PHRs - Are they a reality?

I believe that PHRs will be slow to start.  Few people will take the time to research them and spend the money.  The user needs to learn the new software, go back through one’s records, and enter the data.  People do not have time or the patience to do this.  It only adds more complexity and one’s health is not always a priority.  For PHRs to take hold, they should be provided free in with an integrated and easy to use interface by the health insurance company.  The person will be sent information about how to access one’s PHR, which will have all the health information there.  Optimally, when the person changes health insurance providers, the information in the PHR will be transferred to the new provider.  However, health insurance companies may be reluctant to design PHRs because they do not know what to include and the cost cannot be justified.

Examples of HIT implementation

Florida:  An electronic intensive care unit (e-ICU) for remote monitoring of patients 24/7.  The system will notify medical staff onsite in case of a crisis.  This technology has saved lives.

Massachusetts:  E-prescribing technology.  Hand held devices are used to check medication history and renew them, as well as, check allergies and drug interactions.  Handwriting errors are also reduced.

Utah: A website for managing health savings account (HSA) balances and health insurance claim tracking. 

Nevada: Digital radiology program to capture X-rays in digital format.  The images can have annotations from the physician. 

Washington state: Interactive website for PHR information, communication, and information.

New York: The same as above.

Tennessee: Website that retrieves information for Medicaid participants.

www.ahipresearch.org/pdfs/AHIP_InvHealthIT_05.pdf

Palm readings

Doctors are overwhelmed by the sheer number of patient cases to review and sign off before leaving for the day. Integrated Document Solutions has created a mobile application for document exchange for prepared cases. The FDA has not decided on mobile devices for primary diagnosis. The screens of handheld devices are currently low resolution. People should know when it is acceptable and when it is not.  Making a diagnosis on a golf course is not good practice.  Navigation tools are also needed to compare past images.  Nevertheless, these tools allow for more communication because it can be done anywhere and a doctor can create a digital signature for verification. Educational material can also be access, but short synopsis only provide a superficial understanding.  Mobile viewing poses a security risk because people lose phones. There should be another person to verify the diagnosis.  Some doctors may not have time to learn these apps and IT staff is being cut everywhere as well.   Lastly, my input is that someone who finds one of these lost devices could send a fictitious diagnosis.

Gibbons, Michael. "Palm readings." ADVANCE for Imaging & Radiation Oncology. 6 September 2010.

Cloud computing

A solution to PACS is cloud computing. This is called application service provider (ASP) or software is a service (SaaS). Limitations of bandwidth between the provider and the site user is a limitation. Now only workstations and the gateway server are needed at the site. Any desktop PC with a web client to access it. This is much cheaper than a typical PACS. No data storage is needed either, which can be also be expensive. Hardware and software is maintained by the vendor. It will be much easier for changes to be made. Backup and recovery will also be handled by the vendor. No IT staff will be needed. Using PACS with cloud computing will also permit teleradiology. The total cost of the computing may be more expensive than the typical PACS. However dealing with a data center could be costly.  However, with cloud computing, the bandwidth needs to be fast enough.  There must be a backup network in case it fails.  Switching vendors and vendor bankruptcy may also be a problem.  A hospital also cannot make any changes to the system.

Schweitzer, Alan. "Cloud Cover." ADVANCE for Imaging & Radiation Oncology. 6 September 2010.

Standards panel

The healthcare information technology standards panel (HITSP) is a public and private sector cooperative partnership.   This group wishes to promote interoperability among healthcare software applications.  This group consists of experts from across the Health Care community.  The Clinical Research Interoperability Specification covers healthcare systems, especially EHRs.  It also includes Electronic Data Capture (EDC) systems and research engines.  The U.S. Dept of health and Human Services awarded several contracts to advance widespread EHRs within the next 10 years.

http://www.hitsp.org/

Creating your own PHR

PHRs can be used on pocket PCs and Palm devices to have information at your fingertips, however you can install software on a computer.  At recordsforliving.com, you can download HealthFrame for $40.  Internet-based Medikeeper adds extra features and you get access to a medical library "MediLibrary".  Some internet-based PHRs allow communication with your doctor.  For portability, you can buy a EMRy Stick for $50, which doctors can update for you by plugging it into a USB port on an office computer.  If the stick is lost, the data is password protected and encrypted.  Make sure you review the security and privacy policies of the products and services.  Check myphr.com, a service of the American Health Information Management Association, for information.  This site also provides a tutorial for creating a PHR.

http://health.usnews.com/health-news/articles/2007/09/11/how-to-create-your-own-personal-health-record.html

Health information technology

More attention has been devoted to improving health information technology to improve quality and safety.

