Running Head: UNIVERSAL PATIENT DATABASE

Universal Patient Database Nicholas Quinn Northeastern University

UNIVERSAL PATIENT DATABASE

Abstract For many years a universal patient database has been thought about but never put into effect. This type of database would essentially be an electronic record of a patients medical history spanning their entire lifetime. Any important piece of information, allergy, or medication would be included. This would provide a professional working with a patient full access to be able to give them the best care possible. The positive sides of this system are bountiful. Doctors would be able to make much better diagnoses with less guessing or risk. Pharmacists would be able to make sure there is never a case of negative drug interaction, duplicate therapy, drug abuse, or allergic reaction. Diagnosis and medication errors would decrease dramatically. The reasons this is being held back is due to concerns over privacy, cost, standardization, and few other smaller matters. There is not currently an organization that would be publically accepted to host this amount of information and the cost to put this all into effect would be sizeable. The best path to take for the smaller logistics of the system are also unclear as of now. There are, however, answers to all of these problems and many different possible paths.

UNIVERSAL PATIENT DATABASE

Background A universal patient database would be an electronic record of every citizens medical history that could be available at the fingertips of all healthcare industries. The benefits would be numerous and would save time, money, and lives. Without this type of patient database that is accessible by more than just individual hospitals, pharmacies, or other health care companies there are many avoidable errors that can occur. In health care, the more information that is available directly corresponds to the quality of care that a patient can be given. With a universal patient database, all of the patients information, medications, and allergies that they often forget would be available at the click of a button. There are innumerable pros to this type of system but there are also a few cons that are keeping it from being implemented.

Pros of a Database System The positive side of things for a system such as this are almost innumerable. The advances in healthcare would be astounding and patient care numbers would go through the roof. In all areas of healthcare such as pharmacies and hospitals the quality of care could increase tenfold and medication mistakes would become a thing of the past. All of the viable information on a patients medical history would be accessible thus eliminating the chances that a patient does not know their allergies or medications they are taking. When it comes to allergies, this can be a life or death situation, which should always be avoided when possible. That also goes for other medication errors that occur when the communication is just not there. It is commonplace in the healthcare industry that the

UNIVERSAL PATIENT DATABASE elderly forget this pertinent information or those that are younger just do not know. These mistakes occur from a lack of communication, which is exactly what this system counteracts.

It opens up the communication to every healthcare professional that needs it. If a patient has a primary care physician but is also seeing multiple specialists or is in and out of hospitals this information is often faulty. Most likely the only knowledge a medical professional obtains is from what the patient tells him or her and possibly records from the primary care physician (Gaffey, 2009). However obtaining these records is a slow process and does not encompass all the other outside treatment the patient is getting. This absence of information transferred to these doctors, pharmacists, and healthcare providers is what causes things such as duplicate therapy errors or drug interaction mistakes. This database system would provide great assistance in that it would eliminate these issues of unawareness. According to the American Association for Justice (2012), preventable medication errors are the sixth biggest killer in the United States. This procedure could eliminate that statistic off of any list. The only problem is, there are a few big cons to this.

Cons of a Database System There are several things holding back the implementation of this program. All of which have their challenges to overcome yet are still doable. The biggest concern in the public eye as well as all-around is the privacy factor. For something like this to be realized, a large organization, such as the government must be able to oversee and create it. The issue there is that the public doesnt trust the government enough to have access to their records. According to a survey done by Forbes only 27% of the American

UNIVERSAL PATIENT DATABASE population surveyed would trust the government with this information. However, out of those same people that were surveyed, 71% would be fine with a hospital, physician, pharmacy, or clinic having that information (Greenberg, Andy). Based on this,

Americans do want this system put in place but they do not know who it should be put in place by. In the view of the general population the government is too untrustworthy to be allowed to hold this information but there is no other organization big enough to put this in place. Those such as Microsoft or Google may be looked at but they have the same trust issues if not even more so than the government. The citizens only trust healthcare organizations with their medical records. So why not create an organization with the sole purpose of implementing this program? That is where the number two issue of cost comes into effect. To create this type of universal database spanning across all types of healthcare bodies would be very costly to construct and coordinate. According to Sninsky (2008), every hospital, pharmacy, health clinic, and others would need to use the same system and model for their database. Also, a new organization or governing body in the medical field would need to be created in order to oversee this process. This would be the only way for the public to trust this arrangement. It would take a lot of money and a lot of man power to create as well as take a very long time to get up and running. Although it would eventually be worth it, many are worried about the meantime and if an organization such as this would last. That is another concern of many. Due to this being a new system there would be a need for standardization and a real trial and error period. As with anything new there can be many unanticipated problems or downfalls. This is scaring people into taking the

UNIVERSAL PATIENT DATABASE leap. Whichever organization would have control over this would need to figure out the best ways to handle the system. They would need to look deeply into the structure of it, the security, who can access it, how it is accessed, what information can be seen, as well

as many other arising issues (Jha et al. 2006). All problems however have a solution, and for a device such as this, the benefits far outweigh the costs.

