Patient record – for the patient, the consultant, the hospital?

Does the patient want to manage the data?

Any time a patient enters a hospital – be that outpatient or inpatient – a detailed patient record is created and updated throughout the stay.  And in these days of GDPR (General Data Protection Regulation – to be effective 25 May 2018) there is now a great deal of focus on who owns the data.  Pretty clear, fundamentally, that a patient record records data pertinent to a patient and should, therefore, logically be owned by the patient.  But the patient does not have a way to record the data – and generally it falls on the hospital to do so – notwithstanding that some of the data may be recorded and stored separately by the consultant attending to the patient.

And GDPR brings many welcome improvements and protections for the patient with respect to the data, the patient’s access to the data and other people’s use of the data.

Microsoft and Google – false starts

In his book ‘The Digital Doctor’ Robert Wachter devotes one chapter to ‘Personal Health Records and Patient Portals’.  He recounts the efforts of two of the Technology giants in looking to break into healthcare: Google Health and Microsoft’s HealthVault.  And both seem to have given up the ghost.  Probably because when people went to use the platforms the value did not match the effort to accumulate and maintain the data.

And what I had not realised: most of the Health Information Exchanges formed during the Obama Healthcare drive have also failed: not as much effort and interest in aggregating and integrating the various health records as we had all expected.  Or perhaps it just proved too hard to do.

So Wachter believes that for now most of the patient health record will be focused with the Electronic Health Record (‘EHR’) providers (e.g. Epic, Cerner, Meditech, etc.).  nad the better EHR providers will, with their customers, provide good portals for the patients to access their data.

And this is not to say that the facebooks, googles, microsofts and amazons will not return once more to provide consumers with another, smarter solution.  But for now looks like the action will be controlled by the EHR vendors.

In some respects I think this is a reflection of the lack of standards and relatively late deployment of EHR (which is the equivalent of ERP in industry). We are now left with lots of data which is not easily integrated or aggregated – certainly not at consumer level. It will probably take a major shift: where consumers have electronic data available to providers and will only deal with providers who are able to process (and update) the patient data. There are some signs that this may be driven by the health insurers – as they look to dictate more and more to the providers. For now through looks like there are major opportunities in the next few years for the Epics, Cerners, Meditech etc – to build out very strong positions, probably to be taken out by the Apples, Googles, Facebooks and/or Amazons when they see fit.

 

 

The Digital Doctor by Robert Wachter

The Digital Doctor -Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

In The Digital Doctor Robert Wachter reviews the successes and disappointments of recent investments in information technology in healthcare in the US.  More recently this  included a €30bn incentive program between 2010 and 2014.  His focus is very much on IT in hospitals and the implementation of Electronic Health Records (‘EHR’).  He compares what people are trying to achieve and what they are actually achieving.

The book provides  excellent background reading

for any clinician or administrator currently involved in planning for an EHR implementation or in building a clinical/ business case for the same.  From the start Wachter distinguishes between the technical and the adaptive challenges,  He argues convincingly that the adaptive changes offer by far the greater challenges and the greater rewards.

Pro Technology Investment

The Digital Doctor should not in anyway be seen as being anti investment in technology in healthcare.  In fact Wachter is clear on the requirements for the investments in EHR and the tangible benefits.  However he shares with the reader some of the mistakes or misapprehensions of previous EHR implementation sponsors.  He would prefer that previous errors are not repeated.  And in the later part of the book the author draws a clear picture of hospitals operating in a highly technology dependent environment.  In this hee also makes the point that all of the constituent elements are already available.

Practical examples and commentary

The book is full of practical and relevant commentary and analysis.  He references patients concerns at doctors focusing on computers rather than patients.  He has a number of suggestions on this.  He references rapid advances in IT in Radiology – but the growing isolation of Radiology from other parts of the hospital.  Again he has a number of suggestions.  On the EHR itself part of the issue relates to trying to serve too many masters. The EHR is important to the clinicians, the insurers, the patients and, sometimes, the lawyers.  As a result having struggled to consolidate/ aggregate the data it may be ‘watered down’.  Lots of discussion also included on ePrescribing and alerts.  His comparison of management of alerts in aircrafts and hospitals provides food for thought.

Relevant to all involved in EHR

We know that to get EHR right we need clinical leadership and sponsorship.  As a CIO and CFO I found the clinical perspective in the book thoughtful and informative.  Would recommend to clinicians, IT and admin/ finance personnel involved in upcoming EHR projects.

 

 

 

Older people

Respect and celebrate older people. Today is International Day of the Older Person.

Check out details on the UN page.

In Ireland we recognise that people are living to an older age – and we should celebrate this.  But we also often seem to see this as a problem – as a financial burden – that an increasing proportion of the population will be old and will require more support from a decreasing proportion of younger people.  I just think we have not thought this out.  It is good that people live longer.  Necessarily people will require support for longer – pensions will have to payout for longer, healthcare will need to be available to older people for longer.  But this is progress.  and the objective must be to promote indepdent living for people for as long as is possible.

