This is the first in a 3-part blog series, discussing the opportunities that cloud computing offers in healthcare. I present futuristic scenarios from each healthcare contingent’s vantage point: patients, providers and payers. A myriad of technologies exist today. It will be up to healthcare organizations of all types to get their data ready to meet the demands for data integration, security, portability, transparency and accountability in this brave new world. Mature data governance systems and enterprise-wide data integration will be critical in this endeavor.
Introduction: Welcome to the Brave New World
Now that the Healthcare Reform bill has passed (phew!), it is time to get back to the basics of Healthcare Data Infrastructure. It is such an interesting time to be involved in Healthcare IT! The technology is exciting. The resources are available. Healthcare providers are gaining some traction in the use of electronic health records. Consumers are developing interest in eHealth, mHealth and other web-enabled resources. RHIOs faltered but HIEs are picking up steam, and will also use new web technologies. Could it be that healthcare data systems will deliver on the promise of accessible, portable, transparent data?
But hold on a second! If all that technology exists today, why aren’t we already using it? It’s complicated, but the main reason is: DATA INFRASTRUCTURE. There is a mad dash among providers (hospitals, physician’s offices) to transfer from paper-based systems to integrated EHRs. But, systems that traditionally haven’t been integrated (Finance, HR, Education, Credentialing, Inventory, Purchasing) still won’t be integrated. Insurance companies receive claims from a host of different feeds, and different departments use data in completely different ways. Coordination of Benefits isn’t (technically) well coordinated. My personal ability to assemble a complete PHR might require information from many different doctors’ offices. Mergers and acquisitions challenge even the most sophisticated health systems. The list goes on. Data integration and the need for better data governance everywhere is critical.
There are many kinds of cloud computing, ranging from platform, software and application services to storage and raw computing power. They will offer opportunities for efficiencies of scale and analytic capabilities, housing massive amounts of raw data. The technologies and capabilities at hand are truly exciting, but they won’t succeed without sustained infrastructure design and mature governance standards to ensure common usage, security and data integrity.
I: Patients
It’s so different now when I go to the doctor’s office. When I show up at the front desk, the receptionist, instead of shoving a clipboard and a pen at me, greets me by name. “How are you today, Carol? Please take a seat and use this e-tablet to write down any changes in your insurance, and what you want to see the doctor about today. Your wait will be about 10 minutes, but in the meantime, have a cup of coffee, and use the e-tablet to write down anything else that you would like to discuss. You can also look up some health education materials you may want to find. Our online library is more trustworthy than some popular websites. If you like, we can include this information with your medical record, which you will get an electronic copy of when you check out.”
Even though I’m feeling crummy, when I get escorted to the exam room, I’m surprised to see that the setup is completely different. Instead of the tiny stool the doctor used to sit on, hunched over a computer terminal tucked into the farthest corner of the room (so they can type without prying eyes?), there is a full-sized desk with TWO chairs. The doctor comes in, shakes my hand, and says “I see your blood pressure has been under control. But your blood glucose is a little high. Let’s look at your readings.” She sits next to me as she pulls up my chart on the computer, and shows me a graph of the data I’ve been sending through my monitor at home. Twice a day, the monitor reminds me to check my vitals and transmit them to the office, where they are downloaded to my chart. “This could be why you’re feeling light-headed.”
As we look at the graph, we discuss my recent surgery and other medications I am taking, and we come up with a plan to make some modifications. “I talked to your surgeon and he says things went well. But I see from your e-tablet that you’ve also been researching Alzheimer’s. Is there someone in your family who is having symptoms?” We discuss my Dad for a while; then she adds the note to my family history, and makes some changes to my prescription. She then offers to review everything we’ve discussed today on the computer, to make sure she has noted everything correctly. “When can I see you again?” I’m startled because usually the front-desk clerk makes all the appointments, but she finds an opening in her calendar, and automatically sends me an email reminder.
When I’m ready to leave, the front desk clerk hands me a printed copy of the summary from today’s visit, and she swipes my health card to update my medical record and file the bill at the same time. I now carry this card in my wallet, along with my insurance cards and credit cards because I want to have it with me. I can also access this information through the web at home, or even at work, through my personal login. When I go next week to see the dentist, he will be able to access all of my latest drug and medical history information, in case he also has concerns about my blood glucose or blood pressure.
That coffee was really good. Maybe I’ll have another cup on the way out!
This benefit of having integrated data available through remote exchanges to this patient will enable her to have a data-informed discussion with her practitioner and to be a better informed patient. Her office visit is more personalized and streamlined as a result of integrated scheduling and billing. The time spent is more educational because she can get information for her condition as well as her relatives, from a trusted source. And through sharing this information, important updates to her family history become part of her own health record. This is the profile of the new healthcare consumer as a result of Cloud technology.
photo by kevinpoh via Flickr (Creative Commons license)
Carol
Newcomb is a Senior Consultant with Baseline Consulting. She
specializes in developing BI and data governance programs to drive
competitive advantage and fact-based decision making. Carol has
consulted for a variety of health care organizations, including Rush
Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross
Blue Shield Association and more. While working at the Joint Commission
and Northwestern Memorial Hospital, she designed and conducted
scientific research projects and contributed to statistical analyses.
Carol
Great post. I read this with interest because I discussed EHR and the reasons for its slow US adoption in the new book. I agree that technology and data issues have been a bottleneck until this point.
I can only hope in the future I don't have to keep filling out silly forms at a new place. It would be nice if they could send me to a waiting room with my favorite music playing!
Posted by: Phil Simon | April 30, 2010 at 02:26 AM