Consumer Health Application

You are in a stretcher being taken to the Hospital Emergency Room.  A business trip or vacation  has been interrupted, you are away from home, no one you know or knows you is around. You’re unable to communicate with the paramedics even if they could understand you; you’re just trying to  keep breathing. Where is your health information: your medication records; your most recent doctors visit; lab results? Even your emergency contact, blood type and known drug allergies?

Will digital medical records save your life?

Now imagine you have an a consumer health application, a simple health card is in your wallet. It contains your emergency contact, blood type, allergies, health insurance and a web site to access your full health information. You could also have an  Emergency report with you that you printed before going on your trip. All this information could save your life.

All your family health info

The majority of us leave our health information in the hand of professionals, our doctor, the clinic or hospital. Most times this is enough; our family doctor can fax or send details to a specialists, the hospital or clinic will sent lab results or clinic notes to our family doctor. All your health information is safe and secure in the hands of the medical professionals you deal with regularly. But when an unexpected event occurs, this safe and secure health information is not available to the paramedics or doctors tiring to save your life.

Your health information at your finger tips

Maintaining your personal health information gives you and your family control. Keeping a family health record will give you a secure, safe and comprehensive set of health information that can be used to keep you healthy.  And when you need it it could provide a voice that is missing during an emergency situation.

Global eHealth access

When traveling we don’t normally take all of our health information with us. You may have some recent details on your prescriptions, but not much more. A friend told me that when he travels he usually runs for exercise, on his shoes he has a tag that contains his doctor’s name and phone number as well as the doctor’s cell phone. If my friend were to drop unconscious someone could contact his doctor and get help immediately…hopefully. While this medical emergency contact information is a start it doesn’t suffice for most people with serious health conditions.

It makes perfect sense for a healthy person to carry emergency contact information. Perhaps, it would be worthwhile to have more immediate info accessible to the emergency response person wherever you may be. Yet a simple slip of paper with information on it is not enough. How does someone know you have such a document in your pocket? Some solutions such as medic-alert have been used for individuals. A simple call to a toll-free number provides access to medical information using a call center services. Is there a better way?

Personal Healthcard can be used to access info during emergency

One solution to this issue is USB key technology. Why not use a USB Key? How many USB Keys do you own and how many have you misplaced or lost? Compare that with your credit card. You carry one or more of them in you wallet, purse or pocket. Even when lost you can easily get them replaced or reissued. Devices like a USB need a computer, credit cards just need card readers or scanners. And even without the computer or internet a smartcard can have information on it and in it that can still provide information when needed.

Many have compared eHealth with eCommerce and ATM banking. We can take a page from this domain and use the smartcard. This is used for credit and debit cards. A personal healthcard based on smartcard technology can store encrypted data about the individual and also have access to family members’ health details if needed. The card would have a photo for identification and a number and name to identify the person quickly. Yes, it would be required that the emergency response would have to have a card-reader to access the stored data on the card. The technology can even have information printed on the card, along with a Name, Health card number there can be an emergency phone number to a central agency.

The card can also have a 2-d barcode that can be scanned to reveal more details that may be needed by EMS and that the user would want to keep private form someone visually inspecting the card. Scanning the 2-D barcode could also direct the user to a website. With added security questions and login the site can provide access to a full health record. Add RFID and a biometric such as a fingerprint, retinal scan or DNA and you have a very secure mobile device for health information. This would eliminate individual hospital cards and allow global access to health details wherever you are.

Clarity Health Journal 2-D barcode

Such a solution could be used by anyone. The scanner and card-reader technology is readily available and easily deployed by EMS and hospital ER departments. It would reduce the stress related to remembering passwords and also make it easier in case of emergencies.

Praise to the volunteers

This week the eHealth scandal in Ontario hit the press, $ 1 Billion spent to deliver electronic health records with little results. The Auditor General’s report on the eHealth initiative highlighted the cost of consultants hired, and the wasted opportunity to modernize the healthcare system. This same week our neighbor passed away, who volunteered for 48 years at the Etobicoke General Hospital. Consider the value of this selfless act against the actions of eHealth.

In my extensive experience in the health community of Ontario I’ve met many dedicated individuals seeking to improve health care. Nurses, doctors and regular people who directly impact health care. Volunteerism is very important in our health care systems both for fund-raising and in the delivery of care. These unpaid support staff in our hospital system save millions of dollars to the overall health care system.

