ehealth » SharedRecords

SharedRecords: A model for global infrastructure with local control

Whether you believe the answer to better information access is personal health records, electronic medical records, or national health infrastructure, you can appreciate the need for a neutral infrastructure. The idea of SharedRecords is really more of a social contract than just a technology. In the SharedRecords point of view, the ability to access and share critical information like health care histories and land records should be considered a public good in much the same way that we view roads and waterways.

Analogy with transportation

To flush out the analogy with transportation systems, consider each of the standard approaches.

NHI - a national healthcare infrastructure is the equivalent of the government providing not just the roads and railways but also operating all of the vehicles and determining all of the routes, rates, and timetables.
EMR - electronic medical records are more like private toll roads were each toll road is provided by a clinic. The clinic also provides the vehicles and the drivers for the roads. If you want to go somewhere beyond their road, they'll drop you off at the end of the road nearest your destination.
PHR - personal health records stored with private companies are like toll roads where the patients provide the vehicles and the clinics build the interchanges.

In our view, SharedRecords corresponds to public roadways that guarantee public rights of way and can handle all sorts of vehicles and types of traffic. Just as public roads were able to support horses and buggies and cars and trucks, our common infrastructure for information will be most successful when it includes everyone.

SharedRecords description

In it's simplest form, SharedRecords provides a way for hospitals, physicians, and patients to:

store records
- each record is encrypted with a unique key before storage
retrieve records
- only the person (or clinic) storing the record knows the key for a given record
share records
- the key can be given to authorized personnel either on paper (usually as a barcode) or digitally. In this way, sharing an electronic document is no different than sharing a paper document.
auditing record access and updates
- the history for every record, including when it and where it was created, when it was accessed, and if new versions have been created is stored and available as part of the public record.

This method of sharing records critical to reducing the cost of adoption and providing the local flexibility necessary to best serve the patient's needs. Because SharedRecords can be managed exactly as existing paper records, the infrastructure provides interoperability between offices that work entirely on paper and those that use all electronic documents. It also avoid the need for any centralized administration of public / private keys (SharedRecords does not require a PKI or public key infrastructure because each document uses a unique symmetric key which is managed locally). Lastly, because all of the records are encrypted the centralized storage of the records does not create the same type of privacy concerns and issues typical of today's PHR, EMR, and NHI systems.

Furthermore, the auditable nature of SharedRecords means that:

digital records now have the equivalent of a secure paper trail, and
paper records (e.g. printed versions of records that contain the SharedRecords key) can not be forged

For more, see http://sharedrecords.unamesa.org/ or the prototype SharedRecords web service operated by UnaMesa at http://www.sharedrecords.org/