hospitals, nursing homes, and home healthcare providers in southeastern Wisconsin can share patient information electronically. The organization is attempting to create the relationships necessary to the voluntary exchange of information, but politics has convinced it to take only part of Yasnoff’s advice.

The exchange continues to pursue what Dr. Edward Barthell, president of the National Institute for Medical Informatics and WHIE’s co-principal investigator, calls a blended model.

Its initial step will be to place more time-sensitive data, including past medical history, in a regional repository to be made available in emergency rooms, and less time-sensitive data to be placed in a federated system, one maintained by the original source that responds to queries about specific data on specific patients.

“Politically, it’s hard to get people to agree to place that data in a central, regional repository,” Barthell said. “We’re trying to take the best of both worlds.”

Barthell said the emergency department project will be financially aided by a Medicaid transformation grant awarded to the State of Wisconsin, and he said the legal departments of metropolitan Milwaukee healthcare systems are going over data-sharing agreements that would govern the handling of patient information.

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