Folks, I'm not sure the assumption that this is going to be a single
"mammoth" system is valid. There may be some confusion here between what
Google is proposing, and what the federal effort entails. The latter
strikes me as being focused on data portability, process standardization
and offering incentives, including subsidization.

While I think the speed of the effort is going to be a huge challenge,
the fact that medical records keeping is already highly structured
offers hope for success. In this sense, I see similarities between what
is currently happening in the medical records field, and what has
happened in the property recording field - a similarly highly structured
field of records keeping populated by trained specialists that has
successfully converted to electronic systems. In my opinion, that
success is largely due to its structured, specialized nature. However,
to underline the speed challenge, its also an effort that has occurred
over 2 decades (although without the subsidies/incentives). 

Many of the concerns expressed here - all legitimate - make assumptions
about NARA and the success/failure of its efforts in electronic records
keeping (unrelated, and dealing with massive inconsistent and
unstructured demands with inadequate resources) and a sort of "big
brother" fear of a single, mammoth, hack-able system. I don't honestly
see the connection to the former, nor have I seen a final proposal for
the latter. If your fear is of a massive federally managed system
maintaining your private PHI, such a system already exists in the form
of Medicare/Medicaid. This boat left shore a long time ago.

The county recently converted to an electronic medical records system.
We've had our hiccups, but overall its gone smoothly and quickly, for
many of the reasons I just mentioned. One area of success has been our
ability to convert file rooms to examination rooms, providing better
service, and more revenue. There are definitely areas of concern here,
but we're not exactly dealing with uncharted territory.

Dwight Wallis, CRM
Records Administrator
Multnomah County Fleet, Records, Electronics, Distribution and Stores
(FREDS)
1620 S.E. 190th Avenue
Portland, OR 97233
Phone: (503)988-3741
Fax: (503)988-3754
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