I think the recent development whereby state pension eligibility is being pushed back to 68 and eventually 70 is an example of a part thought out solution.  This will save the government money in the first instance.  But many of these people find themselves in employment contracts which see their employment ending at 65.  And many of these people are well capable of continuing to work past the age of 65.  But the economics have not actually been worked out.  It may be that people will not want to continue in full employment, that they may want to take on a less physically demanding role, that they may be willing to work at a different level in their current organisation.  But after a career with an organisation they have no entitlement to such arrangements – yet the government sees fits to defer their state pension.

The answers are not necessarily straightforward.  For the companies extended contracts may change their people cost ratio – with relatively expensive human resources being retained in an organisation and potentially ongoing commitments to continue to support pension contributions.

But it is International Day of the Older Person today – and when I read two Sunday newspapers I saw no discussion/ celebration of people living longer.  Let’s make this an Older PErson friendly world – since most of us have an objective of living healthily to an old age.

 

 

Death of Cancer – Vincent C deVita – Review

Did not finish ‘Death of Cancer’  thinking we have arrived – if the death of cancer is arrival. But a fascinating insight for the layman into the work and times of a leading oncologist over the last 40 years.

Would not be qualified to comment on his explanation of cancer and the various patterns of development – but all seemed logical, if somewhat frightening.

Great feel for the journey of a somewhat frustrated cancer killer – one who feels that FDA regulation has unnecessarily delayed treatment of many patients.

Story is personal – in dealing with a number of family and close personal friends and their cancer battles. Indeed his own story features in the end of the book.

I think the overall message is very positive – with the reservation that cancers continue to mutate and that many times patients may struggle to get the best treatment: because doctors may be over conservative, may not have the skills/ resources available to them or the latest potential solutions may be tied up in FDA type regulation.

But a good read and reasonably informative.

Adopting the emerging healthcare technologies

Emerging healthcare technologies: not a surprising piece. The focus is on Electronic Health Record (EHR), Cyber security, Accountable Care Organisations, Population Health analytics, Remote care, mobile and wearable technologies.

Mobile, cloud, analytics – all core to developing and delivering effective and efficient healthcare solutions.  And, of course, given the current cyber security threats, security is a prerequisite in implementing and expanding dependence on technologies such as cloud and mobile.

Seems that the electronic health record must be a core foundation of making all of this work for the patient, healthcare providers and society at large.  We need a way to aggregate, consolidate, cross correlate the data. This will provide better solutions for patients and improved care.  But this access for providers to patient data should be controlled by the patient.

Security

I have always thought of security as an enabler rather than a hindrance or obstruction.  Cloud and mobile in healthcare make this case.  Interestingly i see cloud as offering greater security – with the opportunity to leverage real in-depth security expertise, not necessarily available internally to healthcare providers.  And cloud and hosted solutions offer lots of simplifications in supporting mobile access to data.

Analytics

Much of what we have seen drive data analytics has come out of the mobile/ cloud/ social developments – tracking and analysis of data captured on mobile devices and through end user participation in social platforms.  Healthcare is data intensive – with more and more of the data captured electronically and potentially available for analysis.  The tools for capturing the data and the tools for storing, analysing and displaying the data have advanced hugely in recent years.  Providers who do not have the ability to capture/ analyse/ understand the data will find themselves significantly disadvantaged in competing with other providers and negotiating with buyers of their services (patients, insurers, government, whoever).

Challenges

Great opportunities for all healthcare providers to improve the quality and relevance of their offerings, the method of delivering their services and to acquire new business remotely  -through new healthcare technologies.  But the challenges should  not be underestimated – traditional models for Information Technology delivery will prevent organisations leveraging the opportunities available. Providers need to be more dynamics, adopt new technologies and new methods of delivery.

 

 

UK – gathering momentum for electronic health records

Good to see that US push on electronic health records has not gone unnoticed elsewhere.

UK Health Secretary, Jeremy Hunt, seems to be push adoption of electronic records and alluding to the nonsense which is the current situation.  Will be interesting to see whether UK government seeks to push some real pounds sterling behind the initiative.

There have been a lot of scare stories about confidentiality of personal data – privacy of personal health records.  The key point is that the records belong to the patient.  Must be possible for patients to get better service by having up to date, comprehensive, electronic patient records which they can choose to share with any healthcare provider.

Some interesting debate taking place in the US now that we are in the ‘meaningful use’ phase of adoption – where providers need to demonstrate that the solutions are being used between providers and between providers and patients in a meaningful way.

We should not underestimate the potential complexity of moving this forward – and some of the likely blockers to change.  But this should be about improving quality of patient care and making it more efficient for everyone.  Should enable providers to provide an improved service.

