Technical questions on how to build and store an electronic health record (EHR) are trivial compared with the more visceral issues of who should own it, what it should contain, and who can input into it.  By 2012, 70% of physicians had faced those questions, made tentative decisions, and taken on an EHR system.

Today, each patient’s primary physician is expected to review and act upon data in the EHR.  That means the physician will demand a veto over data entering the EHR.  Without control over new data, volumes could become excessive (e.g., a personal DNA sequence), or contain time wasting chronicles (e.g. patient attempts at explaining mood swings), or worse — unreliable data from devices lacking FDA approval.  If uncontrolled, the EHR could become a medical hazard and career revitalization for malpractice attorneys.

Even with just data from welcomed sources, a physician’s EHR review work could be substantial.  Data coming into the EHR include prescriptions, physician-ordered blood, tissue and urine testing, assorted medical imaging, notes from other physicians or professional treatments or hospitals.  And now there is data from mobile apps.

Apple’s Healthbook app is expected to track blood sugar, heart rate, breathing rate, weight, hydration, and physical movements.  How many observations between doctor’s visits?  A lot.  Even before Apple enters the fray, other vendors were pushing weight scales, activity trackers, blood pressure cuffs, heart monitors, and diabetic condition monitors.  Some of those devices are Food and Drug Administration approved but some are not.  Any which are incompatible with the physician’s EHR data exchange standard will create difficulties and will likely be ignored.

A further concern is that physicians don’t get reimbursed for using the mobile technologies to deliver patient care.  Also, many doctors and patient advocates are concerned that Internet-based systems aren’t secured to HIPAA standards and that patient privacy might be breached.  Mobile technologies will not be widely accepted until compatibility, reliability, reimbursement and security issues are satisfied.

This physician-centric EHR is unlike what most patients had wanted to see. They fantasized of one where they are in charge, have convenient access to every data entry, and can control who has access to any part of the data.   After all, it’s our data! 

Unfortunately, we can expect the real EHR to behave more like an uncooperative bureaucrat.  Apple Healthbook may be as close as we come to something friendly.

Alan Daley is a retired businessman who writes for The American Consumer Institute Center for Citizen Research