Healthcare: Set my data free! #HIMSS12 #BPM

The world is desperately in need of data in motion and our health depends on it. I’ve passed three days now at the HIMSS Conference in Las Vegas, NV and have been struck by how many organizations are paralyzed by their challenges with data stored down in silos, inaccessible for timely decision making, and unavailable to patients. Our world is moving fast, so why is our data so much slower?

One of the biggest challenges to keeping data in motion is the legacy systems that have been implemented over the past forty years. One of the greatest inventions and the biggest hurdles is the database. The methods once employed to capture useful information were an amazing step forward from paper, but have outlived their usefulness now that we’ve reached a stage of maturity where it is no longer impressive to capture, store and retrieve data.

Not only do many systems ‘sit’ on data, they are often not very good at sharing with others. In two separate discussion yesterday, the first between physicians who focus on information technology (AMDIS), and then later a panel discussion with the CEO’s of Kaiser Permanente, Geisinger, The Mayo Clinic and Intramountain Healthcare, both spent considerable time on the challenges of silo’d data and poor interoperability. The bright spot of the second discussion was patient access to their own health records but only in these more advanced healthcare systems.

Sharing success

Intramountain’s CEO told a great story about a patient needing urgent care being helicoptered from a city 400 miles away, but being inside the Intramountain network throughout, with complete data transparency so that by the time the patient was in Salt Lake City, they had been under continuous care (with continuous data) for the entire event. A doctor was even monitoring throughout using a mobile device. By contrast, a patient being transferred from a hospital across town initiates an electronic medical record only when they arrive at the Intramountain facility. The data necessary to make decisions only starts to come into play well into the care cycle.

Intramountain benefits from having one of the oldest Electronic Medical Record systems in the country and the benefits are obvious. Others on the panel were in the same position but they are exceptions to the healthcare rule.

Effects

It is great to have these examples, but most can’t tell this story. What does silo’d data and lack of interoperability between systems mean for us? It means the important diagnostic decisions, financial options, and best practice patterns aren’t available in the timeframe needed for action. The result is uninformed care and duplicated and wasted effort.

The frank fact is that software for electronic medical records isn’t serving the audience of patient, physician and the extended care community. Millions of dollars spent entrusting the solution to big electronic health record vendors hasn’t achieved the goal of information accessibility across the healthcare value chain. I predict the next wave is interoperability based on data in motion.

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Categories: Data Analytics / Big Data, Healthcare, Markets, Mobility

Author:Chris Taylor

Reimagining the way work is done through big data, analytics, and event processing. There's no end to what we can change and improve. I wear myself out...

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14 Comments on “Healthcare: Set my data free! #HIMSS12 #BPM”

  1. February 23, 2012 at 4:59 pm #

    Chris:
    thanks for the update….
    Your observations are on the mark!
    So if intermountain had created a simple output of the EMR to include all relevant clinical notes, labs, consult reports, in a chronological order and allowed a secured pdf output that can be emailed to the receiving facility intermountaion or any other , the problem is solved. Every day I refer patients out and get referrals. In my case the chronological pdf file follows the patient. So no errors in communication or duplication of tests. In many cases the patient gets a procedure needed in tertiary center without wasting money on re-consultation. Unfortunately I do not get the same luxury from other centers that have invested tons of money on EMRs. So what is the big deal about Kaiser and IM? They got federal dollars for this?

    Did anyone in HIMSS even raise the issue of HIPAA being abused and misinterpreted to prevent information sharing?. Here is an example. Let us say doctor A sends you to have labs at labcorp or any other national lab and refers you to doctor B for consultation. Today there is NO WAY doctor B can view your labs in a hurry. The only way he can get any info is if the patient told you where he had the labs and who ordered it. Then doctor B send a HIPAA release form to doctor A ( not even the lab!) and ask them fax the labs to his office where the patient is lying in crisis. . This is what wastes so much time. Often labs are duplicated because even if patient has a portal access ( EHR) they are not going to know how to use that darned thing when they are facing a painful crisis or a near death situation. Tell me if you think that is the meaning or spirit of HIPAA

  2. February 23, 2012 at 8:46 pm #

    Dr. Murali, I appreciate your thought-through comments. Part of the reason for the challenges you mention is that the EMR’s are data silos that work against data sharing. The challenge to the PDF solution is that data in a document can’t be accessed or aggregated very easily. The data is in its own paper silo. It may solve the duplication problem but comes with problems of its own.

