cloudsAs I progress in life I have occasion to visit new and different health care providers. Every one of them gives me a six to eight page form requesting information. It’s the same information every time. It may be formatted differently but it’s still the same information: name, DOB, address, insurance, past history, ROS, permissions, etc.

The electronic medical record was planned to eliminate this endless repetition by putting every one’s information in a “machine readable form” that could then be read by the computer systems at any health care facility.  My colleague, Bruce Niebuhr, and I spent many years following the evolution the electronic patient record or electronic medical record.  Recent years have seen significant advances in the field.

Many hospitals and group medical practices now use some form of electronic record keeping (1). Sharing of information between hospitals and affiliated group practices has increased also. Thus, one can be referred to a provider and that person can access your information on-line. This however does not happen very often. From Thompson, “For example, the [WRJF] study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards for exchanging that data with other providers to allow widespread physician access to a patient’s records” (2).

Even with good inter-provider cooperation, I still find myself in the position where one office swears they sent over the data but when I get there that information is nowhere to be found. Again, I offer my own copy for inspection so we can proceed.  This is the interplay of human fallibility with computer systems and it highlights the basic ethical question regarding information. Who owns it and who is responsible for insuring it is available where and when it’s needed.

I think the case is clear that there are many “owners” in this endeavor. The patient owns themselves and whatever he/she can personally report about themselves is theirs. The providers own what they create: test results, assessments, notes on treatments, internal accounting and so forth. Everyone has privacy rights. Patients have the right to control who sees test results owned by the provider. Providers have the right to keep internal accounting and employee data private.  It’s a complicated process.

What about putting all this information “in the cloud?”  The cloud is that transparent realm of distant servers where everything is kept and you can access it anywhere, anytime. It works for your favorite musical selections and family pictures, but how about medical data (3, 4)? Security issues aside (they can always be solved), I like the idea because with a cloud-based information structure there can be many interfaces. There can be one for providers and one for patients. Everyone could review, edit, add and delete information as necessary and stay within their ownership and privacy rights. I’d never have to fill out those redundant “new patient forms” again.


  1. Robert Wood Johnson Foundation . Hospitals, Physicians Make Major Strides in Electronic Health Record Adoption, July 8, 2013.–physicians-make-major-strides-in-electronic-health-re.html
  2. Thompson, D. U.S. Hospitals Triple Use of Electronic Health Records, US News and World Report, July 8, 2013.
  3. Terry, K. Medical Practices Move Health IT To Cloud, InformationWeek, 9-6-2013.
  4. Spottswood, T. Electronic Medical Records in the Cloud: How Safe is It? Northwest Regional Primary Care Association.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: