Goldsmith: Electronic Records Transformative, Though Challenges Exist


Former Indianapolis Mayor Stephen Goldsmith touts the innovation of the push toward electronic health (and other types of) records. Although, there are challenges in building the connecting networks, he contends. Read his column on the matter in Governing:

Whether one is discussing health care, education, housing, or any of the other myriad and complex public challenges, the path to transformative breakthroughs starts with electronic records. Unfortunately even the process of creating electronic records presents enormously difficult issues. In my work as a prosecutor and mayor, I found that every entity can see how easier access to data from other organizations will facilitate better decision-making — but inevitably, each entity questions whether the other organizations can be trusted with its information.

To move toward an integrated network of digital information requires that participants agree on terms, governance, protocols and a process to mediate conflicts. Designing these data networks is complicated because you’re actually creating a network of networks, all of which have their own issues. A hospital will manage a network of providers and interested parties — including, for example, its clinics and its doctors. Yet this network will also be part of the statewide electronic network. To the governor’s health secretary, he or she is at the network’s center, but to the hospital president, or medical group administrator, or community health center, they are the center, and their efforts and interests take precedence. Harmonizing these interests requires careful mapping and understanding of the consequences.

That is the easy stuff. The electronic record is a step towards better outcomes, not an end in itself. Who, for instance, gets to define the outcomes, especially when an outcome that is central to one party is not so central to others? Huge amounts of accessible data can now be managed to provide insights that will dramatically improve public interventions, but that management requires careful consideration about how it happens, who supports it and how the data gets to the field worker. Too often these systems serve the person at the top but not the person really doing the work. We have seen this in, for instance, large federally supported child welfare systems that view the job of the caseworker as less important than supporting oversight in Washington.

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