Docs for Docs

Wired 3.03, March 1995

HIGHLIGHT: This is the breakthrough the health-care industry has chased for 20 years. It's called the virtual patient record. And it's going to change medicine and health care forever.

Five years ago, what should have been a smooth surgical operation turned into a nightmare for Dave Morgan. The senior researcher at Motorola went to the hospital for surgery on a cancerous kidney. As he lay on the gurney, the anesthesiologist flipped through Morgan's medical records, which the surgeon would later need to operate successfully. The anesthesiologist placed the file on a nearby chair. Minutes later, Morgan was wheeled into the operating room, anesthesia filling his veins. The surgeon came in and, failing to find the records on the gurney, asked who had them. No one remembered where the records were except Morgan. As everything faded to black, he moaned, "They're on the chair."

Medical records are the first thing a doctor turns to when a new patient is admitted for treatment. But the records are often unavailable, or, during emergencies, there's not enough time to retrieve them. So doctors will fly blind, relying on sheer knowledge and experience rather than an understanding of the patient's history. Records - some estimate as much as 10 percent of them - also get lost. Usually, this doesn't cause any harm, but for some patients, such as those with drug allergies, it can be fatal. Many people end up in hospitals because drugs have exacerbated existing medical conditions - 7 to 10 percent of those under 65, according to the health-care consultants Towers Perrin.

Another problem with medical records: they are costly. Tracking doctors' procedures and patients' welfare consumes vast amounts of hospital resources, with back-office staff translating handwritten notes into databases on networks of workstations that process the information. According to one study, medical costs could be cut by 15 to 30 percent if doctors had adequate information when making decisions. With health-care costs consuming about US$1 trillion dollars a year, paper medical records could represent billions of misspent dollars.

Come up with a way to radically improve medical record keeping and not only will you save lives, you could make a few billion.

After his close call in the hospital (the surgeon found his records), Dave Morgan helped found the Computerized Patient Records Institute, a group devoted to developing systems for storing and accessing medical records and influencing the national standard that govern those systems. Morgan and the institute have found powerful allies in digital technology and wireless personal digital assistants. Take patient records out of paper form (where they are hard to copy, easy to lose, and tough to transfer), and they become virtual patient records - mobile bundles of bits that can be instantly shipped around the country, from hospital to doctor to pharmacy to insurance company. Likewise, turn the computer into a wireless PDA, and it, too, becomes mobile, following the doctor from patient to patient. Over time, the virtual patient record becomes increasingly detailed - it forms a complete profile of a patient's medical history, from birth to death. Combine everyone's virtual records, and an incredibly detailed model of the nation's health care emerges. Simulations can then be performed, calc