Isn’t it amazing how we can travel the world and pay for nearly anything with a credit card? This is possible because credit cards are simple: they use a standard device; they are relatively secure; and they use a common data standard. In the world of electronic medical records, we should strive for this same level of interoperability. Just like a credit card, we should be able to use our medical records anywhere in the world, anytime we choose, and maintain personal control over our information at all times.
Credit cards use a standard device to store information; all of the data is encoded onto a magnetic stripe. Since credit cards don’t carry much data, this works well. Medical records, however, are quite complex and sometimes require a substantial amount of storage, especially when including x-rays or other images. Another important difference is that medical records must be constantly updated. Carrying outdated medical records is more dangerous than not having any records at all. Credit cards aren’t designed to have their data added to or changed, they are “read only.” Medical records need a standard device, similar to a credit card, but with the ability to read and write data. USB storage devices are easy to carry, and offer plenty of storage space; and some are even designed to fit in your wallet. Almost every computer built in the past 12 years has a USB port, so they should be nearly as universal as credit card terminals.
Credit cards are relatively secure. The cards are protected by security codes, expiration dates, and encryption when used online. Most people keep their credit cards in a wallet or purse, so they are accessible at all times. Medical records should be used in the same way. Patients should have their data handy at all times. Just like making a purchase, their health information should only be available to physicians they choose. One key difference is that credit card purchase information travels over a network. Sending medical data over networks is where the model fails. There are many reported health data breaches every year, many of which lead to identity theft. Rather than using a network like the banking industry, medical records software should save data in a standard format on a USB drive. Just like with online purchases, encryption can protect sensitive medical data.
Credit cards use a common data standard. Terminals all over the world can read credit cards, regardless of manufacturer. This is possible because of standard data formats. Magnetic stripes have been exactly the same since their introduction in 1975; however almost everything has changed in medicine in the last 35 years. Even though medical technology will continue to evolve, interoperability will require a common way of storing and communicating data. Extensible Markup Language, or XML, is a common way to store and communicate data. It is used everyday by millions of websites and software programs worldwide. There is already a version of XML, known as Health Level 7, or HL7, that is specialized for communicating and storing medical data. Choosing a standard data format is necessary for any interoperable system.
The Solution to Interoperability is SIMPLICITY. Rather than complicated and insecure national health networks, we should look to the credit card as a model for an interoperable health system. First, an interoperable medical records system should use a standard device, like a USB drive. Second, it should be secure, using strong encryption and personal control over the USB drive. Finally, an interoperable system should use a standard format to store and exchange data. The result would be a simple, secure medium that allows individuals complete control over their comprehensive medical information.