Talk of a nationwide electronic medical records system has centered on cost, feasibility and whether it will provide better care.

But there is one potential benefit to such a system that few have talked about: the possibility of mining a massive database of patients, doctors, medical strategies, procedures and prescriptions to rein in costs based on statistics. In other words, a health care system that pays for what works, according to the numbers, and doesn't pay for what doesn't.

It seems so Silicon Valley: a clear-eyed, numbers-based system that points us all in the right direction. And yet: silence.

"Part of why you don't hear it yet is because I don't think anybody has figured it out very well," says Emily Lam, director of health care and federal issues for the Silicon Valley Leadership Group.

That's fair enough. We are still in the early stages of the latest discussion on how to rescue our abysmal $2.3 trillion-plus health care system. There are huge issues to wrestle with: 46 million without health coverage, increasing costs, misaligned incentives, an aging population, the influence of for-profit insurance and pharmaceutical industries, the self-interests of doctors, hospitals and the patients they serve.

Those promoting electronic health records emphasize that having comprehensive information at doctors' fingertips would improve patient care. Doctors would be flagged when prescribing conflicting medications. They'd be alerted to alternative treatments. Patients could more carefully track doctors' instructions and monitor their progress with chronic diseases, such as diabetes.

And yes, they say, savings would result. Hospital stays could be better coordinated with the availability of staff and equipment, meaning they would be shorter. Redundant tests would be eliminated. More health care calls could be made without requiring a visit to the doctor.

As for using the same electronic information and powerful data mining tools to build a financial model that would discourage ineffective treatments?

"It's an ethical debate. It's a moral debate," says Dr. Robert Pearl, who as a Kaiser Permanente executive helps oversee the largest nongovernment electronic medical records system in the country. "It has to be held by people across the entire spectrum."


And it's a debate that should start now.

The beauty of these early discussions is that it's still hard to envision exactly what the system would look like. We are years maybe 10, maybe more from the possibility of a comprehensive national records system. Questions of ethics, law, logistics, technology and medicine still need to be settled. And so, we are free to talk about what a data mining component might look like. Or what we think it should look like.

The potential pitfalls are huge. Information identifying individual patients would have to be stripped from the files before any numbers were crunched. We'd need laws and regulations aimed at maximizing individual patient privacy and punishing those who would violate that privacy.

And who would control the information and determine which treatments are "effective" and which are "ineffective"? I'd vote for a government agency or a government-appointed panel of experts. Insurance companies, which appear to exist primarily to deny and decline coverage, would need to be kept at arm's length. Same for Big Pharma and other for-profit players.

The process has to be transparent. The raw data and the conclusions drawn from them should be publicly available. There needs to be an appeals process. And those who insist on a treatment deemed ineffective should have the option of paying full freight for the procedure (provided they find a willing doctor).

Is that the outline of a perfect system? Hardly. There are probably better ideas.

But here's the thing: Our health system is so dysfunctional that doing nothing isn't feasible. Coming up with something better is going to require all of us doctors, insurers, patients, hospital administrators, big businesses, labor, government entities to accept changes we are not entirely comfortable with.

Yes, there will be losers. But if we can get it right, the overall health-care system will come out a winner.

Contact Mike Cassidy at mcassidy@mercurynews.com or 408-920-5536.