Individuals are becoming more involved in their own health care through personal health records (PHRs).  This type of system will present the information in a usable format that the user can control.  There are two types of models; a standalone agent which is updated by the patent and an integrated one with a networked PHR that includes information from a variety of sources.

Electronic Medical records are used by Health Care providers and are stored on the hospital or health delivery system.  The standards on the system conform to the organization's needs.  Using a system patient specific services can be recommended, physician reminders created, and communication between Physicians. 

Electronic Health records (EHRs) are like EMRs, but they can link data from other providers for a more detailed view.  This record type is more interactive.  If EMRs and EHRs can exchange data, they are considered interoperable.  However, because there is no standard, uniformity is a major issue in the advancement of the systems.  An example of an EMR is a computerized physician order entry (CPOE) can increase efficiency by ordering various services.  An example is E-prescribing.  However even in this service, there is a difference in feature implementation.

There's also a concern about Data Security and inappropriate access.  HIPAA requires that Electronic Health transactions be standardized.  Few hospitals have a fully implemented system.  Cost is a huge barrier to the implementation of the systems but they can save billions per year.  The federal Veterans Administration and the private Kaiser Permanente has already implemented a system.

http://www.kaiseredu.org/topics_im.asp?id=655&imID=1&parentID=70

Electronic document management systems

Health IT professionals mistakenly believe that an electronic document management system (EDMS) is for document imaging.  This is akin to computer-based patient record (CPR) being confused as a clinical data repository.  EDMS is an electronic system that manages documents, which are preserved “containers” of data or interpretable information.  This can include hand-written documents, films and photographs, computer-generated diagnostic images, audio and video clips, and more.  The commonly used Picture Archival and Communication System (PACS) is an example.  Other examples of integrated component technologies are document imaging and retrieval, and enterprise report management (ERM).  Examples of patent record CPR are electronic patient record (EPR) and electronic health record (EHR).  

Health care IT professionals are also not comprehending documents and their management until they are involved with them.  Unstructured data in documents can still be handled as structured data partners.  Structured data is discrete, such as automated laboratory data.  Unstructured data could be transcribed patient radiology reports.  Diagnostic image data could be a digitized x-ray that is stored as bit mapped data.  Other document images are bit mapped as well.

Analyzing search failures

Search queries on Two National Library of Medicine Web-based consumer health sites, ClinicalTrials.gov and MEDLINEplus, were examined to develop intervention for failed search results.  The issues examined in this study were query formulation, content coverage, and system functionality.  

Even though the accessibility of health information is growing, consumers are still unable seek this information properly.  Examples of search failures are the improper use of queries, terminology, and terms.  This article sought to determine the seeking behavior of uses to make improvements.  The issues addressed were query formulation, content coverage, and system functionality.  However, there were a few challenges in this study.  Searches are usually only 1.7 words long and it may be unknown if an application or a user imputed the data.  

The majority of the queries were in scope, system relevant, and exhibited the proper terminology.  The failures detected were categorized into four groups.  One was related to user queries and the others were due to issues with system design.  The majority of search failures were found in the first category, mostly due to erroneous use of supported and unsupported operators.  Query misspellings were also another cause.  Failures in the other groups were due to an absence of relevant information in the system or its limitations in searches.  

These results can be used to improve health information systems.  Frequent searches for information not stored in the system can signal possible additions.  Out-of-scope queries might mean that the coverage requires clarification.  Errors in query formulation may lead to interactive query intervention, and failures due to system limitations can mark a possible area for improvement.  

http://www.lhncbc.nlm.nih.gov/lhc/docs/published/2003/pub2003049.pdf

Electronic medical records

The functionality of electronic medical records (EMRs) is increasing, thus they are becoming increasingly complex.  The current systems used today are poor and have safety issues.  An information and communication technology (ICT) would greatly improve the function of current EMRs.  EMRs are responsible for the storage and retrieval of data about a patient.  EMRs also called electronic health-care record (EHCR).  The functions of EMRs can include many different types of captured data, which includes ePrescription or eRx.  Health-care providers are required to keep patient records, but there is disagreement about what information should be on the network.  The selection of data is critical in finding relevant information, therefore the filtering and presentation of data is essential.  The usability of an EMR is critical and should be user-specific.  It must meet specific demands and be easily accessible. 