    There needs to be a higher-level process approach to resolve the needs of the patient, the needs of the care providers, and the needs of the payers. Throwing technology at the problem without having great knowledge of the functional silos, hand-offs and gaps is a big part of the issue. It is a problem of not seeing the forest (the high-level flows and permissions) for the trees (the chunks of data and transactions). I haven’t encountered a business yet that solved a problem by pure technology solutions. It won’t happen with healthcare, either.

  3. Craig Leppan
    February 24, 2012 at 12:32 am #

    Reblogged this on Ovations Group Blog and commented:
    Great message from Chris Taylor as always around BPM and data in motion.
    It certainly applies to our insurance industry and our efforts in the back office around our core services, as well as the new venture to connect brokers and insurers via the http://www.Lime-st.co.za service.

  4. February 25, 2012 at 11:05 am #

    Thank you, Craig.

  5. February 25, 2012 at 11:20 am #

    Chris.. I’m sure you are aware google extracts data from all kinds of documents. So pdf documents can supply that data. What doctors object to is the waste of our time in filling nonsense on forms.
    If you send my your e.mail through ( http://www.drmurali.com ) I can send you more detailed information about these problems includign woeful experiences in scores of hospitals. . Information / data is only as useful only if it can be mined/ used for patient care/ billing/ fraud detection/ etc. . EMR companies hold on to the data and just want to sell it. They are so obnoxious they make their search engines for the data very complex and just unusable at client end. This is where I advocate regulating them until it really hurts. They have had a free ride with no regulation from the end users. ie. doctors. Remember EMRs are medical devices that are used in “effecting and facilitating patient care” so they can technically be regulated like medical devices. FDA is capable of doing this if they do not shape up soon!

    • February 26, 2012 at 4:29 am #

      You may be interested in PDF/H

      http://www.aiim.org/Resources/Standards/Committees/PDFH

      Chuck

      • February 26, 2012 at 7:22 am #

        Dr. Webster. I understand the telephone parallel and appreciate the simplicity of the PDF as a tool. It would certainly allow for interoperability at a certain level for those who need to interoperate with partners who aren’t at the same stage of EMR adoption. This is a very temporary fix, though, and it should be noted that it doesn’t prepare the sender or receiver for 2015, where there needs to be statistical data in the form of quality metrics on healthcare outcomes that can be improved upon.

        In the meantime, if the goal is to move data between a referring doctor and the referred, I can see where this is better than a paper chart. Getting everyone into a truly interoperable network of providers able to move data, analyze data and act on complex events will take much more.

  6. February 26, 2012 at 7:30 am #

    chris..I have met and exceeded the MU2 in my office in spirit. The trick for medium and small size practices ( now almost eliminated by fear of obamacare) is to know what information to collect, what information is important for quality control, how does that information fit into our internal CQI program, how to collect that data seamlessly without duplication of tasks, understand how that CQI program affect the patient experience. It is better to get our needs addressed first and then worry about MU2-Government version. I do no know of any doctors in practice( especially those who own practices) willing to compromise on quality or outcomes..after all it is our livelihood!

    • February 26, 2012 at 7:38 am #

      Dr. Murali, Understood. At a practice level, there needs to be quality outcomes. That doesn’t mean that the system as a whole can meet its needs with data silo’d in documents. The best analogy I can provide is of a driving record, data common to every country in the world. To understand how to improve the safety of driving at a macro level, there needs to be data available about how many drivers of each age are on the roads, what types of accidents they have under what conditions, etc. If the data was stored locally and shared by documents, this would never allow for the study of the patterns that need to be addressed in communities and populations.

      While each doctor can be focused on their own quality and outcomes, the lack of data standards and centralized, granular reporting keeps healthcare from having a macro picture of trends, best practices, where to spend more or less, fraud, etc. While the PDF can resolve early interoperability challenges, it isn’t a long term fix at a regional or national level.

  7. March 2, 2012 at 6:28 pm #

    HL7? With XML for integrated data-definition records? It does work for the open type XML documentation where the data definition documents are stored in a central repository.

  8. April 4, 2012 at 4:39 am #

    Hi,Chris Taylor
    Thanks very nice share … I follow your site constantly … important issues … Congratulations … I entered this site by chance, but I found very interesting blog on this website.

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