Over the past few years, development of health information infrastructure (HII) has moved rapidly from “What is it?” through “Why do we need it?" to “How can we do it”? 

Although more than 100 communities are now pursuing efforts to provide anytime, anywhere healthcare information and decision support through HII, a realistic assessment of progress reveals a sobering picture of much activity, but few (if any) new systems in production. The handful of communities with operational HII has not increased significantly, and physicians using EHRs in their office practices are still a distinct minority (albeit growing slowly). Using the simple measure of how few Americans have complete electronic health records, much clearly remains to be done.

Nevertheless, there is reason for optimism. Health record banking, first proposed in 1997 by Dr. Bill Dodd, a general practitioner from Scotland, has emerged as a feasible approach to building HII and is gaining increased attention.

A health record bank serves as the custodian of a complete copy of your health records (the originals remain in their current locations). After each episode of care, your provider deposits newly generated information in your account (required by HIPAA if you request it). You retain sole authority over access to any part of your health record bank account information. Normally, you make the complete record available to your own doctors and to healthcare personnel treating you in an emergency. You have access to your records yourself, including the ability to add information. The concept of a health record bank is simple, and its operation is straightforward and inexpensive.

Health record banking addresses the key problems of privacy, financial sustainability, interoperability and EHR incentives for physicians. By giving consumers clear ownership and control of their own complete electronic records, each person is empowered to establish and maintain his or her own customized privacy policy. Ultimately, this is the only way to satisfy everyone’s privacy requirements.

Financial sustainability could initially come from small monthly fees for health record banking accounts; a 2005 national survey found 52 percent of consumers willing to pay $5/month or more. Later, as the healthcare savings are demonstrated and the value of aggregate information increases, other revenue sources could be engaged to reduce (and perhaps eliminate) these fees.

Health record banks greatly simplify interoperability. By requiring all health record banks to use the same data standards for deposits and withdrawals, everyone in the healthcare system needs just one identical interface. Since each patient’s complete record is in a single account, the banks do not need to communicate with each other to retrieve patient data.

Finally, health record banks provide at least two options for EHR incentives to physicians. Banks could pay for deposits of standard electronic reports of outpatient encounters generated by office EHRs. Alternatively, the bank could provide no-cost access to an ASP-model EHR in exchange for transfer of the information generated into patients’ accounts.

Of course, the institution operating a health record bank must be trusted. To help accomplish this, federal regulatory legislation was proposed in the last Congress and will be reintroduced in this session. A trustworthy technical architecture is also necessary, and is achievable with state-of-the-art technology.

The appeal of health record banking is growing. Louisville, Ky., is planning a health record bank, and a recent report to the Washington state legislature recommended development of a statewide health record banking system supported by the governor’s $9 million funding request. Also, the recently announced Dossia initiative led by Intel and Wal-Mart is a health record bank for their employees. Every community that now has an operational HII is using key elements of the health record banking model.

It is time for health record banks to be built and operated to determine if their full promise can be realized. I hope that 2007 will be the turning point in HII history – when the exploration and experimentation ends and true implementation efforts begin in earnest.

William A. Yasnoff, MD, PhD, is Managing Partner of NHII Advisors, an HIT consulting firm. He previously served as Senior Advisor, NHII, U.S. Department of Health and Human Services.