Electronic health records spark identifier debate: some say single, voluntary approach would reduce errors; others want to build on decentralized system.(Practice Trends)

WASHINGTON -- One key to the widespread use of electronic health records is a single, voluntary identifier for each patient, Newt Gingrich said at a briefing sponsored by the Alliance for Health Reform. Most patients would embrace a comprehensive system based on single, voluntary individual health identifiers because of its potential to reduce medical errors and otherwise improve health care quality, said Mr. Gingrich, former speaker of the House of Representatives and founder of the Center for Health Transformation.

But Carol Diamond, M.D., managing director of the health program at the Markle Foundation, a charity dedicated to using technology to improve the nation's health care and security, called for a system that can be accessed using multiple patient identifiers.

Any new system for electronic health records should build on what already exists, she said. "We have a decentralized [health care] system. That's been the premise of our approach," Dr. Diamond explained. "We are never going to get to this giant database in the sky that's got everything that we need."

Last July, Markle and several health information technology organizations released a "road map" that outlines a decentralized approach emphasizing patient privacy, interoperability, and local community involvement within an established framework.

One technology solution is unlikely to fit both a two-physician practice and a hospital with hundreds of beds, said Colin Evans, director of policy and standards for the digital health group at Intel. He added that a model that's based on people accessing decentralized data "may work generally" but would require aggregation of data.

He noted that the United Kingdom's National Health Service is developing a computerized medical records system based on a semiaggregated model.

Physicians and hospitals will need both financial and nonfinancial incentives to participate in a new system, noted Mickey Tripathi, president of the Massachusetts eHealth Collaborative. "For doctors in small practices, it's risky to invest $25,000-$50,000 for an [information technology] system," he pointed out, noting the marketplace currently provides no incentives to do so.