Central Databases and Clearinghouses

I don't actually advocate this idea, as I think there are too many ways it can go wrong, but I propose it as a thought experiment. The other day, halfway through my anesthesia cases, I get a call from a pre-operative nurse. An 85 year old gentleman having prostate surgery visited his cardiologist for "preoperative clearance." He remembers having an EKG done in the office, and was told, "It's fine." He doesn't have a copy of it. When the preoperative nurse calls the cardiologist's office, they say their system is down and they can't fax over the EKG. The patient is next in line for surgery; the nurse would like to know whether I want to order an EKG. For me, the answer is simple: yes. I trust the patient and expect the EKG will be "fine." But if I went forward with anesthesia and he had a cardiac complication and I didn't actually review the EKG, that wouldn't be sound clinical judgment. The EKG is simple and quick; it's ready for my review by the time I meet the patient in pre-op. Indeed, it is normal sinus rhythm with left ventricular hypertrophy, nothing to write home about. The anesthesia proceeds smoothly.

This happens often, especially with labs and EKG in the preoperative setting. But over time, this incurs a significant expense. If we had access to his cardiologist's data, we wouldn't reorder the test, which probably gets billed for a couple hundred dollars. Why not build a national database as a repository of every single lab, EKG, and radiology study done on patients throughout the country? Most hospital systems now already use electronic records. Many people are struggling to build ways for these systems to communicate. But labs are pretty standard, and it seems that having them reported to a central clearinghouse and then retrieved from that database could eliminate the problem of "having labs done but no one can find them." Of course, patient privacy, regulating access, preventing unwanted intrusions, and other HIPAA related issues rise to the forefront. But I imagine if those security issues can be appropriately addressed, this can significantly reduce unnecessary testing, improve population research, and aid clinicians everywhere.