October 3, 2005
KatrinaHealth.org
Hurricanes to the Left. Hurricanes to the right. Hurricanes every-damn-where. It’s hard to think about the Future of Health, when the present is so compelling. And hurricanes do compel present attention when they are close by.
I heard it said recently that every civil disaster is used by all interest groups to promote their interest no matter whether it is related to the disaster or not. This is a variant of politicians’ favorite game “create a crisis, solve a crisis” and its healthcare cousin “create a crisis, never solve the crisis, just keep funding it.”
“Crisis” is overused to evoke FUD (fear, uncertainty, dread…thanks, IBM). And action. And urgency. And appropriation or taxation depending upon which end of the shovel you’re on.
However, when one looks at the value of Electronic Health Records (EHR) and the recent storms, there may be some wheat amongst the chaff. The needs following the storm may have broken some barriers.
The development of electronically saved personal healthcare information has been ongoing for at least 40 years. The “record” is conceived of as an electronic version of the paper thing. There is a desire for a better file cabinet. And there is a belief that there is some set of information that is “vital” to know about each person to assist in their care. In acute, episodic care, this is generally not true. Because institutions funded most EMR/EHR development, the benefits have generally derived to institutions and not to patients.
The rise in dominance of caring for chronic medical conditions has focused the need to know current care plans and some relevant information about diagnostics.
There is nothing wrong with a virtual paper chart in a better file cabinet. It is a step in the right direction. It can be accessible to multiple people in different places at one time. It doesn’t get lost with adequate systems design. And it can, if properly designed, be easier to find things in.
But it doesn’t address many of the functional needs desired and which people see as leading to improved quality, safety, and efficiency in healthcare. There seems to be a general belief that the EHR genie will, with three wishes, create cost savings in healthcare. If experience is a guide, it’s not likely. And as currently conceived, it is not focused on the individual.
It seems to me what people really want/need is ACCESS and not necessarily a virtual manila folder. And individuals don’t want to populate the chart. One cannot know which pieces of healthcare data you have generated in the past might be helpful in future problem solving. You just need access to all of your information whenever and wherever you want it.
In the care of chronic conditions (e.g., diabetes, congestive heart failure, etc) there is some immediacy concerning recent treatment plans and medications.
The storm highlighted this value at the Veterans Administration. To their credit and because of pressing necessity, they have been blazing a trail of sorts with EHR. When veterans were evacuated from the New Orleans area to Baton Rouge and Houston and points beyond, doctors at local VA facilities had access to the patients' medical records. That was cool.
But it’s a closed system. Some recommend that the entire healthcare system be closed, like the VA System. Then we could impose a one-size-fits-all solution.
But there is another way. Creating accessibility of personal healthcare information to individuals and providers whenever and wherever it is needed.
Perhaps the most interesting outcome of the recent storms in this regard was the creation of KatrinaHealth.org, a data base with patient pharmacy history. As reported in Healthcare IT News:
“KatrinaHealth.org…contains prescription histories, available information on patient allergies, information on drug interactions and related data to help physicians and pharmacists care for evacuees. Many of the evacuees had their paper medical records destroyed by the storm, have no access to their medication data or can’t remember what pills they take or in what dosages, creating a potentially dangerous situation.”
“The site, which is hosted by Gold Standard, draws information from retail pharmacies, government health insurance programs such as Medicaid, state health departments, private insurers and pharmacy benefits managers in the Gulf States. More than 150 organizations that include federal agencies, the American Medical Association, local health departments, healthcare information technology companies, retail pharmacies, pharmacy benefit managers and the Markle Foundation collaborated on the project. The companies involved, such as SureScripts, RxHub and GoldStandard, are voluntarily funding the project.”
This information has been made available to the clinics treating the survivors of the storms and more recently has been made available to physicians and about 25,000 pharmacies nationwide.
Nice piece of work. And it shows that data from multiple sources can be made available. The next step: make it available on demand to the owner of the information, the patient.
