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Friday, October 28, 2016

Un-common Language... communications in healthcare.

Among the many issues in American healthcare is the inability to share information among medical providers… patients, care-givers, institutions. This takes on many different forms and has several causes. Both form and cause need to be addressed prior to resolving the underlying issues of healthcare quality and costs.
One of the main issues in the cause column is that the many Electronic Health Records (EHR) do not easily talk to each other. This is a result of each of the EHR development companies (eg: EPIC and Cerner among hundreds) preferring to keep their systems proprietary… and the healthcare providers accepting this lack of standardization, because they want to maintain control over their patients. In both situations, the silo affect is willful protection of their profitability… not patient care or cost control. There is no standard way to share information between the silos, absence of such a common communication tool will limit the ability to reduce costs and improve care in the future.
The second issue is that medical professionals and business entities do not utilize a standardized language to describe any part of healthcare. For example, the ubiquitous drug “aspirin” can be described in electronic health records (the taxonomy or ontology of the data) in as many as 72 different ways. This problem makes it very difficult to accurately communicate between silos of healthcare. It makes it virtually impossible to standardize in ways that facilitate data statistics and algorithms... therefore analytics and clinical studies are hamstrung.
In other industries (financial for example) there has been standardization that allows for communication and aggregation of information. One can easily establish a link between one’s bank, investment, insurance, tax and debt accounts, for example. But in healthcare, an individual has no way to pull together their historic medical records… physician visits; prescription history; blood and image diagnostic work; hospital surgery records; vaccinations, and so on. Even though federal law has established the requirement that a person be able to get access to her records… it is required only that they be emailed (with no requirement for promptness), faxed or mailed on a memory device. This makes the record unsearchable, and virtually unusable during emergent situations.
All of this lack of communication in healthcare means that a patient cannot actually ‘own’, and carry with them, their personal medical history. This leads to situations where treatments are delayed, or repeats of diagnostic studies are necessary… adding costs and exposure to radiation… never mind, inconvenience.
There are two ways that we can, in the USA, take control of our health record. The first will likely never happen… have the federal government mandate a standard communication format, and require on-line access to an individual’s medical records. While this was done at the start of the digital revolution in diagnostic imaging with a standard called DICOM, to which all medical manufacturers must comply in order to achieve FDA approval… it seems the electronic medical record software used by all institutions and physician offices is well beyond standardization.
The second way seems more achievable. By individuals demanding access to their medical records in a digital format, they can take control of their history. This would have to be done as an individual, or by some sort of aggregator. It is the future, but when will it come?
It is somewhat obscure to envision a state where we have our personal medical records in one place, accessible to anyone to whom we want to deed access. This could be for emergent situations; second opinions; predictive analysis and so on. But we must start somewhere.
By asking our medical providers to give us our digitized records, and keep them in one place, we have a start. At least then if we need them on short notice, they are in one place. This would include previous blood or other diagnostic tests. Medical images (CT, MRI, Xray and UltraSound) are all digital today, and copies can be maintained by the individual. Records of vaccinations, flu shots and such are also important to have in one place. It is a start, but not enough.

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Grad. Saint Mary's University, 1975, got into the medical device business initially in sales, then various management positions up to president, all in Medical Devices. I prefer therapy products over diagnostic, but they are all fun, and in a way have defined my life. I have now evolved, with help from my 35 year partner Lynnda with whom I now share every hour. I am into staying healthy, photography, kayaking, bicycling, gardening and two books a week. I wish I had gotten to this stage earlier!