The Push to go Digital

There is a large push from the government and industry to bring the health care industry to the digital world. The government has set aside 59 billion from the stimulus package for improving the health care system. For example 19 Billion is to be set aside to convert from paper records to electronic medical records (EMR’s).

Wireless product maker want to get in on this by building equipment that could transmit patient data directly from the monitoring equipment to a computer to enter it all automatically. Big companies are working on solutions for this kind of wireless technology, companies like Intel, general Electric, Cisco, Microsoft, Google or Qualcomm. It will take a large investment to shift but they also hope for even greater savings which are health care system needs.

Google in combination with CVS Caremark has set it up that CVS Caremark customers can download their prescription records into Google Health.

Microsoft has set up a deal with New York-Presbyterian Hospital. Microsoft is helping them image and digitize their health records. They can be viewed by customers online or exported to Microsoft Health Vault. They are also using other Microsoft technology to manage these records.

Something that may be a positive result of Health Records going digital and allowing patients to access them is it allows the customer to take a more active role in there health care, hopefully encouraging healthier lifestyles.

Q+A on Electronic Health Records

Q: What is a Electronic Health Records (EHR) or Electronic Medical Records (EMR).

A: It is an individuals medical records in an electronic format.

Q: What benefits are there to using EHR’s.

A: They are believed to reduce costs, promote standardization of care, and reduce errors. It may also allow research to be done faster because the digitized data is easier to work with and their would be more of it. It will also improve individuals access to their medical records, hopefully make billing more accurate, and reduce duplicate services.

Q Are there challenges or risks to using EHR’s.

A: Legal liability in technology used in health care is a risk to the company using the EHR. Another challenge that needs resolved is control of records, as in who has control, the hospital, the physician, the patient, and also how these records are maintained if say a physician retires. We need to be able to mark the documents as official and unaltered, this can be done with the use of digital signatures but is a challenge to maintain for a large organization. Another challenge is that each organization will use the records differently and want to display them differently so at least the display of data must be customizable even if the data is stored the same way across different organizations. The only increased risk to the individual is that their information may be stolen from the companies database and used for identity theft, although this is not any higher than banks or other companies who have your data, and similar data protection requirements could be put in place.

Q: Are EHR’s really used in the health industry today.

A: In the United States the probably the successful use of EHR is the Department of Veteran Affairs has a enterprise wide implementation the call the ‘Veterans Health Information Systems and Technology Architecture’ or VistA. A study a few years ago showed that less then 10%, (Wikipedia footnote 3), of health care providers in the US had fully integrated solutions, meaning that it was being used in most aspects of the hospital, not just a small section like billing. Some of the biggest challenges to migrating are physician and nurse adoption, basically if the people who will enter data and uses the system the most don’t like to use it then it won’t get used and the system will fail. The other largest challenge being cost to implement a EHR system.

Q: Are there consumer accessible EHR’s available.

A: Google is building Google Health and Microsoft is building Health Vault both of which are in beta (testing) stages but they have made them available for you to use and you can enter your data, and you can check if they can accept your providers data, they can accept data from a variety of sources and you may be able to have you pharmacy or health care provider enter data for you automatically and not just yourself. Also a few organization have their own implementation, for example IHC has myHealth which you can get access to, you can see more information about this in an earlier post.

Q: If I use one of these EHR’s is my health organization going to be able to use it.

A: The short answer is currently probably not, ask your provider or check there website to find out. There is a large governmental push in the United States to convert health providers to EHR’s and also legislation attempting to force them to make the data interoperable so that it should be able to be moved easily. So I imagine within the next ten years (hopefully a lot less) most organizations will have a form of EHR that you will probably be able to access.

IHC myHealth

Intermountain Health Care has a service called myHealth. It is a patient accessible online EHR similar to Google Health or Microsoft Heath Vault but is specific to IHC. You can get more information about signing up for this here. It allows you to track prescriptions and view some test results, for yourself. It is tied directly to IHC so they also allow you to setup appointments and send and receive messages from your doctor. They have a a tour available at this location. Find the link for ‘Take a tour’ under ‘My Health Care’. If I had records with IHC or was going to be living here for a while I would sign up for myHealth. The difficult part is signing up, because you must go in person to a IHC facility, you should be able to find out how from either of the hyperlinks above.