A minimal standardized set of data should be defined in a continuity of care record (CCR) to allow for communication and cooperation between care teams and providers, which is called interoperability.  This requires technical and semantic interoperability standards.  Technical is the containment of the structure and syntax of a document.  Semantic is the preservation of metadata when transferred between systems.  In order for EMRs to gain a wider acceptance, the security and potential misuse of health data must be addressed.  To ensure an effective system, EMRs should be implemented worldwide.

Kohn, Deborah. "Electronic Document Management Systems: an overview." Topics in Health Information Management 23.1 (August 2002): 1(6). 

Managing information

Health information technology can eliminate the use of handwritten records and the errors associated with them.  The ordering of duplicate tests by different doctors will be eliminated and errors reduced.   Some examples of health IT uses are personal health records (PHR), electronic health records (EHR) and electronic prescribing (e-Rx). 

Personal health records are for your quick reference, such as your latest immunizations.  PHRs may be provided with a health care plan, but it may come with a fee.

Electronic health records are computer based and used by hospital staff for up-to-date information.  This usually includes health conditions, allergies, treatments, tests, and medications.   These systems help reduce errors and can even warn about drug interactions and provide reminders about tests and procedures.  It may be possible to link PHRs with EHRs to share information.

Electronic prescribing is the sending of your prescriptions from doctors and health care providers to your pharmacy electronically.  This reduces errors due to poor handwriting, drug interactions, and a drug not being covered.

There is a potential security concern about the privacy of health information.  Medical identity theft has already occurred in some hospitals and doctor’s offices.  Rules and limits on who can access your information have already been established by the federal government in accordance to HIPAA.  Doctors and health plan providers need to be instructed on the privacy and security of health information.

http://healthinsurance.about.com/od/healthinsurancebasics/a/health_IT_overview.htm

Handheld devices and radiology

Radiologists are beginning to use handheld devices such as the iPhone and iPod Touch for patient diagnosis and care. These devices can be used for literature review, tracking patent information and billing, communicating with other doctors, taking images, and reducing costs. Additionally, handheld devices could prove to be a vital tool in disaster situations. A study found that the examination scores of brain CT images on PDAs were higher than that on LCD monitors. This could be due to a difference in the display surface or the luminance of the handheld device. The ability to move the device under ambient lighting to alter the contrast may also be a contributing factor. With access to the internet, doctors can now research rare diseases and read medical updates. The versatility of handheld devices would expedite the accurate diagnosis and treatment of patents, especially those in the emergency room. In addition, this could be done remotely without a computer present. However, despite the benefits handheld devices offer, some doctors are hesitant to use handheld devices because they can be a distraction, pose a security risk, and possibly reduce personal interaction with patients. Less than half of Radiological Society of North America members use PDAs, and of that, less than quarter use them for radiologic applications. Nevertheless, as informational devices continue to advance with faster processing, more memory, and higher resolution, the availability of medical applications will reciprocally grow.

http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/FeaturedCategories/ACRBulletin/Archives/2010Bulletins/April-2010.aspx
http://www.rsna.org/Publications/rsnanews/May-2010/handheld_feature.cfm
http://www.rsna.org/publications/rsnanews/apr05/hhtech.html

Combining Healthcare and Technology

According to Department of Labor, careers in healthcare and technology are projected to grow. The Bureau of Labor Statistics forecasts the medical and health informatics field to have a faster than average employment rate of 18 percent through 2016. Medical informaticians use their information science skills to advance the sciences. Medical informaticians have diverse responsibilities in utilizing the expanding volume of medical information related to healthcare delivery and research, such as the evaluation of medical tests for health insurance companies. The need for trained medical informaticians to manage health records is in high demand, as well as, people who can create applications for them. Additionally, current techniques need to be taught to medical students, as well as, the creation of new techniques.

http://www.washingtonpost.com/wp-dyn/content/article/2010/08/30/AR2010083002043.html

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