More Data for Healthcare Systems

Curtis Franklin Jr., Executive Editor | 3/12/2012 | 8 comments

Curtis Franklin Jr.
CIO-centric conversations about the health information exchange (HIE) concept tend to orbit the twin concerns of privacy and the sheer tonnage of data expected in a fully functioning HIE universe.

As with most data projects, the usefulness of an HIE undeniably will depend largely on the wealth of information available on each enrolled patient. Unlike most of the people talking about the HIE reality, Dr. Farzad Mostashari, the national health IT coordinator, is arguing in favor of collecting more and more information at the point of patient contact, rather than figuring out how to hold back the tide of information.

The purpose behind the HIE is simple and admirable: All the pertinent information about a patient's healthcare should be available to any provider seeing the patient, no matter where the provider is located, when the access is required, or which provider generated the original record. In some visions, patients would also be able to generate information themselves through devices ranging from blood pressure cuffs to blood glucose meters that would pass the data through a gatekeeper service and insert it into the record.

Understandably, many industry CIOs have expressed reservations about the potential flood of data, and healthcare professionals have expressed concern about the reliability of data entering the records.

Dr. Mostashari, though, is looking for demand to drive HIE adoption. An InformationWeek article by Neil Versel describes Mostashari hosting meetings in which he talks about a future in which HIEs are inextricably linked to healthcare reform. When the rise of HIEs is tied to issues like meaningful use and electronic health records, the scope of the change mandated by recent laws and regulations becomes clear.

The truth of the matter is that healthcare IT is beginning a process that will fundamentally alter both the scope of activity and the nature of the job to be done. Retention and retrieval have been the centerpieces of activity for the last century, but interoperability and communications will form the foundation of healthcare in the century to come.

For CIOs in the industry, staying on top of regulations and paying close attention to standards-based data interoperability efforts will be keys to staying on top of the breaking information wave. Have you decided which standards will get your support? Is your position one of leading HIE efforts, or do institutional politics make holding back and waiting for the dust to settle the winning position? There are no simple answers in the midst of a change this significant. Embracing the complexity and selling the results to the healthcare practitioners in the organization are really the only ways to make it through to the other side. What's your plan?

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DBK   More Data for Healthcare Systems   3/14/2012 6:12:04 PM
Re: Chance for potential misuse

You are correct that as a whole the general public has not fully thought through the implications of what can happen when you post it on social media.  I guess he fear of losing privacy seems to out weight giving it away.  Seems that one is driven by choice and one is being subjected to having something taken away.

David Wagner   More Data for Healthcare Systems   3/13/2012 5:54:51 PM
Re: Chance for potential misuse
I'm inclined to mostly agree with you, though I think that convincing Americans to agree to be less private is going to be tough. Now, we've seen that they'll trade privacy for something they perceive to be of value (like access to Farmville), but that value has to be sold to them.

I say only half-jokingly that Facebook has already shown us the path for this-- just take what you want and apologize later. If doctors save enough lives that will make more news than the abuses.

DBK   More Data for Healthcare Systems   3/13/2012 3:30:38 PM
Re: Chance for potential misuse

Obviously keeping the patient information safe is paramount.  This is true if it is electronic medical records or paper medical records.  If someone was of the mind set they can take the paper records and ingest them to repurpose so it is difficult to guarantee security electronically or physically.

Operating from in the cloud helps to keep the data secure.  In addition it establishes a process that the data will reside in the data center and not on the devise.  Having a well designed wireless infrastructure will be critical for this to occur.  That infrastructure will need to consist of a Distributed Antenna System, DAS, and wireless access.  The DAS can support a direct connection to the telco provider and support a G4 deployment and then connect the G3 or wifi.  For the security of your data DAS will be a big step to enabling this solution.   Connecting the wireless can help off set cost for wireless minutes and enable nurse mobility and improve patient response and support.  In addition a separate channel can be set up to provide guest wireless access to provide an enhanced customer experience.  It is all about the wireless experience.

Zaius   More Data for Healthcare Systems   3/13/2012 3:23:47 PM
Re: Chance for potential misuse
The secutiry problem goes far beyond simply misues. As long as insurance companies have the end users by the short and curlys, it is a matter of retaining one's insured status as long as insurance companies can simnply cancel insurance for leaving out that you had fly at age 14 or that a woman doea not write down that she had a miscarriage in her early twneites (not that uncommon even mow). UNtil the law starts to protect the insured or we get some kind of universal covereage and insurance companies are not just raking in profits nobody wants their information to bwe accessible to anyone they do not designate. Using a Social security linked code makes the records vulnerable to employer snooping too.

These issues must be resolved before any kind of infrastructure for digital records will be welcome by the patients or the doctors. Another issue that begs resolution is the high cost of malpractice iunsurance and the ease with which any person can bring a lawsuit againsta doctor or hospital whther real or spurious. I am all infavor of justly reimburs=ing people for injuries, but the current system has been rewarding the first guys into to the courtroom for far too long now. Some kind of system must be put in place to prevent clogging the courts with spurious lawsuits while allowing for real ones, and something must be done to limit awards realistically. The way it surrently works, the lawyers make money, the doctors have to limit time with patients so that they make enough to pay their insurance, and the end users pay much higher costs than necessary for health care and insurance.

Get these outof the way and nobody will care that much about privacy protection. It will still be needed, but not the the current extant.
CurtisFranklin   More Data for Healthcare Systems   3/13/2012 3:16:30 PM
Re: Chance for potential misuse
@David, I'm inclined to mostly agree with you, though I think that convincing Americans to agree to be less private is going to be tough. Now, we've seen that they'll trade privacy for something they perceive to be of value (like access to Farmville), but that value has to be sold to them.

We also have to convince the healthcare providers to buy into this. Right now HIPAA has them so spooked that many will reflexively oppose any sort of greater openness, so we need a fair amount of institutional education if any of this is going to get off the ground.
CurtisFranklin   More Data for Healthcare Systems   3/13/2012 3:13:24 PM
Re: Chance for potential misuse
@Gigi, I'll agree with much of what you said, but disagree with one part: I don't think the unique identifier (or password) should be based on the Social Security number. We already hang far more off that poor, over-worked, under-designed numbering system than is safe or healthy, and I don't want to think about the possible consequences of hanging even more data on that structure.

We do need something that's universal, portable, secure and accessible, but I just don't think the SS# is it.
David Wagner   More Data for Healthcare Systems   3/13/2012 1:25:34 PM
Re: Chance for potential misuse
@Gigi- I'd like Americans to be willing to trade a little bit of their medical prviacy for the ease of use of this information to save their lives. I'd hate to see someone die because their medical records didn't get to a trauma unit fast enough.

We're never goignt o get security and privacy perfectly right, but this is a place where I'd rather get it wrong slightly more to get the data transfer right.
Gigi   More Data for Healthcare Systems   3/13/2012 12:14:31 AM
Chance for potential misuse
"All the pertinent information about a patient's healthcare should be available to any provider seeing the patient, no matter where the provider is located, when the access is required, or which provider generated the original record"

Curtis, one side it's a good movement because the basic objectivity of portability can meet. But at the same time it increases the potentiality of security risk and privacy concerns. Any open accesses systems can be get misused and end ups in a messy way. In my opinion the best option is protecting the documents by patients with a secured password based on SS number.

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