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TECH: Interoperability/schminteroperability

This week the Clinton/Frist (or should it be Frist/Clinton) legislation got on breakfast time TV, and Brailer’s office announced that it was going to be starting the first few pilots towards interoperability with some $60m available. A more ambitious $4bn bill was introduced too, although that won’t go anywhere unless someone adds the words "Terror" or "Iraq" to the title. But while all the fuss is about interoperability of data transfer, there is a whole set of players who need data to become electronic before it can be made "interoperable". While the larger medical groups and hospitals are rapidly getting on the EMR adoption curve, it’s a much slower process among the small practices that account for 75% of America’s doctors and patients — most of their information is stuck in paper. Other countries solved this problem the old fashioned way — the government paid for doctors to get EMRs in their offices.  Before we get too worked up about interoperability and RHIOs, a bigger national push to get smaller practices using clinical information technology might be a better idea.

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JC
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JC

When Kaiser or any organizations, large or small are to store patient data, they risk all the concerns about HIPAA violations. (see $200k fine on HIPAA violation news) Hence, it is critical to look at the challenges for protecting individual privacy either in centralized data repository, or local data as one, not seperately.
Since technolgoy would always have failures at sometime, or somepoint, we need to make sure all eHealthcare applications that access such data adhere to the requirements of HIPAA.
JC

gadfly
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gadfly

//applications don’t run off of their own duplicated “marts” but on the same physical version of the source data that every other application in the enterprise is running on.// It depends on the application. Let’s say you have a data warehouse with patient info. Some applications will access the data directly, and the “data set” will be limited to whatever the user asked for. This data set is only at risk if the user prints it out, makes an electronic copy, or forwards it somewhere. However, the IT world (especially Health IT!) is not that simple. Imagine if it’s not… Read more »

matt
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matt

I agree that securing the source data is but one aspect of information security. Having a single physical set of data – one thing to secure – is favorable to having the data split into many parts and physical copies. True “data warehousing” seeks to minimize (or eliminate) physical duplication of data… since duplication of data results in inaccuracies in the data (and wasted resources): physical cubes are replaced by virtual cubes (in the WH), applications don’t run off of their own duplicated “marts” but on the same physical version of the source data that every other application in the… Read more »

gadfly
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gadfly

My point, though, is securing the data warehouses won’t secure the data. I agree an organization will save money on staff and operations with fewer data warehouses – it just won’t mean anything from the perspective of protecting information. Data sets have to travel. Encryption helps, especially en route, but the data is reproduced in readable format in any application where someone queries for output results.

matt
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matt

While I agree that there won’t be a single data warehouse, fewer data warehouses are easier to secure – from a technology, staffing, and operations perspective – than having more… which was my point.

gadfly
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gadfly

I want to add that huge segments of the MegaDatabase will also be reproduced as datasets for any number of downstream applications. The reason Integration is such a hot topic today is because these applications tend to split off into thousands of unconnected little fiefdoms – patient alert system here, population management data there, billing here and there…not to mention tribes of contractors doing prototyping…there’s no such thing as keeping the data in some Fortress of Safety.

gadfly
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gadfly

There wouldn’t be one database. There would have to be several for redundancy. And then there would be tape/platter back ups. I worked in a department that did such back ups just for IRA accounts at Bank of America, and I can assure you this is where corporations try to cut corners. One was faking an understanding of Access programming, and the president of that division was getting fake summary information simply because he had no way of knowing otherwise. People would forget to label the platters, and they would just stack up in the storage room. A couple utterly… Read more »

matt
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matt

Is it easier to ensure that one database (that has 300 billion records) is secure or 5,000 databases that each have (600 million)?
Each database contains the medical records for lots and lots of people… and compromise of any one would be a big problem.
Insurance companies are already centralizing claims data for all kinds of analysis. Centralizing real clinical (EHR) data would make their analysis that much more accurate (in comparison to what they’re doing today with claims) and result in fewer “false” positives. How is this not a good thing?

gadfly
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gadfly

//errors in records (bad coding, aggressive prescribing, poor diagnosis or a diagnosis deliberately exaggerated // The thing I have a hard time wrapping my mind around is that it’s not just the physician’s interests that might distort a medical record. The patient’s interest in accurate diagnosis might vary over time. A patient might under-report symptoms for a range of reasons from macho psychology to insurance consequences. Other times a patient might want the diagnosis to access certain services: for instance parents might want a child diagnosed with Attention Deficit Disorder so their child will get disability services at school. A… Read more »

gadfly
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gadfly

//given the proper safeguards// One word, dude: Mastercard. There will never be proper safeguards to protect the data. There needs to be proper safeguards to protect people from the consequences of its theft. My Mom became the victim of identity theft when someone stole her purse two years ago. She did all the right things: she filed a police report, cancelled her credit cards and implemented fraud alert witht he credit agencies, cancelled her checks and had an identity theft affadavit notarized at the bank, etc. This was a lot of time and effort. But despite all this, to this… Read more »

Sue
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Sue

“Underwriting is constrained by laws, not by the capabilities of insurance companies to do better underwriting. They have enough data today to figure out who’s a good and bad member / group. They’re just -legally – not allowed to underwrite that way.” They can’t legally charge an individual more than the rest of the group the individual is placed in, but they can use that data to determine the premium group the individual is placed in and in many cases whether or not the individual’s initial application should be denied or coverage modified by exclusion of pre-existing conditions. That’s the… Read more »

Sue
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Sue

My concern relative to centralized data collection isn’t that people won’t be able to hide medical conditions from underwriting, but that errors in records (bad coding, aggressive prescribing, poor diagnosis or a diagnosis deliberately exaggerated to receive higher reimbursement) could in fact result in relatively healthy people being rated improperly and being forced to pay higher premiums. Think about the challenges consumers face when mistakes are made in their credit reports. There is a process to correct that but it is time-consuming and puts the burden on the consumer. The complexity of medical records would make correcting a consumer’s medical… Read more »

matt
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matt

“The thing I fear is that it will create a centralized database that will make it easy for insurance companies to access in underwriting…” Underwriting is constrained by laws, not by the capabilities of insurance companies to do better underwriting. They have enough data today to figure out who’s a good and bad member / group. They’re just -legally – not allowed to underwrite that way. The more that data is decentralized, the less it’s useful for analysis… for good things like identifying and recalling dangerous drugs, reducing regional, local, racial, and economic disparities, reacting to bioterror, etc, etc. And… Read more »

gadfly
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gadfly

All I know is that the billing module was what Kaiser wanted when they made their deal with Epic, and it was the first thing they were going to implement (starting in Colorado, if I remember correctly). I’m not sure whether Kaiser was after the point-of-sale extractions, for patient profiling, or just the ability to keep on top of billing efforts made in order to implement fees and penalties.

Lin
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Lin

How does anyone see the EMR working in billing? Will it help to decrease billing errors? How?
Does anyone have any thoughts about the unintended consequences of this? Or the new errors that will be created (like in electronice prescription writing – errors due to poor handwriting decreased, while other types of errors increased)?
Lin