Electronic medical records are being viewed in some smaller countries like Iceland as a national asset. They are viewed as a means to improve population health and also to stimulate research in the country and elsewhere. Iceland has been pursuing such a strategy for years (see: Centralized Health Databases: Lessons from Iceland; Iceland’s Research Resources: The Health Sector Database, Genealogy Databases, and Biobanks; PDF) and Israel now seems to be pursuing a similar goal (see: Israelis' medical records to be put online for research):
The Israeli Cabinet...[recently] passed a decision launching the "National Digital Health Plan." Approximately...$286,490,000) has been budgeted for the plan which includes technological development, international cooperation, concentrated academic and industrial efforts and regulatory changes to encourage data research...."Israel has a gigantic database that embraces almost the entire population, a large population relative to – let's say – the Baltic countries, one of which has one million people in this database; we have almost nine million people. This is a focused database of the health records of almost each and every one of us over the last two decades," Netanyahu said. "This is a great asset and we want to make it available to researchers, developers and companies in order to receive two things: Preventive medicine and personal medicine, personally calibrated for each person." Netanyahu also said, however, that Israelis would need to agree to share their medical information. "Of course, this depends on the agreement of each person – this right is maintained absolutely," he insisted..... According to Prime Minister's Office Director General Eli Groner, "Every doctor in Israel will be able to see the clinical files of over 98% of the population." The new plan, he said, will "unify the system and create a voluntary data bank that will draw researchers and industry here from around the world." "We are upgrading the quality of the digital medical file so that future doctors will be able to make better diagnoses. We are certain that this decision will be of highest importance."
The Icelandic national database has been developed by a private company called deCODE Genetics. Here is a summary of its business model copied from its web site:
...Iceland, deCODE is a global leader in analyzing and understanding the human genome. A combination of factors provide unprecedented power to uncover the genetic basis of virtually any disease or trait. These include the generous participation of so many Icelanders in our discovery work, our comprehensive genetic and genealogical resources, the relative genetic and social homogeneity of the Icelandic population, and its high quality universal healthcare. Using unique expertise and population resources, deCODE has discovered genetic risk factors for dozens of common diseases....The purpose of understanding the genetics of disease is to use that information to create new means of diagnosing, treating and preventing disease.
Unlike Iceland, Israel's population is extremely heterogeneous. Rather than being primarily a database driven by research considerations like the one in Iceland, the National Digital Health Plan seems to have a dual purpose. It is designed to support health care delivery by an amalgamation of health files for 98% of the population of Israel and also to function as an asset for biotech research. The biotech industry in Israel has been highly successful with one expert asserting that Israeli research is present in between 25% and 28% of the world’s successful biotech-based solutions (see: One in four life science innovations has Israeli roots, says expert).
What is the likelihood that a similar "national digital health plan" could be adopted in the U.S. The answer is: pretty slim. For one thing, we don't have a unique patient identifier (see: Has the Time Come for a Unique Patient Identifier for the U.S.?). For another, we don't have a common EHR and EHR vendors have slow-walked interoperability in the past but there may now be a change in this attitude (see: What Epic & Cerner are doing for interoperability: 11 observations). Finally, the warring, tribal political factions in the country that conjure up paranoic ideas like "death panels" would probably view a national digital plan with suspicion (see: Death panel). Even the NIH is faltering in its attempt to build a large biobank, but this may involve bureaucratic blundering or research overreach (see: The Faltering Effort to Develop an NIH Biobank; Time to Pull the Plug?).