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.