Is Centralized Patient Record the Solution?

As I go back to the importance of Patient Records, the question were addressing the critical question as shown in the title...

We see the benefits but there comes a lot of concerns:

One Medical Journal speaks of the matter and centralized or non-centralized (or they call demand aggregation).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068075/?tool=pubmed

Some of the concerns and issues are:
1) Security in terms of access, modification, and lost

"For many years, the authorities have understood the risk of losing all of the data of a centralized system if the system is destroyed."

Meaning that if he destroy the brain, the body will be lost. Their analogy of comparing the ARPANET and the defense mechanism was to have a "independent but heads" network. So if one head is out, they still have other heads to execute objectives. In laments term, there is no one central spot if destroyed would place the system below life support. Also, the question is authority (Security, privileges) and who has access becomes a great issue since the user level is on a national level.

Another note is what about changes to the data... Concurrency issues are increased since there are more users who could access, modify, and write.

2) Lack of flexibility and maintenance
Since most organization has the standardization of terminology, does the coding have to be "standardization"? That is the question... Some would argue it would make everything easier but when there are many various organization, groups, and associations that dictate the standardization for their industries. When there is a conflict, who dictate the standardization? Since a platform has to be universal, cost of upgrade, maintenance, and performance could be extremely high. This is why I believe universal interface will be emphasized (and pay as a service like cloud computing services)

3) The infrastructure investment is higher. The argument (the journal) is that dedicated service is not better than on-demand.

"Finally, to maintain the completeness of the EMR, every single actor has to be connected to the centralized system to notify it of every single operation he makes. Regarding the case of drug prescriptions, for example, the regulation of traffic load and security could be very difficult to manage."

The workload to change instantly, would require a bigger investment in capital, human capital for performance and maintenance, and protection and monitoring

The other listed are in addition to the article that came up when thinking and analyzing

4) Operational and Procedure issue. Will the data generate locally and poll into the database? Instantly? You see the issue on how the national EMR database is utilized with produce another set of question (as well as contingency plan issue when a disaster occurs). Added the issue of HIPAA and how the data is made, sent, or changed is questionable.

5) Unwarranted access and cost to the patient (like insurance). With a complete patient record, insurance and other parties could charge a higher premium because they could base it on your whole record. (See it like credit report could generate a higher premium even if the information is right or wrong. Another example, higher premium because you are in higher incidents though no fault of your own.) There are a lot of ethical question in have a patient profile and potential denial of service (higher concern and liability though treatment might be crucial).

These are some concerns and the importance is how important that data is, who has access, how they utilize the data, and checks and balance. If those could be addressed, some of the issues could clear itself out. But they are not defined nor explained and this "quasi" standard will not resolve the issue at hand.