Medical records stored on databases could boost the effectiveness of health care markets in the EU but pose major challenges regarding interoperability and the privacy of patients.

Electronic medical records (EMR) files are recorded in electronic format and containing the medical information of a patient and the evolution of his health over time. These records are primarily from medical records, ie records and legal documents created in hospitals, or care center during medical treatment or care administration.

The DME may contain information about the social characteristics of the patient, the treatment progress, problems, medication, life support, medical history, immunizations, results of laboratory tests and radiological examinations.

For doctors, hospital operators and the entire medical staff, the electronic medical record provides the opportunity to organize, automate and streamline the work flow. It provides a complete file containing all the information as a result of medical or health-related activities.
Issues:

Patient mobility

While patients are increasingly mobile in Europe, the DME, searchable by clinicians in different places of care and different languages, can make treatment safer and reduce costs.

The issue of mobility is closely linked to interoperability. If the standards of DME remain national, it will draw up new barriers to mobility of patients. This means, however, that these standards will not only overcome the language barriers, but also the differences between systems of health care, from medical treatment to the marketing of pharmaceuticals.

The European Action Plan on eHealth (2004) the development of health care systems interoperable across the Union by 2010 a priority. In June 2006, the Unit ICT for the health of the Commission adopted a new strategy to promote the transformation of the European landscape care santéPdf external, in accordance with the policy framework of the Commission, i2010Pdf external.


Costs and savings

With a relatively low initial investment, electronic medical records allow physicians and medical personnel to share the results of medical examinations more efficiently, thus avoiding several times to practice the same kind of examination on the same patient, when it will consult another physician or is treated in another health center.

In addition, computers could be used to reduce the additional costs, such as drug prescriptions and hospitalization expenses and transportation. An anonymous database on the health of all patients could be used to make health care markets more efficient. For example, the effectiveness and safety of generic drugs compared to the original drugs could be tested independently and more efficiently.

External Rand believes that the introduction of electronic medical record in the United States will lead to savings of about $ 80 billion (55 billion euros) annually, most of which come from the reduced time of hospitalization patients and time of convalescence, followed by the administration of medications as an outpatient.

However, scientists are divided about whether electronic medical records will result ultimately in lower costs for national health care. They lead to a better assessment of diagnoses, especially if they are associated with genomics. Thus, more diseases and deficiencies could be detected and therefore more treatable. Consequently, life expectancy could increase.

Analysts warn that, insofar as electronic medical records will expand over time, it will take several years to achieve their full potential. The research published in Archives of Internal Medicine external showed no significant difference between ambulatory visits with or without DME.

Privacy and Security

Electronic medical records contain highly sensitive information on individuals. They therefore require the maximum protection against all kinds of abuse. The challenge is this: is a DME meaningful only if the medical staff has access to necessary data. Meanwhile, we must ensure that unnecessary data in the context of a specific treatment is unavailable and that all data is not distributed or available to individuals or organizations not authorized.

Recent losses of data, including the United Uniexternal, aux Etats-Unisexternal and Canadaexternal, reiterated the importance of protective measures more effective. A poll conducted in November 2007 by the British newspaper The Guardian external demonstrated how this challenge is crucial. According to the survey, nearly 60% of general practitioners in the United Kingdom are reluctant to load the data from their patients to a national database for fear that sensitive personal data being stolen by hackers singers and teachers. According to the study commissioned by the British Medical Research external (UK Medical Research Council), the general public shares this sentiment.

On 15 February 2007, members of the Working Group on Article 29 Data Protection Working Party issued a working paper on the processing of personal data concerning health in the medical records électroniquesPdf external. The document warns: "In terms of data protection, it should be noted that EMR systems are [...] not only the capacity to process more personal data (eg in new contexts or by aggregation), but also to allow a greater number of recipients greater access to data than a patient. "

The working group said: "By bringing medical information to a person from different sources, thus facilitating and widespread access to such sensitive information, the DME systems are creating new risks and provide an unprecedented scale in danger of abuse of medical information about people. " In this document, the Working Group on Article 29 provides advice to operators of health care and doctors.

Some of the most difficult issues in the implementation of EMR systems include the introduction of integrated and interoperable solution for access control systems and data security.
Positions:

"The initiatives of the EU's eHealth (eHealth) are designed to eliminate language barriers, technical and administrative allowing citizens to receive health care more easily, even when they are away from their country of origin. I hope that our recommendation and the SOS project will save many lives in emergencies, "said European Commissioner for Information Society Viviane Reding, presenting the recommendation on cross-border interoperability of systems of records medical electronics.

John Halamka, a professor of medicine and head of information service at Harvard Medical School in the United States, wrote in the monthly newsletter of the Continua Health Allianceexternal: putting the patient at the center of the exchange of data on her health and responsible for making their personal data, confidentiality of health will be the responsibility of each patient participating in the DME system. Patients can recover their files, protect the confidentiality of their personal information and submit their data, if necessary, only for those in need. Insofar as the policies are local safety standards established for electronic health records must be sufficiently flexible to deal with relatively heterogeneous systems.

The New York Times external quote David M. Cutler, a specialist in health economics at Harvard: the information is a double-edged sword, especially in the field of health. Better information can, for example, to terminate certain mass markets in the pharmaceutical sector. In contrast, it can also stimulate demand for other drugs in markets smaller and specialized. And if better information really helps to understand the evolution of health care, it can also lead to more care for more people and higher costs for the whole system.

The Standing Committee of European Doctors (CPME) recognizes the growing importance of technology in online health care administration health. The Committee greatly appreciates its use to support the work of doctors. CPME note that there are considerable differences across the EU in the approach of physicians vis-à-vis the health area, particularly regarding the approach to ethical principles, the degree of control over the patient's file and the level of integration solutions for eHealth in health systems. CPME says that further studies are needed to handle different ethical approaches and techniques, since this represents a considerable barrier to the concept of a European system.

CPME also believes that all patients, whatever their background or the nature of their problem, should be able to obtain medical assistance are assured that their sensitive personal data are only accessible to caregivers who need this information to provide appropriate care. According to the CPME, the patient should be contacted to give its backing to the widespread use of its data.