My test run of Google Health

So last time I wrote a little about Microsoft's Health Vault. This time I thought it would be fair to give Google Health a test run, which is also in beta. A lot like the Health Vault I was required to log in in this case with my Gmail account. At first glance I think it was relatively simple to understand.

Google Health Choices

When you sign in you get a list of links that allow you to do different tasks. Most of them are self explanatory. One thing I did notice that I liked, was the ability to see drug interactions. After you enter medications, in the appropriate area, you can click on the drug interactions link and it shows you drug interactions that may occur with your medications.

When I tried to import medical records I was expecting to see an area that would allow you to import basically any file on your computer to the website. Instead it takes you to a list of medical services that you can link to with your Google Health account, like CVS pharmacy’s or Medco. When you click the link for explore health services it takes you to a site that lists a bunch of online services for various things, like building a schedule to take your medications or medication pricing comparisons. I thought this would be nice if Microsoft’s Health Vault had these features, I went back and checked, Health Vault does but it is in a different location a little harder to notice.

Google Health Medication Entry

Entering a medication or medical condition was easy with Google Health you can just type it in or you can select one from the list they provide. You can also see that their is more options that you can enter like immunizations or Allergies.

I personally can’t say which one is better at this point Health Vault or Google Health. Health Vault gave me the option to load a file or medical record where as Google Health refers me to other companies to do so as far as I can tell. Health Vault also had the potential to import data from other devices to my account which I didn’t see a way to do in Google Health. Google Health I found easier to use and navigate, I also like the way you could select from a list of medications to enter into it, instead of just typing it in, which I think could help prevent errors. The drug interactions check on Google Health was a good idea in my mind, but I wonder how accurate it really will be. All in all I see potential in both of the services, they both currently have a few different features but I could see them both adding features to improve them, especially since both are still in development. They are both also being done by to large software companies that have the potential to make it work well. We’ll see what happens in a couple of years. The end result may be that people will use what they already have an account for so Gmail users may end up using Google Health and people that use something like Hotmail may use Health Vault.

A little about Microsoft Health Vault

Microsoft has a beta version of what they are calling Health Vault. It is publicly available so you can try it but you will need a Windows Live ID. I already had one so I gave it a try it was easy enough to sign in. It is easy to create a profile for yourself. The area of records look a little like an excel table. I have a screenshot below of the Medication table it is empty but you can see that it would be easy to read.

Medication Table.

Below I show a form of how they they allow you to add a predefined record type. In this case an allergy and how you react when and other information about the allergy.

Adding an Allergy Form

They allow you with the default options to add a fair few things like your allergies, medications, diabetic entries to track it over time, and so on. I wasn’t able to try it but their are some devices you are supposed to be able to buy that can enter info. for you so that you can easily track things like diabetic testing or blood pressure. You can also add things like Custody of Care forms. They also allow you to just upload a file so that if you can’t enter it into one of there predefined records then you can upload it as another file type and you can retrieve it and read it, its just not as convenient. You can also tell it is not quite finished, for example I could never figure out how to enter my blood type but there is a spot for it. It will also allow you to export your data as a csv (comma separated value) file which can easily be imported into other programs like excel or a database. They could easily add more formats in the future.

All in all I think it has potential but is not done yet. If I was a person with a Windows Live ID it would be an easy option to pick in the future when it is a bit more refined. The Windows Live ID also give you access to a lot of other services, like email, blogs, web pages, etc… So they could tie it into other services they already provide and give you a one sign in access to a lot of what you may want to use. But before you jump on and try Health Vault wait until I tell you about Google Health.

Introduction to Electronic Health Records

Electronic Health Records or EHRs are medical records about a person that are stored digitally, they are also sometimes referred to as EMRs or Electronic Medical Records. EHRs often include a patients demographics, medical history, allergy's, immunizations, lab results, radiology images, billing, and any other medically pertinent information about a person.
EHRs are not heavily used in the US today, many of our doctors offices and hospitals have not implmented new technologies, they operate much the same way as they have for the past 50 years. This is in spite of the benefits of less medical errors, lower cost of care, and easier access to record across multiple sites to makes treating the patient easier and reduced duplicate work. One thing that must be done is to insure that this information is secure. If compromised the information contained in an EHR could identify someone for the rest of their life. In this blog I will attempt to explain some of the drawbacks and benefits to EHRs. I will also try a couple of the ones available to the public free of charge.