Considering that the practice of Aviation Medicine is focussed at the pilots, use of emerging technology in healthcare is inevitable for those who fly technologically the most advanced systems. One such development shall be the personal health record (PHR). PHR is the medical information in possession of an individual about (her-)himself. Presently it is mostly a document on paper, but ideally should be a digital storage devise. Digital PHR may not only store health information, copies of reports from physicians, hospitals and labs, but so also legal documents such as the health and other insurance data. PHR may also include a minefield of information that the treating physician may not have an easy access under normal circumstances, including exercise schedule, dietary habits, herbal or non-prescription medications, or results of domiciliary tests such as blood pressure or sugar recordings.
It is the internet penetration and increased application of Information Technology in the healthcare sector, that shall bring in the next major shift in PHR. Large scale utilisation of Electronic Medical Record (EMR) and Electronic Health Record (EHR) in both civil and military set up, looms ahead in the future. The terms EMR and EHR may appear interchangeable, but there is a clear demarcation between medical records and health informatics. An EMR is the digital medical record containing patients’ demographics, medical history including allergy lists and immunization status, current medication, archived laboratory and imaging studies and preventive health practices. An EHR is a distributed personal health record in digital format providing access to a patient’s health information at the point of care, providing secure, real-time, patient-centric information to aid clinical decision-making. EHR can be accessed over a network, providing the health information from several locations and/or sources, including EMR. The database of EHR in military or airline industry shall serve another vital purpose of quality audit, resource management, outcome reporting, and public health surveillance for both communicable and non-communicable diseases.
Two healthcare related developments in the United States shall have a bearing on the future of individual health record. First is the Common Access Card (CAC) of Department of Defense (DoD). CAC is a smart card issued as standard identification for active duty military personnel and other DoD personnel. This general identification card allows authentication for access to DoD computers, networks, and other DoD facilities, besides enabling the users to sign documents electronically, encrypt email messages, and enter controlled facilities. CAC in future shall incorporate RFID chips or other contact-less technology to store additional information and access facility to restricted areas. Second, the United States Army has already developed a combat health support information management system called as Medical Communications for Combat Casualty Care (MC4). This extensive health management system provides complete EMR through out life about each service member to the tactical medical forces, besides enhancing medical situational awareness for operational commanders. MC4 during operations serves a vital purpose providing the deployed medical forces with quick, accurate access to patient history, casualty resuscitation information, and automation tools facilitating – patient tracking, medical reporting, and medical logistics support. The operational commanders too have an enhanced medical situational awareness with the online medical surveillance information and trend analysis capabilities in respective theatre of combat operations.
Military technology invariably acts as a technology demonstrator for commercial exploitation later. This too shall be fate of the CAC and MC4; and may be in the coming years the Indian military with the help of Indian IT firms develop a multi-purpose identification-cum-access-cum-medical records-cum-global positioning system (GPS) enabled chip worn by the armed forces personnel. So also the commercial pilots with secure digital PHR shall have ease of access for medical care as well as their periodic medical assessment. The onus on the aeromedical community is to embrace the newer advances in medical informatics, while keeping abreast with the advances in diagnostics and therapeutics, for defining fitness for aviation duties.
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