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In his fascinating recent book, The Creative Destruction of Medicine, Dr. Eric Topol describes how technologic advances are changing the paradigm of medical practice from one which is largely physician-centered to one which is more directly patient-centered. The remarkable advances in the informational processing capacity of modern computers has facilitated a virtual revolution in our ability to explore the genetic substrate of disease. There may in the future be the ability to generate a personal genetic “fingerprint” which not only identifies the unique characteristics of an individual’s genome, but also identifies his susceptibility to various disease states. Miniaturization has permitted the creation of ultrasonic machines not much larger than a cell phone which can perform the essential functions of the large office console of the past. Facility with nanotechnology will transform the entire field of drug delivery and will revolutionize the diagnostic capabilities in the field of cancer.
 
Various cell phone “apps” are being developed which can monitor an individual’s blood pressure, blood sugar, heart rhythm, and potentially many other vital parameters. All of this information can then be transmitted electronically in order to determine the most appropriate and informed personalized therapy.
 
Perhaps nowhere, however, do we find the potentials and the challenges of this new technologic age more clearly focused than in the electronic medical record. We live in a digital age when an individual can put a piece of plastic into a machine in one corner of the world and pull cash from his bank account on the other side of the globe. And yet, that same person might appear in an emergency room for a severe acute medical condition and have no access to his own medical records stored away in his doctor’s office or in a different hospital in the same city.
 
The potential of the electronic medical record is clear and enviable – seamless access to all relevant medical information available real-time for optimal patient care; access to community or population-wide disease and care information critical to public health and social planning; information regarding disease presentation and therapy and outcome vital to further medical research regarding pathophysiology and therapy. One could certainly imagine that the profession capable of the sort of advances described above would be “ahead of the curve” when it comes to informatics. And yet, just the opposite is the case – the medical profession lags somewhat painfully behind the rest of the society in the implementation of electronic information storage and transfer. Despite a major governmental initiative, which includes direct reimbursement, only 50% of physicians have adopted electronic health records in their practice, and a significant majority of those who have undergone the conversion are unhappy with their choices. Hundreds of products have been marketed without any assurance that they can effectively communicate with each other, or even optimally serve their primary objectives. The conversion process can be both time and money intensive, which is difficult for many providers who are already overtaxed in both regards. However, the professional reluctance reveals more than the just the inertia of status quo, or concerns regarding cost. One of the single greatest strengths of electronic information is also one of its greatest potential weaknesses – the ease with which information can be stored and transmitted makes it extremely difficult to protect the very privacy and security of that information. Credit card and identity theft have become common if not rampant in our society. What are the consequences of revealed private medical information? Unlike the ability to cancel a credit card and receive a new one, once it has been revealed that someone is under treatment for a specific disease, the cat cannot be put back in the proverbial bag. What might be the ramifications for employment, social status or even the availability of future access to health care?
 
At the Florida Heart Research Institute we have been fortunate to make many valuable contributions to medical knowledge based on our access to and sophisticated analyses of electronically formatted clinical registries. However, we recognize that the challenges that lie ahead will clearly require more standardization of language and more innovative approaches to the secure protection of personally identifiable health care information.