Dorothy volunteered for 48 years, beginning with the fund raising efforts to build the local hospital; helping to get patients to their appointments and working in the gift shop. Her children were born in that hospital and in the end she passed away there. Last Friday the hospital honoured her work by flying the flag at half-mast. Even though a volunteer received no pay for their work, it is the most valuable gift that can be made.

Compare this with the millions of dollars taken out of the health care system by consultants working at eHealth Ontario. We all pay for our health care through taxes, so this is our money being spent. Even the consultants working at eHealth are tax payers, they should have been watchdogs of our money.

We can make a difference in health care. We need more dedicated professionals and individuals committed to helping improve the system.

Transparency is Critical

I am of the opinion that transparency reduces errors as well as corruption. My belief is that you should behave as if the world is watching you. And in this day and age this would seem to be the case.

Everywhere you turn there are cameras, all forms of media channels, and lurkers. Do you remember Rodney King? Do you think the policemen would have acted the way they did if they knew a camera was recording their actions?

Access to information laws make it possible for reports to get detailed information from meeting schedules, bills and invoices along with any public document. There is just no hiding the facts, and if someone tries this it is more damning than the actual evidence.

Politics and healthcare have been linked for many reasons this past year. Primarily it is because of the escalating costs associated with government run programs, our aging population and our rising chronic diseases. Some believe that government should not run our healthcare system. I believe if we trust the government to collect our taxes, pay for education, build our roads, and manage the military than why is healthcare any different?

We need to be transparent on the cost of healthcare and the delivery of it needs to be focused on the people involved. You don’t want a doctor or nurse to pause for a second, when delivering care to check if you can afford it. If a patient needs help then provide the care needed. No insurance company, private or public should get in the way of patient care. No secret decisions or exclusions; transparent public scrutiny is the best way to achieve better care.

I recall reading about a hospital that not only allowed but encouraged patients to review doctors’ notes and entries in their paper charts. What the administrators noticed is that very quickly the doctors’ handwriting improved. The reason is obvious, patients would ask questions of notes they couldn’t understand or read, this increased the time doctors’ spent to explain what they wrote. Clearer written notes also became more explicit and coherent. Imagine.

Now if this was electronic, the patient could also review, annotate and correct errors. The system could provide full audit trail and timestamps. No more questionable practises, short hand notes or incorrect doctors’ orders. And also better drug management would be possible.

Shining a light on health practices, giving access to those that need it while securing privacy of personal details, I believe will lead to better health outcomes. The same is true of financial investments and government.

Would Bernie Madock have been as successful with his ponzi schema if everyone knew how their money was being invested? Would Watergate have happened? It’s all well and good for newspapers and investigators to find and report on these events, yet it would be to everyone’s best interest to prevent them from happening, and the means to achieve this is greater transparency.

Who’s your keeper?

When you go on vacation you give a key to your home to someone. You may even have a neighbour that keeps an emergency key for you. And you trust them not to go through your stuff; just water the plants and bring in the mail. Who does this for your health information?

When you are travelling do you have enough information with you about your health? Can you get your health information? What if you are unconscious, perhaps your spouse or travel partner can convey the information needed.

Of course your family doctor has your health information, right? So is your doctor your keeper? Can they provide this info when you are out of town? When you are in the waiting room of a hospital in another city or country, when you can’t speak for yourself, who is your keeper?

Medic Alert has a great message; “we speak for you”. Their service includes more then allergy alerts it includes health information. Other services provided phone support for medical emergencies.

As a Scuba Diver my wife and I belong to Divers Alert Network(DAN), along with travel insurance DAN provides a 24-7-365 phone services in case of medical emergency. But they don’t have my medical record.

Perhaps all you need is a sheet of paper folded up in you pocket, with a list of numbers, perhaps drug prescriptions and contact details. Is this enough?
With my bank card I can go to any ATM almost anywhere in the world and withdraw money. I may not be able to deposit a physical cheque but with ATM access and internet access I can do almost all of my banking anywhere I go.

Clarity Health Journal

Yes the same is possible with my health information. A smartcard with PIN access, that can be read in any computer in a hospital of doctors’ office. And you can use the internet to access what you need. Of course you will still need a neighbour to water you plants and feed the cat.

Manage your diabetes

Clarity Health Journal

Clarity Health Journal is a powerful communications tool that will improve the dialogue with your health-care providers, whether you’re managing a condition that requires continuous monitoring or even if you see your doctor only once a year.