 

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The Challenge of Change – Brendan Drumm

Just finished reading Brendan Drumm’s account of his experience of leading change in Public Health in Ireland – as head of the HSE from 2005 to 2010: ‘The Challenge of Change – Putting Patients before Providers‘.

Interesting book on a number of counts: good discussion of a major change project, public health is of interest to all of us, provides an insight into implementing change in public sector and poses some interesting questions about the role of politics and politicians and their impact on provision of public services.

He is very forthright on a number of points:

  • Patients (ie the public) need to demand change
  • Practitioners need to lead the change
  • Primary care is at the centre of any effective solution
  • We do not need more beds
  • Rationalisation of A&E services across the country was the only option – backed up by significantly improved ambulance services
  • HSE (and therfore the public) was paying too much for drugs
  • The revised consultant contract (80/20 split of public/private) work is the way forward
Was somewhat surprised not to see some more coverage of potential role of technology in enabling and sustaining change e.g. potential benefits of electronic patient records.

Clearly be believes that he has mapped out a way forward for public healthcare, that we have made significant progress during the last five years and that if the curent incumbents stay on message we will see real changes and benefits for patients in years to come.

It will be interesting to see how a number of changes play out:

  • Ongoing discussions re consultant contracts e.g. reimbursement; changing role in context of 80/20 arrangements
  • Further consolidation of A&E facilities across the country
  • Further role out of integrated services
  • How will the current Minister for Health drive forward the changes?

 

 

 

Healthcare provider CEO – a perspective on IT

Attended the 16th Annual Conference of the Healthcare Informatics Society of Ireland (‘HISI’) today.  Excellent keynote from Michael Dowling, President and CEO of the North Shore -LIJ Health System USA.

He made some opening remarks about a number of the key drives for change in the US: consolidation (insurers and providers), budget issues, healthcare reform movement.

WRT to IT he claimed to have seen less progress than he would have expected (given that Healthcare is one of the most technologically advanced industries) – probably because (1) fragmented healthcare industry and (2) lack of great products.

He argues strongly for a subtantial commitment to IT – if providers want to trak outcomes and to manage the continuum of care.  He is looking for his investment in IT to generate quality, productivity and efficiency – with better outcomes for the patient.

He had some interesting views on RoI and investment in information technology.  Quick RoIs do not occur – and people too often build false expectations.  IT will not solve the healthcare cost problems. These are down to technological advancement, democratisation of advertising by pharma, demographics (in 100 years we have added 35 years to the average life), life style/ behaviour (e.g. child obesity).  Many of these issues are not being addressed at the right level.

Mr Dowling made a number of other observations:

  • need to move from pay for service (ie volume) to pay for value
  • IT must be used to connect different providers right across the contuum e.g. hospitasls, socil services, ancillary services
  • important to implement systems which do notlock people into doing what they are doing today
Finally Mr Dowling reminded all of us about the risks of losing the human factor though over dependence on technology.  He expressed his frustration tihw so much unproductive email (referecing the quote ‘the problem with communication is thinking it has occurred’).
Al in all an excellent key note from a CEO committed to investing in information technology to improve patient outcomes.  And a CEO who is very upbeat – in spite of the current economic challenges in all markets.

 

Privacy and healthcare

Require patient-centric approach to privacy in healthcare

Returning again to the subject of privacy – this time in the case of healthcare.

Interesting paper produced in the US by the Patient Privacy Rights group – the case for informed consent.

Paper references interesting statistics about the number of patients now demanding privacy – in fact the number of patients avoiding early medical checkups/ treatment because of concerns re privacy/ confidentiality.

The paper pushes a very valid principle – that the medial data about the patient belongs to the patient and not the hospital or clinician. Therefore it is not sufficient to think about patient privacy being addressed by software vendors.

The paper outlines it as follows: It is a mistake to design health IT in a paternalistic manner — assuming a corporation, vendor, provider or government agency knows what is best for each individual patient. Instead, we should build ‘patient-centric’ health IT systems.

The challenges posed are potentially complex – but they need to be addressed. For operators they will require changes in processes and systems. But these changes will be required to meet legal requirements and in order to establish and maintain credibility with patients.

Another positive for social networks

Using social networking to support effort to get fit.

Like many others I struggle to get out and take exercise on a regular basis. I have many false starts (or false dawns). May target to walk four times a week – or run twice a week; generally do well for a week or two, then let it slip (early morning meeting, bad weather, travelling for work, any excuse will do…).

Was thinking about some application which would (1) assist me in tracking my efforts and (2) put me in touch with similar ‘athletes’ or ‘would be athletes’.

And then, via a contact on facebook, I come across dailymile

Have to say – looks like a close fit to what I think I need. Some nice features including (1) setting out routes and measuring them and (2) summary analytics.

Will report back after a few weeks of use of the site – looking to use this social network (connected to facebook and twitter) to assist me in becoming more healthy.