In search of a sexier model

Dr. Bill Yasnoff hasn’t been hauled before Congress yet, but he’s waiting for a call. No, he’s not embroiled in the IRS scandal, but he might have an idea that saves the cause of patient data exchange and helps make the Affordable Care Act, well, affordable. Yasnoff, who served in the Department of Health and Human Services under former Secretary Tommy Thompson, has been promoting regional electronic health record banks for several years, and thanks to difficulties with the existing model, the idea could gain some traction.

In a March 2013 article published in the Journal of the American Medical Association, Yasnoff explained why the existing institution-centric model has failed. The goal of health care IT should be to make comprehensive electronic patient records available when needed, but under the existing model it’s difficult to get the comprehensive information required to avoid duplicate tests and medical errors, which are key cost drivers.

That’s because the existing IT architecture prevents an efficient data search, as the information has to be retrieved and put together before clinicians can determine whether it meets the search criteria. “You have what computer scientists call a sequential search, where you have to look for one thing at a time,” Yasnoff noted. “Sequential searches are incredibly inefficient and take huge processing resources.”

He said the reverse is true with health record banks, which are central repositories and could be operated as private entities, much like financial banks. To protect the patient information contained in the records (under this model, the patient controls the data), the banks would have to be regulated by the government, also like financial banks.



Under Yasnoff’s model, basic health record bank accounts would be free to consumers. Revenue sources would include optional apps, priced at about $20 per year for reminders and alerts, plus advertising (with consumer opt-out for a small annual fee) and fees for research use of the data (with consumer permission). Health care organizations would interface with the bank, not with each other, and legal agreements would be negotiated between the consumer and the bank.

Yasnoff acknowledges that health record banks are unproven, but unproven models are all we’ve got. Not everyone is giving up on the current model, but it might be time to try something else because if we’re going to reduce costs, one of the essential ingredients is a sustainable model for patient data exchange. 

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