21st Century Health Care?

Interesting use cases abound for Master Data Management, but few hit as close to home as Medical Health Records. Though known colloquially as Personal Health Records (PHR), Electronic Health Records (EHR) or even as Employee Health Records (also EHR)… there is a substantial need across the care triumvirate (Patient-Provider-Payer) to begin to align content across purposes in a non-leaky way. A very interesting company – MedCommons – has been pushing for a Continuity of Care Record (CCR) designed to help pull digital content “critical to the continuity of care” so that a patient can be transferred across providers with high fidelity. To my “digital” dismay, it seems that the majority of records are hand carried. Just ask an armed forces person about their medical jacket that they hand carry from point-to-point across their care continuum. How absurd is it that online services like Spokio can assemble your online footprint, but no one seems ablidged to offer similar aggregation for the treatment of disease, proactive management of health.

I mean, how stupid that we cannot agree on a non-depricating set of formats and exchanges for the appropriate sharing of health records across participants. Sure there are those worried that pre-existing conditions will impact their ability to receive insurance, or that a PCP may learn of a pre-existing STD that might through loose lips sink a marriage, but these are meerly obstacles in need of the proper application of policy driven “opt-in” authorizations.

At the end of the day, if everything is auditable, my decision to withhold information becomes MY decision, and I’ll need to take responsibility for it. Similarly, a providers/payors access also brings a certain set of responsibilities. In the “trust, but verify” culture to which we are a part, it seems that loose federations, policy management/enforcement/ as well non-repudiable audits and intentional design bear the right set of controls to build these systems.

It is astonishing that providers order additional, oft-repeated tests, for self-protection against malpractice. That providers sit idly by not giving patients the ability to archive and share their disease/treatment portfolios, in a way that might offset large segments of the cost…. if my specialist had a copy of the tests run by my PCP would they ask for a new assay? would it be enough that we could know/record that they viewed the prior results and therefore be absolved of negligence?

I’m sure that I’m oversimplifying, but when does the 80:20 rule take effect, can we save 80% by managing the specific treatment of the 20? I’m not talking about taking unfound risks, but merely about exercising better judgement. With patients surfing the internet, we have to think that an educated “consumer” is a “good” consumer, why not support the broad – population wide – “best treatment” capabilities afforded by statistically significant population… by anonymizing our PHR’s, enabling them to be mined, determining which diagnostics were deterministic (and which wastefull) , which treatments produced the best outcomes and what the options are.

Here we are with 21st century IT in retail lending and personalized advertising. But we, health consumers, seem to be counting on the limited experience of our physicians as the only director of our own mortality, when let’s face it, the analytic resources and data does exist. Why don’t insurance style actuarial analysis make it into our own wellness management portfolios, helping us consumers lead more healthy lives – enabling the “smart consumer” the choice that they desire…. not choice assembled by the griping few, or the chance of a caring soul who shares a disease and blogs their experience, but rather on an industry that takes the initiative to make a broad push to improve the 80%, and who knows this probably applies to the trailing 20% as well.

Spoken by a dad, whose spouse has spent countless nights researching diseases based upon observed symptoms, leading her to substantial enlightenment. This knowledge, in turn has, more than once, provided her with information that our family’s PCP didn’t have the time to accumulate through either experience or training.

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