A global socio-economic-medico-legal model for the sustainability of longitudinal electronic health records. Part 1.
OBJECTIVE
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.
Shabo
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IBM Research Lab, Haifa 31905, Israel. shabo@il.ibm.com