Easy to Use; The Clarity Health Journal allows you to manage your care.

Easy to Learn; You can access links on relevant health information.

Easy to share; Allowing you grand access to doctors and other care providers.

Who is Clarity Health Journal for; This allows you and your family to take control of your health.

Clarity Health Journal

eHealth Application Design

The concept of a personal health information application is compelling. As individuals we want our health information accessible by our doctor, pharmacists and other care providers when needed. We also want security and privacy when the information is not being used.

Today your doctor maintains a file folder with your health information in it in their office. If your doctor is like 80% of doctors today they keep your records in paper form. If you go see another doctor only if information is communicated from one physician to the other. Usually by phone doctor to doctor, or nurse to nurse or even by fax.

Should you be hospitalized the facility will start another file folder for your data. Your family doctor may be notified, but unless he has privileges at the hospital they are unlikely to participate in your care there. And it is unusual that your family doctors’ files will be transferred or shared with the hospital staff.

Health Information Gap

Pharmacies will fill prescriptions received from your doctor or from any legitimate board certified doctor. Because you can take a prescription to any pharmacy it is unlikely that the pharmacy has a record of all your medication. Since you get prescriptions from your family doctor, specialist or hospital physician it is unlikely that anyone of these sources has a complete history of your prescription or medication. If you use over-the-counter, alternative remedies or vitamins it is unlikely that anyone will review these within your health information.

How can we communicate our health concerns or issues effectively and reliably even when we can speak for ourselves? Ideally we want the care provider to have all the information they need, we don’t want them to be guessing. The best way to provide your doctor with all they need is to bring it yourself and have it available for them right then and there.

There are many paper based personal health journals that you can buy. These are notebooks that are sectioned off with categories about your conditions, medication, daily diet and activities. For people with ongoing or chronic conditions like diabetes these notebooks may have specific sections for glucose levels and lab tests related to the disease.

Patient Centric

Today’s technology allows you to access your money anywhere in the world through bank machines. You can share photos of your vacation instantly with family members and friends from around the world. Web technology and the global infrastructure it is based on allow us to access information from both reliable and unreliable sources alike. We also walk around with technology on smart phones that is more sophisticated then business computers of 10-15 years ago that were tethered to our desks.

The ideal of having a secure, private health information available anywhere in the world is not just theoretically possible it is technically feasible.

Syncronized Health information

To begin we need to secure data both at rest and in motion. The latter is the simple solution; using SSL (Secure Socket Layer) and encrypted end-to-end transmission of data we can prevent interception and misappropriation of personal data. For secure data being stored we can use encryption of personal data based high-level cryptology. While it is recognized that there is no perfect solution for encrypting data there are techniques used that will make the theft and decryption of this personal data un-economical for hackers. After all how important is it to be able to determine a specific individual’s ailment? What needs to be secured is personal identifying details that could be used for identify theft.

Two security levels must be considered – the physical security and the access security. Physical security can be addressed by the location of the database. Is it the physical machines that store the data in a safe place? And if the machines are compromised physically by someone entering the datacenter and taking the machine will the information still be safe? Therefore the means to decrypt the data and the actually physical files can not be together. This way multiple sources need to be compromised to unlock the information. Think of this like a safety deposit box that needs two unrelated people to have keys to enter, if you only have one it’s still not possible to break into the safe. This is similar to the access security as well.

Permission to access that data can be secured by userID and password. But this is only a minimum. Usernames and passwords are often simple, people tend to use the same user name and password on several applications for easy of recall. Strong passwords are easy to create but few people follow the basics on how to establish password, even more critical is that many users don’t change their passwords frequently. There are techniques to force strong passwords, to expire passwords at regular intervals and to improve user access.

To return to the banking example when accessing you money online you use a physical card and secret pin. When using online banking without a card reader device, you use a login with the card number as well as potentially a security code that is printed physically on the card. Can a similar method be used for health care systems?

eHealth the future depends on it

The recent scandal with eHealth Ontario has derailed the progress of electronic health records for the citizens of Ontario. Yet, if you look at the progress to date, since 2004 when the SSH (Smart Systems for Health) agency was formed the project hasn’t been much on track anyway.

Estimates are that between $600-700 million has been spent on the provincial initiatives for electronic health care. What did this funding produce? How did we get to his stage?
The challenge with any large complex undertaking is to divide up the complexity into manageable and deliverable chunks. This makes it easier to tackle the big problems. If you look at the entire problem and build a detailed, comprehensive and complete solution the time and effort it takes will erode the proposed outcome. By the time the analysis and design is approved the environment will have changed, and before building the brilliant and complex product, the solution will be obsolete no longer meeting the current needs.

