After reading Nick Jacobs post - Dirty Little Secret, I was struck by the fact that a development already underway, and one that the US government is investing heavily in already, may prove an avenue to a big science approach to curing disease.  It is the move toward sharable electronic health records that could cover a hundreds of millions of people, depending on how fast these are adopted by providers, and what arrangements for sharing access to such records are reached.

At present, private medical records belong, in theory, to patients whose histories they record.  They have been primarily paper records, and are rarely shared effectively even by different providers serving the same patient at the same time, much less offering a lifetime basis for continuity of care.  But as regional health information organizations (RHIOs) grow, and electronic records expand to cover patients’ life health, as well as their sickness histories, the potential will increase for creating enormous studies that can identify the best ways to prevent, diagnose early, cure and enable patients to recover from disease.

The model already exists within the Veteran’s Health Administration, whose large and disparate entities are already involved in a uniform, sharable health record on the veterans they serve.  This basic model could end up including the life health histories of the majority of the population of the United States, already 300 millions of people.  The privacy of individuals could easily be protected, as long as the continuous records for individuals can be shared in anonymous form.  Of course, this will require truly interoperable systems so that all appropriate providers can access them for individual patients’ needs, and researchers can access them for monumental research needs.

This should enable, if not cause, a shift toward a big science approach, with many researchers collaborating on the same data base, and required to share their findings for the good of all, instead of the small science that is intended to benefit those who discover a modestly better or even a “me-too” solution they can market successfully.  And unlike current small science, it should be possible to ensure that this big science pays as much attention to how to reduce the incidence and prevalence of disease, rather than merely how to cure it more profitably.