I’ve given the EMR issue much thought. Heck, I even wrote one of my medical school secondary application essays about it. I don’t claim to be an expert at all, and I like a lot of the comments in response to Levy’s post. But this is something that is going to be very complicated. And security must be factor number one in this case. Of course the real challenge is ensuring medical professionals have access to the information they need at the instant they need it, without all kinds of necessary encumbrances. The typical challenge of security.

Please see the vigorous discussion of the Google EMR proposal in the comments of Levy’s post.

Meanwhile, since 2002 I’ve been a vigorous user of PatientSite, that hospital’s secure email and partial-EMR system. Lucky me, my primary, Dr. Danny Sands, is one of the co-managers of PatientSite’s creation, and one of the pioneers of best practices for patient-physician email. It is *blindingly* obvious to me that this is infinitely more effective than not using email.

But there’s a lot of resistance. Over on the e-Patient blog two weeks ago there was another vigorous discussion about patient-doctor email. As I noted in a comment there, a key issue is that insurers won’t pay for time spent emailing (or on the phone for that matter), and some of us are working to change that, by documenting the cost reduction that accrues from better primary care (etc).

Dave – I love the article. Even more than the lab coat length (which I happen to think is helpful, although most people outside the medical world don’t seem to be aware of) is the discussion of the EMR systems that are becoming commonplace.

Some large companies, e.g. Microsoft and Google, are vying to be the data holder of patient medical records in the future. While their goals are certainly more than altruistic, there are some valuable lessons that can be learned. The ability of patients to contribute to their medical records in a controlled fashion (i.e., they cannot alter test results or items left by a doctor, they can only add notes, readings and other information that is noted to be patient generated) and to review their details is essential. But security and privacy must be maintained and guaranteed. At the same time, healthcare providers must have unlimited access to this information in times of crisis. It’s quite a challenge to do all of this, and integrate it across differing platforms and hospital systems. But don’t get me started, I could write a huge post on this topic alone.

Let me ask a tough question: does Mount Sinai have a hotline (basically a *consumer* hotline) you can call if anything ticks you off?

I’m so sorry I have not been able to come down to the city sooner. I will be there on April 5th and I know you’re getting out soon, but I was wondering whether you were still up for visitors. If not, I completely understand, but I wanted to touch base and see how you felt before I’m out there. =)