There’s no way I can see a global central clinical database working. Likewise the current models of distributed databases are chaotic and prohibitively expensive (monetarily and politically). Instead my best guess is that we’ll evolve into a social media integrative model.
For example, Twitter, Facebook, this blog along with other blogs can be configured to share information seamlessly. It shouldn’t be too long before an EMR installation would include the same type of processes where a list of other systems would be available in which to simultaneously post patient registration data (what I call person-level data) along with visit specific information (visit-level data).
In this model when a patient shows up that comes from another office that is using an EMR we’d search to see if that EMR could receive incoming posts. If so we’d select it and import the patient registration data, update it if need be (which would post back to the original contributing system). As the conclusion of the visit the new visit-level data would post back to the other system at the same time it posts to ours. Subscribing systems would see the note as an “outside note” but integrated with the medical record so if the patient returned the record would always be up-to-date.
It would be the responsibility of everyone to make sure of the accuracy and integrity of the patient data. EMRs that have junk in them would very quickly be “unsubscribed” and their users would suffer.
I’ve long thought that the social aspect of medicine was about to take off is some manner, but I was thinking more of physician to physician social collaboration as opposed to practice to practice. Dr. Voran outlines here really a new social economy of patient information controlled by the patient. There’s a potential business plan in here both for new EHR systems as well as the applications to support them, the connectors. Shows how the social sphere is could really be a kind of new online economic model for many vertical markets and types of information.