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.

New Years eHealth proposal

From 1997 to 2001 I experienced first hand the shortcomings of the Canadian healthcare system. Over this period my family saw the death of three close relatives. We experienced the fragmentation of the Ontario health care system. From community hospital to academic health sciences centre, private homecare and nursing care, cancer care centers and palliative care, each doctor and hospital maintained a health record, yet none had access to the information from the previous location. Blood work done one day would be repeated because the lab results were not shared between providers. New specialists would conduct the same interview done the previous day or just the same morning in a different clinic. The only full health record was what we, as a family, maintained. It kept us involved in the care process and we were able to inform new clinical staff with the details from previous visits saving time and money for us and the healthcare system. We were not the first family to experience nor the last, others have expressed similar frustration with medical records.

My background is not medical. My experience is in information technology. For two decades I worked in the financial sector developing software for banks, trust companies and credit unions. In the late nineties I deployed financial solutions, supported document scanning and presentment for cheque recognition and bill payment on the internet. The financial sector has benefited greatly from technology advancement, greater efficiency and performances. With my experience in IT and the eye-opening experience of the fragment healthcare system it was apparent that health information exchange could be and should be improved.

In 2001, with a strong team of developers we began the process of creating an eHealth solution. The Clarity Healthcare Framework was the starting point.

Clarity Healthcare Solution

Over this previous decade we deployed electronic form applications to collect patient assessments. These are used to measure quality of care in hospitals. The ultimate goal, to create a personal health application that would allow patients and their families to keep and monitor all the health details, a life-time health record. The Clarity Health Journal focuses on the patient and their family to help them manage and monitor their health.

There are challenges to maintaining a full and complete health record. You can start and keep your own information easily enough. You can maintain a blog or a website with the details of your diet, exercise and even medication, but what do you do about doctors’ notes, lab results or hospital visit details?

Health information exchange can be used to improve the overall health delivery. Easier access to health records means better quality health. Each doctor, hospital and clinic maintains health record for the patient, only the family maintains a fully holistic view of the personal health information.

Health Information Gap

While we do online banking and use ATMs around the world to withdraw cash from our bank accounts, pay bills with Paypal and other online services our health information is locked up in a filing cabinet someplace. We can’t access those records. Our caregivers have access to the record they created, but we have no way to access them or share them with family and friends involved in our care. Even when permission is granted to a spouse, partner or adult children; doctors or hospital administrators can still refuse access or prevent flow of some information needed for your care. 2010 needs to be the year we take control of our health information.

These days most patients have access to the internet in some form. Digital cameras, scanners and fax machines can be found in many homes. Larger percentages of patients have cellphones and computers. Technology is no longer a barrier for patients and their family. Still many doctors’ offices and hospitals still maintain paper records and written notes.

Back in 2001, I started a family history using a family tree maker software. Online I found resources that included ship manifest of 18th century that had been scanned, OCRed, categorized into a database. Old paper records hand written using quill pens are now indexed and searchable online. You can expect hospitals and doctors’ records could be as advanced as genealogy software makers. Technology can offer a solution to making paper health records available online very easily.

Ontario eHealth can easily offer a service to scan all health records and categorize the data for patients. The process doesn’t have to be a mega project. Each hospital can maintain a scanner to OCR records into a database. When a patient arrives for a new visit, if they already have a paper record the history can be scanned. New visit details would be collected electronically online. Within a very short period of time all patients health records would be online. Doctors offices could either scanner records internally or send out the records to a services bureau. Within 2 or 3 years a majority, if not all, records would be online. The resulting database would have both the images of the paper records plus the categories details of the electronic data. It would be indexed and searchable and could be made available to patients and their families to use.

The personal health record can then be enhanced with the individuals own data. Once online the patient and their family uses and share this info wherever they are, with doctors, hospitals and clinics. A truly universal healthcare system is possible.

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

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?