Just briefly, I want to talk about the electronic medical record (EMR) from the point of view of patient expectations of how they will be managed. We ‘ve talked about errors in the record, as well as the complexity of the privacy issues. And for the record, I want to repeat what Fred Trotter wrote as it concerned Microsoft’s new Health Vault:

Medical records belong to the patient, except when they don’t. They should be accessible to the patient except when they shouldn’t. The records of minors are always open to their guardians except when they are closed. Segmenting data in order to protect portions of health information is currently an intractable problem of free-text analysis. Tagging patient records with critical information is difficult. Trust is far more complex than is first seems. Finally, patients should be allowed to “control” their own record, except when that control would allow them to do something that would invalidate the record.

But the question I have concerns that of omissions and completeness. Will patients have different expectations of doctors and hospitals once they know they’ve converted from paper to electronic medical records? Will the EMR take on a different status of sorts in the patient’s mind? In the old days (most of which are still with us) the patient knew that his or her paper record was scattered about the different providers, and for most, there was no single, all encompassing medical record. But the vision and the hype for electronic medical records is just that — if there’s an emergency, a hurricane, or you are on vacation without your medication, your info will be at hand through the net.

But as we know, that will not be the case most times. Either by design, incompatibility, law, or systems failure, something will be missing. Will it be important information? Who knows. But the public, as it has with banks, credit cards and other electronic dependencies, may believe it to be complete. They may, in fact, have a view of EMRs that is more in line with the industry’s marketing image than with the intricacies or record-keeping reality.