A debate has been running this week over access to medical records.
The Australian Medical Association wants medical records to remain confidential between doctor and patient unless each individual patient gives permission for the records to be used or the records are de-identified.
But there are other interests at stake, individual and general. On and individual level, it would be helpful if some or all parts of a patient’s records were available on computer to every emergency ward in the country. The records of an unconscious patient might show things like drug incompatibilities, allergies, illness records which will enable emergency doctors to avoid inappropriate treatment. On a general level, records of patients are an invaluable aid to medical research. At present the controlled trial is often the only medially accepted way of telling the value of a treatment. True it is the best way, but it is expensive and time-consuming. With the aid of modern data-creating techniques on computer, researchers could add immeasurably to medical knowledge. Moreover, in Australia there are huge untapped databases of raw information with the Health Insurance Commission (Medicare, pharmaceuticals and veterans), state health departments (hospital admissions) and private insurers. Further, if doctors abandoned paper records and comptuerised, data could be collected more easily. Cross correlations on treatment, lifestyle, age, sex, medication could yield important results which would be better than our present void in many areas of treatment.
Doctors and the AMA cite privacy as a critical concern. Indeed, privacy is a major concern. However, it is usually more strongly thought of as a concern among people who are not ill but fear illness and knowledge of the illness getting out and among people very recently diagnosed. Usually people with major illness after a moderate time are inclined to do whatever they can to add to the store of medical knowledge so their disease can be better understood and treated so others can benefit from their suffering.
But still the AMA and some doctors are playing hardball. Do they have something to fear and hide. Quite possibly. Many doctors fear having to move from paper records to computerisation because they worry about mastering the technology. That is not a long-term difficulty. The real worry is that some doctors fear computerisation because of its chilling comparative accuracy. Quick treatment comparisons over a wide database will reveal which doctors are treating in accordance with up-to-date best practice and which are falling behind. Small wonder some doctors fear computerisation and national databasing of medical records in the same way some teachers fear national literary and numeracy tests. Some of them might be shown up.
But the national cost of poor medical record-keeping is likely to be higher than poor literacy and numeracy.
In the Medical Journal of Australia earlier this month the National Centre for Epidemiology and Public Health team, headed by the ANU’s Professor Bob Douglas, called for a national medical records database to replace the existing “”pen and paper” system. They rightly concluded that, though the database would not be cheap or simple and would take up to a decade to implement, the benefits would outweigh the costs.
Good doctors should not resist that. Doctors who raise privacy issues as a means to stopping it should be asked whose interest are they serving, their patients’ or their own.
It should be fairly obvious that the medical benefits of a national database will greatly outweigh individual privacy concerns or the interests of doctors who want to shield behind that to cover up their unwillingness to bring their skills up to best practice.