The health record banking model for health information infrastructure

The goal of health information infrastructure (HII) is to assure the availability of comprehensive electronic patient records when and where needed. An effective HII must overcome the challenges of privacy, stakeholder cooperation, incomplete information, and financial sustainability. The recent increased adoption of electronic health records by providers has created a real opportunity for HII implementation. Attempts to implement HII with systems that attempt real-time aggregation of institution-centric records stored in multiple locations for each person has been unsuccessful. The high implementation costs, incomplete data that inevitably results from lack of availability of all relevant information sources, and the difficulty of assuring ongoing stakeholder cooperation are key factors. A network of health record banks, community repositories of electronic health records with access controlled by patients, can address the key HII challenges. Privacy is protected by patient control, allowing each individual to establish and maintain their own privacy policy. Stakeholder cooperation can be accomplished by having individuals request their own data, invoking the legal requirement for providers to supply digital copies of their records on patient request. To achieve interoperability, ongoing financial incentives to providers can ensure that data supplied uses acceptable standardized formats. Financial sustainability can be achieved through new value created by the information itself when utilized for innovative applications for both patients and other health care stakeholders that are only possible when comprehensive records of individuals are available. Health record banking can therefore unlock the potential of HII to simultaneously lower costs and improve the quality of care.