Siddhartha Mukherjee:

Finally, we need to acknowledge that our E.M.R. systems are worse than an infuriating time sink; in times of crisis, they actively obstruct patient care. We should reimagine the continuous medical record as its founders first envisaged it: as an open, searchable library of a patient’s medical life. Think of it as a kind of intranet: flexible, programmable, easy to use. Right now, its potential as a resource is blocked, not least by the owners of the proprietary software, who maintain it as a closed system, and by complex rules and regulations designed to protect patient privacy. It should be a simple task to encrypt or remove a patient’s identifying details while enlisting his or her medical information for the common good. A storm-forecasting system that warns us after the storm has passed is useless. What we want is an E.M.R. system that’s versatile enough to serve as a tool for everyday use but also as a research application during a crisis, identifying techniques that improve medical outcomes, and disseminating that information to physicians across the country in real time.

I don’t disagree with this sentiment at all, but this paragraph is assuredly much easier to write than implement. Just as Mukherjee points out earlier in this piece that, “medicine isn’t a doctor with a black bag,” [1] EMRs are not simple digital copies of paper notes. These are highly complex systems encompassing clinical notes, order writing, laboratory and pathology and radiology results, vital sign tracking, medication administrations, and on and on. And the data these systems generate is highly dimensional. Even if we were able to easily “encrypt or remove a patient’s identifying details” [2] I am skeptical that the data would prove easily interpretable. We will need investments not just in ‘making our EMRs better’ but data science and clinical researchers to leverage that data for improving our pandemic response.

This is really a great quote overall: “Medicine isn’t a doctor with a black bag, after all; it’s a complex web of systems and processes. It is a health-care delivery system—providing antibiotics to a child with strep throat or a new kidney to a patient with renal failure. It is a research program, guiding discoveries from the lab bench to the bedside. It is a set of protocols for quality control—from clinical-practice guidelines to drug and device approvals. And it is a forum for exchanging information, allowing for continuous improvement in patient care.” ↩
You don’t realize how many places identifying information is within a patient’s “chart” until you start trying to remove it. Think about a consult note that I write. Yes, the patient’s name, medical record number, and many other identifiers are in the document headers in structured fields. This could easily be removed. But, I also use the patient’s name and potentially other identifying information throughout the note. So, then you want to scan the note text itself and character match the patient’s name and remove any instances where you find it. What about when I misspell the name? Or use a nickname? Or refer to their parents and use their names? The complexity of the problem grows exponentially. ↩