The discussion about health care reform in 1994 served to highlight the fact that our health care system is a highly diversified system of distinct institutions, including individual doctors, HMOs, PPOs, clinics, pharmacies, private and public hospitals, hospices, laboratories, etc. In order to provide effective health care, it is imperative that they be able to share information between them. Information systems that are not planned with this in mind are headed for ultimate obsolescence, because they will have failed to provide the principal benefit.
I take it on faith that we should be planning for a future where electronic medical records will be portable across systems. People move, people change doctors, and records need to follow them around. If a patient requires treatment while they are traveling, then remote access will be required, perhaps from the personal physician or from the remote physician. Caregivers will often be called upon to access information from their homes, or from computers that they carry with them on travel. If nothing else I expect to be alive thirty years from now. I don't really know what computers will look like in thirty years, but I sincerely hope that my medical history will still be available.
I hope this makes it clear that the importance of portability of data between systems cannot be overestimated. In particular, medical records should become just as usable as any other record in the new system, independent of the system vendor. This means that ``open standards'' are of paramount importance in the development of future patient record systems. Vendors selling systems into this market will compete in terms of the features that they provide, the service they provide, or any of a number of other factors. They should not however be encouraged to ``captivate'' their customers by creating records that can only be used within a ``closed'' system, because this will defeat the ultimate goal of portability of individual records.