Healthcare applications (Health-IT)
The current administration continues to be aggressive in pursuing healthcare reform. Aside from the issue of universal health insurance coverage, which has gained the greatest coverage in the media, the reforms include much more under the hood. Most notably, this means implementation of electronic health records, and the creation of a nationwide health care infrastructure that would make it easier for healthcare providers to share and access patient records. Part of this plan would create a National Health Information Network (NHIN), which is a broad, interoperable platform for sharing electronic health information. The NHIN would connect providers, insurers, and emergency responders.
According to the Department of Health and Human Services, the government’s health care informatics plan’s goals include:
· “Medical information will follow consumers so that they are at the center of their own care
· Consumers will be able to choose physicians and hospitals based on clinical performance results made available to them
· Clinicians will have a patient’s complete medical history, computerized ordering systems, and electronic reminders
· Quality incentives will measure performance and drive quality-based competition in the industry.
· Public health and bioterrorism surveillance will be seamlessly integrated into care
· Clinical research will be accelerated and post-marketing surveillance will be expanded”1
The concept of electronic medical records (EMR) and patient health records (PHR) is one that has long been discussed, and is already in use in other countries. There is no doubt that it will be part of the current administration’s broad health care reform initiative, and there are already legislative incentives in place to encourage health care providers to get with the program. EMR doesn’t just mean that the hospital puts your patient records in their computer—it means a new level of sharing. This of course, is within the HIPAA regulation framework and assumes a rigorous level of security, but it allows for a cloud-based infrastructure to exist for EMR. The benefits are obvious. A patient’s medical records would be available to any authorized health care provider, anywhere in the country. You could travel anywhere you want, and your records go with you. Any authorized provider could access your records in case of an emergency.
Already, there is a common but limited version which has shown great benefit—many of the large drugstore chains keep customer records in a secure database, so that you can go to any branch, anywhere in the country, and receive your prescription. The database also includes relevant information such as drug interactions and allergies. This is only the tip of the iceberg. Ultimately, this limited drugstore application will be integrated with all other healthcare providers. What’s the result? It could save lives. Error rates would be reduced, and caregivers will have more information at their disposal when making critical decisions about your care.
This technology, based strongly in cloud computing technologies, is rapidly gaining momentum. The RAND Corporation, in testimony presented to the Senate Finance Committee, highlighted just a few of the potential benefits of a cloud-based healthcare IT (HIT) system rolled out on a national scale:
“The hope of many is that the broad adoption of HIT systems with the aforementioned functionality in the United States will transform health care in terms of making it more efficient and effective simultaneously. Efficiency would be enhanced by reduced test duplication, improved drug utilization, better scheduling, reduced paper record handling, and improved claims processing and billing. Effectiveness would be enhanced by reduced errors (reduced handwriting-based errors, for example), reminders to improve preventative care, decision support for better evidence-based practice, improved management of chronic illness, and improved continuity of care for those patients seeking care away from their primary provider (such as was needed to support the mass evacuation that occurred after Hurricane Katrina). Effectiveness would also be enhanced by the quality of care assessment such systems would make possible and by improvements in the evidence base for best practices derived from the analysis of large electronic medical record databases.”
The potential social benefit is clear. Not only would individual hospitals benefit by moving to a more technology-based patient record system, society as a whole would benefit by integrating those systems together in a national database that relies on secure cloud computing technologies.
Besides the advantage of better patient care, cost savings would be enormous. In this day and age when the health care debate is often framed in terms of dollars and sense, a cloud-based national patient record system is an obvious element that should be included. RAND Corporation claims that savings that could be achieved would reach $80 billion per year, assuming a 90 percent adoption rate by hospitals and physicians. To put that figure in perspective, it’s a full four percent of the $2 trillion spent annually on health care in the United States.
The benefits can also be seen just looking narrowly at adverse drug events. Every year, there are errors in medication that result from lack of allergy or drug interaction warnings, handwriting errors, and poor dosage monitoring. The RAND study further estimates that the safety benefit would be enormous, avoiding as many as 2.2 million such adverse drug events per year, saving nearly $4 billion per year.
Could these savings be achieved without a cloud computing infrastructure? Not likely. The great benefits illustrated by RAND cannot be achieved if those electronic records are stovepiped, retained only by each individual provider. The cloud-based infrastructure suggested by the DHHS brings the scope of the proposal into greater perspective, delivering the benefit on a much wider scale, and allowing for the greater level of benefits that result only from data sharing to exist.
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1 US Department of Health and Human Services.
2 RAND Corporation. “The potential benefits and costs of increased adoption of health information technology.” Richard Hillestad, July, 2008. Testimony presented before the Senate Finance Committee on July 17, 2008.
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