31 May 08 23:22 | DebOh said...:
The federal government has already developed an EMR that meets the needs of millions of "portable" veterans. No matter where you are in the US, you can pull up the very current medical/clinical record. Since public monies created this system, it is available for private use. This would be a cost effective solution for US Health systems and one that has been field tested and perfected over the past decade.

16 Mar 08 20:32 | TiborDuliskovich said...:
Implant all information into patient and hand over the control over it.
I personally believe, that medical information should be held inside the patient all the time in a form of implanted memory chip. The patient can control who has access to medical history, all the information is at hand at all times, secured and always up-to-date. Some portion of this information may be public, accessible by readers without authentication, some restricted. All access is logged on the implanted chip itself, each reader has a unique number and each person using the reader has a unique ID. Once the standards to record medical information are established and enforced, there will be nothing to stop us using implanted chips. I will be the first to have one when available.

06 Mar 08 10:21 | DonKrieger said...:
I tend to agree with Ms. Pistorio. The mobility of this nation's population coupled with the need for seamless transfer of personal medical information among healthcare providers/organizations in that environment is a proverbial "no brainer". The technology is already in place to accomplish the prompt recording of essential information onto an easily transportable medium (e.g. "credit card") that can be updated with simple devices. Thus, "technology" is not the problem. The challenge is to develop a consistent "minimum level data standard" for recording specific critical and cogent data onto the personal medical card (PMC)- as a low-level "start". The mechanism for coming to agreement on the format as well as what is critical medical data needs to be developed. Numerous academic institutions had worked on and have proposed various solutions. However, it does not appear healthcare communities (providers, organizations, legislators, insurers, etc.) take any of this seriously nor is there an inclination to do anything about it. A seamlessly maintained PMC would go a long way to ensure appropriate healthcare is provided to our large mobile population while removing the "uncertainty" (aka "risk") of providing care in a "new" facility or by a "new" provider based on a patient's "recollection" of their history or medical situation. It would also provide a readily available “portable” documentation of personal medical information of our aging population – especially when there is an event that occurs during travel or when the patient is unable to adequately communicate their condition. I would welcome participation in a forum that would move to actualization of this type of process. The incentives (risk avoidance, cost avoidance, enhanced care, positive outcomes, etc.) for implementation of such as system would far out-weigh any initial costs.

28 Feb 08 00:08 | GerardFreriks said...:
Innovation: Catching, Publishing the Information Requirements in Health
When it comes to a way to catch and express information requirements in healthcare for use in EHR-systems and between healthcare providers it is clear that a new age (a new paradigm) is emerging. This paradigm is not based on the paradigm that messages are based on. The problem with message specifications is that healthcare providers do not understand the intricate details and the consequences of decisions made during the message production process. In addition it is very resource intensive to produce, implement and roll out messages at large scales. The new innovative paradigm is based on a full European standard (EN13606) that is on its way to become an International ISO standard. Tools based on this EHR standard enable clinicians to express in a way they understand their information needs. EHR_systems that are conformant can use the technical artifacts of those tools and implement it immediately (zero time, zero cost). The NHS-England has (is making) the choice not to use HL7 to collect the Information requirements in healthcare but want to use the tools based on the European standard for the EHR. The WHO might decide to do the same.

Curious to learn more? Have a look at www.openEHR.org

Gerard Freriks

26 Oct 07 17:44 | CarolPistorio said...:
It is called collaboration with leadership - share data, make a decision and move forward
There is too much money changing hands by lobbyist of health plans for there to ever be a Universal Healthcare "system". I recently read an article where the HHS is paying a half million dollars to a consultant to determine what EHR, EMR and 3 other terms actually mean. Who really believes that the government has the sensibility much less the capability to create a truly workable Universal plan?

Health Plans have all the money and Providers have very limited budgets. To increase quality you have to start sharing data from the health plans with the providers and start measuring - all that is required if they cannot create interoperability or integration is a few standard import/export capabilities (xls, csv, xml, pdf) to allow one system to absorb the data from another as long as the database in each system has proper elements to map data to. It is really not that hard. For example every application has to have Provider ID information in a database that includes data elements 1,2,3 . Every application has to have patient data in a database that includes data elements 1,2,3 and so on. Then much like a Word mail merge you can map the data to the proper data in the new application and save the format for refreshing. HL7, when/if they standardize it will allow for realtime exchange for things like lab results but it will take years for all the proprietary vendors to make their applications HL7 compliant. You may not buy their next product if you already have one that works....

There are too many initiatives, committees and organizations in the kitchen. Someone has to be the head chef and say this is the recipe we will use for at least 2 years and get US Healthcare on the way to collecting data, using that data to improve quality and education for all HCW if there are trends spotted where improvement is needed.

As for personal health information - if the banks can figure out how to store my data for financial information on a card and "measure" it at each transaction - why in the world can't we have a database with health information stored by some company dedicated to doing just that and not-for-profit - so any healthcare facility (much like Target and Nordstrom) can read the same exact card - access the personal health information of that person quickly and effectively for a positive outcome wherever that person is in the world, Spain, China. My ATM card works anywhere.

HIPAA is important but lets face facts, a paper record held at each facility I have been to in the last 5 years doesn't help anybody including me if it is locked in a drawer. Ask George Clooney how he feels about HIPAA. It isn't working the way it was supposed to. Protect my health data like my financial data. Yes there will be breaches but if we have a "super" facility maintaining it, data is in one place with the best security technology can provide (FBI, CIA Homeland Security). It will be safer than my file sitting on Betty Jean's desk or visible to anyone at the hospital who has access to the health record. At least stored in one place there is always an audit trail of who accessed, edited, added, deleted etc. Patient input can be stored in a special place following each encounter and the validity of comment reviewed and recognized by provider or denied and why. It still will remain a part of the record because another provider (2nd opinion) might very well agree with the patient comment/edit. Cleaner, simpler than what we have now - cement shoes holding us all hostage every step of the way.

19 Oct 07 14:02 | RobertBurney said...:
Not everyone agrees that interoperability is a good thing. The individual patients gains little/nothing over having a Word document available with allergies & current meds. (A Personal Healthcare Record). There are enormous privacy issues with interoperability, particularly if information is stored in regional databases (RHIN).

02 Oct 07 06:32 | PatKing said...:
HL7 and CCHIT are making progres on standards,, but no clear technology leader has emerged
There are a lot of initiatives on the way - HL7 for defining elements of the patient record, and the Certification Commission for Information Technology for certifying interoperable systems. However, I think the only systems that are working at all right now are within health systems - e.g. a hospital system that has adopted an electronic record and rolled out its companion ambulatory care product to affiliated physician practices. It's almost like the old Beta vs. VHS video - until there is a clear market leader, there will still be incompatible technology. From what I hear, systems certified as interoperable now can talk to other systems, but not well - and the hospital electronic medical record systems have pros and cons that make a system attractive to one organization, given its individual priorities, and not to another. Organizations with limited budgets (isn't that everybody?) may be hanging back to see if a clear market leader emerges.

27 Sep 07 10:46 | DebbieWedel said...:
With Universal Healthcare on the horizon, would it not be advantageous for healthcare participants to bring their forms to the table to create one "Uniform" for all hospitals, LTC, clinics, insurance agents, and any other participant that relies on the information to effectively provide service/care to the patient. Just as The Joint Commission is widely recognized as the the governing body of quality assurance for healthcare, why not a software company specializing in medical IT to oversee the electronic Universally.