Even when such complex, complicated systems are built and deployed they become unyielding and unmanageable. They are difficult to maintain and keep current with the ever changing needs of the situation.

There is a large movement in healthcare the favours a monolithic solution, one system that does all. This comes from an antiquated philosophy and those the promote this concept are very much “old-school”. The executives raised on the mainframe or single vendor concepts.

I have been an IT consultant for over 25 years and my experience began with mainframes, although at the same time I used key-punch cards to do my programming for high-school was also when the original Apple, TSR-80 and Pet Computers were introduced. My career is firmly in both camps.

Over time I’ve developed complex systems for the financial sector, manufacturing and service industry; initially on IBM Mainframes, then DEC mini-computers and eventual PCs. In the 1990 my work also evolved into “pen-computing”, wireless and mobile devices. The systems are increasingly more integrated and networked.

In my long career I have personally never seen a “single-source” ONE system solution be fully successful. The monolith approach only works for a short period of time, until new requirements or changes to the business environment requires modifications. Because of accelerated demand on business the monolithic solutions is left behind. Why? Because the time required to change these monolithic systems is often surpassed by new systems and product add-ons. Creating and maintaining monolithic solutions lead to ultimate failings.

Even where one vendor, single source solution in implemented, within a short period work-arounds and new systems will be introduced. Still there are “old school” executives wishing for the ONE solution. They want something simple to deal with in what is actually very complex problem.

The internet is one solution built on the simple idea of allowing documents to be shared regardless of platform used. You can view the internet using a PC, a MAC, Linux, Unix or any other type of computer. Regardless of operating system (OS) as long as you can run a browser you can view the web. To share documents all you need is a text editor to build a simple html page.

It wasn’t until 1996 that I built my first web-page; it was to announce my wedding. Later that year I was involved in creating a web-based software store called instamall.com. The concept was to use encrypted transaction processing to allow users to buy software on the web. It wasn’t very successful but it did point the way to the future of the internet.

Since that time the internet has grown to being more then just sharing documents. Dynamic applications and content have revolutionized how we interact with technology. The growth and acceptance of social networking has effectively changed the world.

The internet is a very large complex system. Yet, its strength is its open standards and architecture that allows many developers to create solutions to problems and develop tools we didn’t even know we needed. Who would have thought Facebook, a simple university student gossip and communication site would have 200 million users in less the 5 years?

Twitter

What about Twitter an SMS message site that asked friends “What are you doing, now?” becoming a political force in the Iranian Election this year (2009)? By having open standards Facebook allowed developers to augment the site with new applications, effectively become a platform for new products that the Facebook staff could not have the time and resources to think about and develop themselves.

I’ve been using Twitter for 8 or 9 months now. Initially, it was novel using SMS to update my status. There wasn’t a lot of hype and only a few people followed my posts. Then suddenly hundreds began to link and follow my tweets. I now use Tweetdeck from my desktop and hootsuite to manage my accounts and Twitterberry on my Blackberry smartphone to send updates from where ever I am. Yet all these products were independently developed not by Twitter but independent developers using the open API provided by Twitter. Because of these a large adoption rate occurred in a short time. Because more the one company was building all the needs of the social users the adoption soared.

It is something to consider for eHealth solutions for a province like Ontario or the country of Canada or globally. Rather than build a monolithic ONE system to solve all the problems it is best to take a more modern approach. Use techniques common to the internet and social network sites; create an open platform to allow multiple developers to integrate and create innovative solutions to the problems of eHealth.

Another failing of ONE system approach is that each clinic, doctor, community and patient has different and unique needs. No matter how long and how detailed a single system envisaged it can never satisfy all the needs of all the users. The open architecture and open standards approach puts more people to work on the solution then could be every deployed and managed by ONE organization.

What is needed now is greater transparency and open specifications and standards can help accelerate the adoption and deployment of electronic healthcare.

The Fax just the Fax

How many remember the first fax machines being introduced to the modern office? I recall it was sometime in the mid-80′s. Back then we had only one secretary in the office that knew how to use this new device. Not every office had a fax machine and it was sometimes difficult to get a document sent out because the receiver company didn’t have one. Within a very quick period of time every business needed a fax number. Its interesting that at the time many thought this trendy device was just a phase. It then became a necessity.

