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Nationalized Health DatabaseBrian HusarBrittany BoyerKeeley McGowan
What Is It?
Government controlled
Tax-payer financed
Independently supervised
Comprehensive electronic health record system
The Current System Is Flawed
Increased proportion of individuals uninsured
Dangerous lack of communication
Resulted in neglect and errors in treatment
Generated roadblocks to research
Benefits
improve insurance programs
increase organization and privacy through improved legibility, accessibility, and security
expand medical care with improved quality, efficiency, and communication
advance medical research by studying trends in vast treatment databases
Initial Strides
Google Health“to provide users the ability to build online health profiles, download medical records from doctors and pharmacies, receive personalized health guidance, find qualified doctors, and share selected information with family and caregivers”
Blue Cross Blue Shield of Massachusettsthe first state to pass a mandate requiring the complete transition to electronic medical records by 2015
Insurance
Reduces paperwork, improves legibility Improved customer service
The Principal - using a database “30% more patients” getting help Preventative medicine responsibilities Drug reactions - pharmacists don’t always
check Sick patients don’t have to accumulate resources from
many offices/locations More efficient business - saves $, eventually this finds
its way to the consumer (less organization effort required)
Organization & Security
Mutually intelligible system Easy to update records
Many people already have access to medical records
Computers are a “neutral technology” (Thurman) Current system: “security through obscurity” Security suggestions: bank-like account monitoring
systems Access on a need-to-know basis
Clip from Grey’s Anatomy
Chinese woman needing stitches Language barrier “Are you allergic to any medications?” How would this be improved with CMD?
Clip from Grey’s Anatomy
System must be mutually intelligible Improved quality of medical care for everyone,
even non-English speakers
Quality of Medical Care
Attending doctor has access to all medical information Emergency situations Avoid malingering Complete medical picture - sometimes patients
forget Specialists & doctors away from home
Easier, faster diagnoses Fewer diagnostic tests - save $
Drug reactions Preventative medicine more possible
Clip from Grey’s Anatomy
15 year old girl having violent seizures Can’t communicate with doctors Run a “shotgun” of diagnostic tests How would a CMD improve this situation?
Clip from Grey’s Anatomy
Diagnostic tests are Expensive Time-consuming Often inconclusive (as in this case)
Less diagnostic testing means More efficient diagnoses Less employee time Saves money Often extra information saves lives
Girl twisted her ankle and fell causing an aneurism- doctors had to search for this information rather than it being at their disposal
The Second Opinion
Tara Parker-Pope Prognosis changes with second opinion
Philly eye hospital: 2nd opinions for eye disorders: changed prognosis 15% of the time, avoided surgery 30% of the time
Northwestern University: reviewers disagreed with 1st opinion 80% of time, avoided mast/lumpectomy 8% of the time
Many hospitals avoid 2nd opinions for cost, time, distraction reasons Physicians sometimes offended by request Huge stacks of paper to obtain, organize
CMD would ease the process of obtaining these vital medical opinions
Medical Research
Collective knowledge of diseases spurs research
Allow researchers to track certain diseases as well as patients’ responses to certain drugs
Enable treatment plans based on patients with similar histories
Analyzing historical trends in families enables doctors to assess risk for certain diseases and take appropriate preventative measures
Track which treatments are most effective depending on specific genotypes
Rob Kling’s Car Argument
What will be the future detriment’s of the database?
What is our responsibility in terms of weighing privacy against improved healthcare?
Privacy and Health Records
HIPAA Background http://youtube.com/watch?v=K3Bd3Z15-_M Patient’s right to access their own medical
records Patient’s right to amend any incorrect
information Patient’s have a say in how their healthcare
provider uses their information other than, treatment, payment and healthcare operations
Privacy
Who could access your records?• Insurance companies
• Future employers • Drug companies
Distribution
If obtained by the wrong person, a paper record can be faxed or copied, but an electronic record can be send out quickly and worldwide
Access to one portion of a person’s records may open up access to all portion’s of a person’s record that is unnecessary to that situation
Genetic Information Mental Health Records History of STD testing, pregnancy testing
Basic risks of Technology
When all records are stored in one place this creates risks such as: Power outages Forgetting passwords Sharing passwords/Guessing passwords Destruction of records
Proposed Security Measures
Audit Trail – electronic methods of detecting and recording the identities of anyone who accesses a record ex. UCLA and Brittany Spears
Encryption of external transmissions of record information
Implementing punishments for those healthcare professionals who abuse their access to people’s classified medical information
Firewalls - electronic barriers that isolate records systems from unauthorized access or penetration.
Problems with these measures
Such security measures are expensive Created many steps for an authorized person
to access the database can result in the forgetting of passwords or paper records of such passwords floating around in an office setting
Ways to make it work
OnFile http://youtube.com/watch?v=54QqnO9AbMk
MedFlash http://youtube.com/watch?v=bspsju40YvI&featur
e=related
Promoting Privacy/Security
Only health care professionals and research organizations that have applied and approved for special access to the databases would be permitted to use the information
Insurance companies would not legally be able to access the database for screening purposes
Digitized records are more secure – one can steal or fax a sheet of paper without leaving a trace
President Bill Clinton at New York–Presbyterian Hospital Admitted for heart surgery under pseudonym
Computer hackers and medical personnel alike attempted to gain access to his records
The hospital thwarted approximately 1,500 attempts by individuals to peek at the records of famous individuals
Options
Maintain current system of independent control
Digitize records
Allow individuals to control personal information
Implement universal health database
Bibliography
Freudenheim, Milt & Pear, Robert. “Health Hazard: Computers Spilling Your History.” The New York Times. 3 Dec 2006. 1 Mar 2008.
Gillette, Bill. “Payers at the forefront of adopting electronic patient health records.” Managed Healthcare Executive. 1 Mar 2006. 26 Feb 2008.
Lohr, Steve . “Google and Microsoft Look to change Health Care.” The New York Times. 14 Aug 2007. 3 Mar 2008.
Mass High Tech: The Journal of New England Technology. “Bay State Senate Bill Would Mandate Electronic Health Records.” 4 Mar 2008.
Oliver, Martin S. "Database Privacy: Balancing Confidentiality, Integrity, and Availability." SIGKDD Explorations. 4.2 (2002). 4 Mar 2008.
Parker-Pope, Tara. “Why It’s Hard to Get a Second Opinion (And How to Make Sure You Get One).” The Wall Street Journal. 1 Feb 2005. 26 Feb 2008.
Szwergold, Jack. “Big Brother and Healthcare.” Management Review 83.2 (1994): 5. Thurman, James N. “Proposed health database has privacy advocates in uproar.” Christian Science Monitor 90.167 (1998): 3.
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