Isn't the stated end goal to have all records digitized so as to be accessible to any practitioner the patient goes to? And such a database would by definition allow a central body with the correct permissions to access those files.
Absent some stunning developments, I do not anticipate this will happen in my lifetime and I am 54 years old now. There are several major players in the hospital and outpatient clinic electronic medical records software market. The ability of different programs to talk to each other and share data is extremely limited, if not non-existent. As an example, the large multi-state system that I used to work for made a command decision two years ago to move all their EMR systems over to Epic. They are moving from state to state converting over all the hospitals and medical clinics owned by the system. Interestingly enough the hospital verison of Epic has serious difficulty in talking to and sharing/retrieving data from the medical clinic version of Epic, with all these facilities owned by the same healthcare system and these two versions are produced by the same company. Epic cannot talk to or share data with Centricity or NextGen or AllScripts or Cerner and vice versa. There is a lot of speculation that the EMR companies do this deliberately to make it far more difficult to change to another EMR system down the road. If you have a proprietary database that cannot be accessed by another program, or at least cannot be accessed without a whole lot of expensive custom programming, this is a considerable exit barrier to changing systems.
Probably the closest thing we have to a single system that can be accessed from multiple facilities that uses the same database is the EMR system used by the VA. They have done a crackerjack job in implementing VISTA throughout the VA system so that a patient in Arkansas can go to a VA clinic or hospital in Idaho and the Idaho facility can open up their chart and provide immediate care. But if that same patient goes to St. Alphonsus hospital in Boise, their version of Centricity EMR cannot access the VA system and vice versa. So there is no information exchange to facilitate patient care. The VA can print pages from the chart and fax them to St. Alphonsus, but there is no electronic transfer. When St. Alphonsus gets those VA records, they have to be scanned into their EMR system as a GIF or PDF, and you can do no data analysis in these scanned records.
The DOD also has a uniform EMR system throughout all of their facilities, so the notion of a military member hand-carrying their medical records file jacket from one duty station to another is a thing of the past. There has been much talk in Congress about how the VA and the DOD systems cannot talk to one another, and should both the VA and DOD adopt the same system? Millions, if not billions of dollars have been sunk into trying to get the systems to talk to each other, and last time I checked, they had pulled the plug on the project. Both the VA and the DOD have done much wailing and gnashing of teeth over adopting the other parties's EMR.
Now, what I think we may very well end up with in my lifetime is a centralized database of medical billing and coding information. The one thing that every EMR system can do is uniformly use and submit billing and coding using the ICD and CPT coding systems. This ensures that the healthcare facility gets paid. Medicare and the private insurers already uses internal databases with this information for data mining to see which facility and provider provides the best and cheapest care. This was happening long before Obamacare. It will be interesting to see if the Feds pass a law mandating a single database with data from all the governmental and private insurance payors. If that happens, then Balog's fears may come true: you can run a search to identify all people in the database with a particular diagnosis. You could argue that the existing government database that is supposed to get reports of all persons denied firearms ownership due to involuntary committments fills this role. But this is very different than some government functionary in Massachusetts being able to read your actual chart notes from your doctor in New Mexico.