I recall we also had limited email back then. Most email was relegated to internal communication. Imagine an email system that only reached your local office network. We still had paper memos being circulated within the office since many executives couldn’t be bothered to use a computer. Their secretaries took dictation, transcribed and typed memos to send out. The fax was a bridge between branches and businesses.

You may think this was an antiquated office, but no this was a company called Systemhouse. We did innovative software development and what we called office automation systems. We introduced a Macintosh, a Hyperion (Canadian built portable computer) and networked IBM PCs in 1984 to our office. Yet the fax machine was seen as the biggest communication tool to revolutionize the office.

Recently I’ve discontinued our fax number. It’s something I been thinking about for the last year or so. For the last two years I can’t remember receiving a business fax, other then junk faxes. Bulk marketers are like pornographers they will use what ever technology is available to scam and promote their services. Junk mail, email and fax spam are a time waster and money drain on businesses. The fax is now archaic in today’s connected environment. We can email, scan and pdf documents and messages. The need for a paper to paper transmission seems redundant. To send a fax you would print an electronic document from your PC, then fax it; at the other end, if the receiver isn’t already a computer, the fax would likely be received and scanned into a computer to be preserved and filed electronically. The fact is that the fax is now history.

Only in doctors’ offices and hospitals will you find dictation and transcriptions still being used. It seems the same is true for fax machines. Paper documents, lab results and hand written notes and orders are still being sent by means of fax.

eHealth PHR vs EHR

As a citizen of a province with a dedicated agenda to providing universal healthcare, in a country that prides itself on its history of affordable healthcare delivery to all citizens; it is surprising to me the disjointed and dysfunctional state of health information technology. The province of Ontario has spent 5 years and over $100 million to build a personal health record. Canada Health Infoway has used $800 million of their budget to coordinated and standardize the electronic health record for all citizens. Original estimate was to have a full implemented solution by 2005, now the date is perhaps 2015.

In 2001, I began the process of building a web-based electronic forms system to support electronic health (eHealth). The concept is simple, while Health Canada Infoway will define the standards and the infrastructure, each application will need forms and the web is ideal for creating accessible forms. We built the Clarity Healthcare Solution to support ISO standards, HL7 standards and common internet standards (XML). As new and evolving requirements are published they would be incorporated. The Clarity Healthcare Solution is implemented at over 10 facilities using a combination of our modules for Rehab, Mental Health, Complex and Long-term Care reporting. These are early adopters, progressive hospitals advancing electronic web forms for patient assessments.

Clarity Healthcare Solution

Many people have the misconception that because we have universal healthcare and a single payer system in Ontario that the government maintains or should maintain the citizens health information. This is not the case. Doctors maintain their records, hospitals have their health records, pharmacies, clinics and various alternative health providers (homecare) maintain their own records about their clients care. There is no single source for the health information. The only one who has the full picture is the individual and their family. Often these individuals do not have actual records, but only personal notes or memories of conversations about their health information.

Many agencies have been setup to provide eHealth or an electronic health record. Much has been spent with little return.

In 2008, we released a trial version of our content rich consumer health journal. Clarity Health Journal puts the individual and their family at the center of care. After all they have the greatest to gain in maintaining their health. Having all the details in one place will make it easier to communicate with their doctor and ensure the hospital has all the pertinent information when it is needed. Combining personal information, hospital records, doctors records, medication, pharmacy and all other health related information like expenses, habits and personal contacts will enhance the individuals’ health delivery. The trial version is a free CPU based download for personal and family use.

Synchronized data from various sources

Later this year we will release the web-based version of Clarity Health Journal that will have a global reach. Clients will be able to share their health information with care providers and family anywhere in the world. Users will be able to request and receive data from the doctors and hospital records, bring together all there health information. This, for the first time will create an easy to transport health information system. If a person changes doctors or moves cities they can take all their medical history with them.

Patient Centric

For people with ongoing health problems, chronic diseases like diabetes, asthma, cardiac, cancer, AIDS etc., the need for continuity and self-monitoring is essential. Clarity Health Journal provides an extensive Diabetes logbook, Food Diary, Medication and dosage tracker. The ability to chart lab results, tests and other readings like blood pressure, glucose levels are essential to promote better health.

Blook Sugar Results

Costs of healthcare are rising. Let’s work together to manage our care in the most comprehensive, integrated and efficient manner possible.