Possible Resolutions to These Issues The solution to these problems and to getting a universal patient database of medical records implemented needs to include many different factors. The most important is that is has to be secure. Citizens do not want to chance their medical information ending up in the wrong hands. It needs to be private. Only those doctors or pharmacist or specialists in direct contact with the patient should be able to view it. It must be universal. Regardless of whether it is a high-tech hospital working on a patient or a small private clinic they should all be able to get to this information. It should be worth the cost. As aforementioned, this could be an expensive endeavor. Therefore, the benefits and results in the long run must be substantial enough to back up the venture. As for privacy, there are many possible solutions to this. If the database were to be accessed on the Internet, it must be very secure. Millions of people trust their banking and money to be online so why not their medical records? According to a survey done by the Pew Research Center 51% of adults in the United States use some form of online banking and 61% out of Internet users us do it. This is over half of the American adult population that trusts their money, their future, and all their hard work to be accessed online (Fox, 2013). If the same, or even greater security goes into creating this system, why should the outcome be any different? If a username, password, PIN number, and id

UNIVERSAL PATIENT DATABASE number were implemented it could supply various measures to make sure those who

should not be accessing the information are kept out. A healthcare organization could be created to oversee and realize this, as an organization based on the improvement of citizens health over anything else would be a more trusted source than say the government or a for-profit organization. Privacy is the biggest issue holding this database back from happening, but there are so many ways to counteract this. Small steps can be taken in all facets of the process to make sure this is a safe and secure network. A number or code instead of the patients names could be used to identify them on the system, making it nearly impossible for anyone who is not working directly with the patient to find them. Patients could also be notified by email or text message any time their profile is accessed, giving them up to the minute knowledge of how their private information is being used. Any misuse could be reported to the managing organization that could shut down access to the patients profile until it is looked into. These are only some examples of fail-safes that can be employed all throughout the process, making sure that there is no point that can be compromised. However, even if most of the privacy issues can be solved, cost is always a deal breaker. The price tag it would take to put this system into place would be large, but there are many avenues that can be explored to help lessen the hit. First and foremost, if this system were accessible through the Internet, all the hospitals, pharmacies, and clinics would not need new technology or computers to be able to access the database. They would not need to purchase new programs or update any software. However much the individual companies want to put into advancing this program they can do on their own. All that would be absolutely essential they would already have. For an organization to be

UNIVERSAL PATIENT DATABASE created and capable of doing this they would also need funding. This could be found

through sources such as the government, pharmaceutical industry, grants from healthcare facilities, and many other possibilities. The government should and would need to play a large role in this even if they are not getting control in the end. They would need to regulate the laws surrounding this and should be responsible for funding it, as it would be a huge step towards improving health care in the United States (Sninsky, 2008). Through grants, taxes, and budgeting towards this they could greatly reduce the cost that could then be picked up by other groups such as the pharmaceutical industry. This is a very wealthy industry that would be greatly improved with a patient database like this, giving them abundant incentive to get this up and running. As it would be a newer venture, there is always the chance it doesnt go as planned. People may not believe in the strict privacy of the program at first or may be cautious to enroll at the beginning. However, as with anything new it takes time to become mainstream. According to Fox (2013), and building off a prior example, since 2003, the number of online bankers has doubled, and that number increases every year. There is no argument that this will not do the same. It may take time to become a forefront in the medical fields but it is extremely worth it. Especially in this technology heavy age that is upon us, it should be picked up much quicker by the people. Every problem has a solution, and these are just a few of the many answers.

Conclusion A universal patient database would synchronize every center of healthcare and put all the information available on a patient into one accessible file. In principle, this would allow every healthcare professional a patient works with access to all of their previous

UNIVERSAL PATIENT DATABASE

medical records. This is an essential part of giving a patient proper care, and the care that they deserve. When it comes to a persons health, the more information available to the doctors, pharmacists, specialists, and others means the better care they receive. This system has not yet been put into effect but is on the future horizon. It is being held back by privacy issues, cost problems, and concerns about if it will work out among other things (Rothman, 2012). These all have solutions, the best ones just have to be figured out. With this project as a possibility, healthcare will continue to grow and improve. The limits are endless and the improvement in patient care and doctor practice would be immeasurable.

UNIVERSAL PATIENT DATABASE References

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Fox, S. (2013, August 7). 51% of U.S. Adults Bank Online. PewInternet.org. Retrieved November 2, 2013, from http://www.pewinternet.org/Reports/2013/Onlinebanking/Findings.aspx Gaffey, A. D. (2009), Communication and documentation considerations for electronic health records. J of Healthcare Risk Mgmt, 29: 1620. doi: 10.1002/jhrm.20010 Greenberg, A. (2010, January 25). Health Care's Digital Privacy Debate. Forbes. Retrieved November 13, 2013, from http://www.forbes.com/2010/01/25/digitalprivacy-ponemon-technology-cio-network-healthcare.html Jha, A., Ferris, T., Donelan, K., DesRoches, C., Shields, A., Rosenbaum, S., et al. (2006, October 10). How Common Are Electronic Health Records In The United States? A Summary Of The Evidence. HealthAffairs.org. Retrieved November 2, 2013, from http://content.healthaffairs.org/content/25/6/w496.full#cited-by Preventable Medical Errors The Sixth Biggest Killer in America . (2012). American Association for Justice. Retrieved November 1, 2013, from http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm Rothman, B., Leonard, J. C. and Vigoda, M. M. (2012), Future of Electronic Health Records: Implications for Decision Support. Mt Sinai J Med, 79: 757768. doi: 10.1002/msj.21351 Sninsky, C. (2008, March 4). Developing Universal Electronic Medical Records. National Center for Biotechnology Information. Retrieved November 13, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088297/?report=classic