By hashmi | January 16, 2009
Connected Healthcare Systems
Naeem Hashmi – 1/12/09
VP, Knowledge Management & informatics
Fresenius Medical Care NA
Healthcare reform package is one of the major initiatives on the top of Obama’s agenda. The $50-$65 billion proposal consists of wide array of tax incentives and government insurance programs to offer affordable health insurance to more people than ever. One of the major factors to lower healthcare costs is to electronically share individual-medical-health-care information among healthcare providers. This will require a robust electronic ‘healthcare information ‘ exchange model to share medical-health information across diverse healthcare organizations.
Technically everything is possible but the challenges that healthcare organizations will face are not technical but to do with culture, initial costs, privacy, and security. The facts are that about 70 percent of physicians practices in USA are very small, mostly paper driven and have no IT staff. They are not ready or can not afford to implement an Electronic Health Records (EHR) and complex interface engines to support connected healthcare systems and also hook on to one of many ancillary systems such as ePrescribing to reduce prescriptions errors. . This demands a new ‘group practice’ business model where a group of physicians collaborate and share common EHR infrastructure, perhaps partially funded by government to cover initial costs.
Mobility is another challenge when it comes to addressing healthcare costs. As people move, the health information needs to move with them. A few innovative approach to address mobility and carrying, capturing and sharing health-care information through use of sensing devices – embedded ‘chips’, RFIDs or other sensors that monitor your vital signs and automatically broadcast any health anomalies to your healthcare provider. For example, in 2001, Matsushita Electrical Industrial Co. Ltd. developed a smart toilet. The seat of this toilet is equipped with sensors to measure such data as body weight and fat and to automatically monitor glucose levels in the urine to check the user’s health status. The information collected is automatically (electronically) broadcasted to personal physician as well as individual personal healthcare records. Though this is a novel idea, but adaptation on a wider scale hit roadblocks because of privacy and initial setup costs for a scalable commercial strength echo-system to support such novel technologies.
Lately, Dr. John Halamka and others have experimented with active RFIDs to track medical equipment and other assets, very much following the path of Wal-Mart’s RFID usage to streamline and optimize its very large supply-chain processes. The business intelligence helped optimize the work-flows using data collected through RFIDs. Dr. Halamka’s approach to embed ‘chips’ that carry personal health information is great idea but has no value when you visit a health-care center and they have no ‘reader’ to sense ‘your embedded chip’. Not to mention the social, ethical and privacy issues that such approaches will bring.
Let me diverge a bit here and describe difference between common forms of medical records used in context of healthcare information.
Electronic Medical Records (EMR) is very much Physician Centric information containing medical treatment, results, meds, symptoms, and lab results etc. Just the medical information. Often stays within one healthcare service provider. No patient access other than what is shared verbally or in writing on paper.
Electronic Health Records (EHR) consists of medical plus financial information shared among participating healthcare providers (not patient). This includes partial EMR information representing using an EHR standard such as HL7 reference model. EHR forms foundation of the Connected-healthcare systems. No direct patient access other than what is shared verbally or in writing on paper.
Personal Healthcare Records (PHR) are very much individually owned health-records – very much like individual health-blog where you have full control over your information.
Goggle and Microsoft are both gearing up to capture your ‘personal health records’ (PHR). Nice idea. But how practical such PHRs are when there are no governing standards for PHRs. Simply publishing content in XML does not make it useful when Physicians and Clinicians have no time to make sense of it (PHRs) to advise you. At present, the role of PHRs will be limited to personal health folder to keep your x-rays to other basic medical information tat you ask from your doctor – but will this help Obama’s vision of reducing healthcare costs and still provide high quality healthcare?
The panel, Connected Healthcare Systems for MIT Sloan CIO Symposium, is quite appropriate at this time. However, there are many challenges facing the healthcare community in the USA while other nations (Australia, Canada, Germany, Netherlands, New Zealand and England) are well underway, have already implemented high quality healthcare system and have architected the connected-health-care systems. What can we learn from their models to develop new ‘connected healthcare systems’ that suits best to our new world – USA?
There are several competing standards driving such private information collaboration across diverse legacy and new healthcare systems pushed by vendors. Likewise, no clear standards/ benchmarks exists for healthcare quality performance… Ideally, there is a need for a nation-wide healthcare data-warehouse to help streamline information exchange. But who is going to manage this gigantic distributed secured data warehouse? An extremely expensive proposition. And not to forget the Insurance and drug companies — how will they exploit such new universal health information resource to datamine individuals to either exclude their coverage or market new drugs to target patients etc… Who will govern privacy and secure access to such sensitive resource?
Let’s hear what you think about the connected healthcare systems on the following topics !