Healthy Living The Potential Of Personal Wellness Records (Phrs) - Business Office Ii Of 3

In my previous post, I summarized a deep conversation I've been having alongside a grouping of knowledgeable people close PHRs. I as well as then offered an innovative, depression cost, uncomplicated solution to bargain alongside the concerns others raised.

The solution I offered led to several questions as well as concerns close (a) security, privacy, access privileges; (b) getting hospitals, clinics, radiology centers, labs as well as physicians to send an electronic re-create of patients personal wellness information (PHI) to a location where the patient has command over it; as well as (c) having the PHI live portable, accurate as well as complete. I reply these questions as well as address the concerns inwards this post.

First, here's a basic diagram of the architecture I proposed (a paradigm of which nosotros have got demonstrated):

* Database Management Systems are software programs that create practice databases. In healthcare, these databases are used yesteryear EMRs as well as EHRs as well as other wellness information technology systems.

** In improver to providing send (publisher) & have (subscriber), encryption & decryption, as well as authentication/authorization functionality, each pub/sub node connects alongside automated information processing templates for querying whatever databases, parsing whatever files, manually inputting data, transforming & translating the data, as well as presenting (rendering) the data.

*** Each information file (DF) is encrypted end-to-end (at balance as well as inwards transport) as well as tin live inwards whatever information format (CSV, XML, XLS, HTML, etc.). They are stored locally, tin live (a) composited (combined/integrated) when multiple publishing nodes send DFs to the same subscribing node, as well as (b) decomposited (broken apart) when a pub node is authorized to send alone a subset of the DF's contents to a item sub node.
Now to the technical concerns mentioned…

Security: End-to-end encryption of the DFs (including PKI methods). It is likewise possible to shop the personal identifiers inwards a dissimilar DF (which could fifty-fifty live stored at a dissimilar location).

Privacy: "Granular level" information command yesteryear patient through PHR (see this link).

Access privileges (confidentiality): The human possessor of a node tin access as well as homecoming a DF alone alongside user call as well as password (or, preferably, alongside a biometric indicator). And the DFs incorporate alone the PHI for which the individual is authorized.

Sending an electronic re-create of PHI from multiple sources/repositories to a location that the patient controls: Each publisher (provider, lab, etc.) node tin practice this yesteryear (a) querying a database to which it has rights, (b) storing the query results inwards DF alongside the transformations as well as translations required yesteryear each of its sub (i.e., patient) nodes, as well as (c) transmitting the DF to the sub nodes equally an encrypted email attachment (or other methods).

Portability: The node software as well as information processing templates are all modular object oriented applications, as well as the DFs are private electronic files, thence everything is really portable.

Accuracy as well as completeness (data integrity): Examples include information validation routines (assessing whether each information chemical constituent is inside predefined parameters), cross-checking information values from dissimilar sources, as well as identifying missing values.

Availability: Since the DFs as well as processing templates are stored locally on dissimilar computerized as well as storage devices, as well as since the DFs tin live updated automatically via low-bandwidth as well as briefly connected agency (such equally e-mail), a recent version of PHI is available anywhere/anytime.

I practice non claim to have got all the answers, only practice come upwards to the tabular array alongside thirty years of noesis as well as R&D. We are seeking to expand our network of collaborators as well as are really opened upwards to creative ideas. Anyone interested inwards joining our squad are welcome to bring together my company's LinkeIn group—Crafting the Future of Health information technology alongside Novel Solutions—at this link (requires registration).

Other questions were likewise raised, including: (1) How best to part PHI amidst disparate systems; (2) How to increment PHR adoption; as well as (3) What makes a PHR genuinely useful to the patient as well as his/her providers inwards price of improving care, self-maintenance, lineament of life and, of course, controlling one's PHI to maximize privacy. In addition, I was asked if I e'er considered Open Source as well as if we've tried to connect alongside the big online PHRs. Following were my replies.

Open Source. We have got dipped a toe into the opened upwards origin "waters," only got "stepped on" yesteryear the FOSS folks who claim that in that location is no such thing equally a genuinely valid software patent, as well as that all software patent holders are greedy, manipulative frauds. After months of fence trying to seek an amicable solution, I left alongside a bad gustatory modality inwards my rima oris (see this link). Nevertheless, I believe opened upwards origin has a place—especially alongside commoditized (non-novel) programs—and nosotros have got offered an OS app at this link for converting XML to CSV.

Connectivity. MS HealthVault, Google Health as well as (I believe) Dossia are all world cloud PHRs. With all the safety concerns over world cloud computing (see this link), nosotros are shying away from them. We've made attempts, however, to larn MS as well as Google interested inwards our new node-to-node organization (issue #1 above), only to no avail.

We have got non yet written the interfaces you lot mentioned (also number #1), although nosotros have got interfaces to legacy (X12) as well as relational databases, equally good equally XML as well as other document parsing routines. And although querying remote/external databases is the 1 method, we've institute that having the DBMS run a query as well as generate an output stored inwards a CSV (or other delimited text file) is a uncomplicated alternative.

Adoption drivers/impediments. I concur that the lack of fiscal practice goodness to the database owners has been an impediment to PHR adoption (issue #2), as well as our crazy provider reimbursement model (pay for quantity, non for value) makes matters worse. It is 1 argue that we're currently focusing on using our technology inwards an application that supports information telephone substitution of referral information betwixt PCPs as well as specialists inwards patient-centered medical homes piece (b) continuing to plain exam as well as elevate our PHR application inwards grooming of its commercialization through workplace wellness programs as well as other venues.

For the kickoff fourth dimension inwards my thirty years equally a provider as well as software inventor/developer, the demand to command costs as well as improve lineament is becoming to a greater extent than widely recognized, inwards constituent because of the recent healthcare reform debates as well as the number of people suffering inadequate care. They nation that truthful (disruptive/discontinuous) innovation—one that saves money, reduces complication, as well as improves overall value—is to a greater extent than probable to live accepted when an economic scheme is inwards trouble. So, possibly the fourth dimension is lastly right!

PHR usefulness. As far equally what makes a PHR useful (issue #3), I would nation it's the mightiness to assist the patient & providers (a) increase/improve noesis as well as awareness of the patient's wellness risks as well as problems, (b) brand valid decisions close how to bargain alongside the patient's item wellness risks/problems inwards the most toll effective ways, as well as (c) larn increasingly competence (through education) inwards implementing the appropriate steps to avoid the risks from becoming problems as well as ameliorate the severity of existing wellness problems for a improve lineament of life. This should include a focus on biomedical & genetic, psychological/psychosocial, as well as environmental factors. And it should avoid information overload (see this link), piece providing consummate as well as accurate data.

[Come dorsum afterward for constituent 3]

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