While many patients and privacy advocates believe a federated model provides a higher level of protection against cyberattacks that attempt to steal medical data, this model also presents a significant barrier to accessing a complete medical record at the point of care. Because a federated model stores patient information at its point of creation, pulling together a complete medical record on an average patient requires access to numerous EMRs, all with different levels of availability, “uptime” and points of failure.
In the centralized model, all providers send patient information from every encounter to a secure centralized repository that maintains the complete record while making it accessible to authorized users. Although information technology security experts suggest that a centralized repository of sensitive data provides a better means to protect the data, patient resistance to centralized storage because of privacy concerns led to the industry embracing a federated approach to medical record storage.
For more than a decade William Yasnoff, MD, advocated the use of a centralized model for storage of medical records in a health record bank. In his model, each patient maintains complete control over the data, directing its use in patient care, disease surveillance, and medical research. Recently, Yasnoff published an article in the Journal of Biomedical Informatics where he outlines how the cited weaknesses of the centralized model could now be mitigated through the use of widely available cloud computing.