Healthy Living Should Personal Wellness Data Reside Inwards Silos?
Over the yesteryear few weeks, I've been engaged inwards a conversation amongst an intelligent grouping of people virtually whether personal wellness information (PHI) should reside inwards disparate "silos" (repositories) that create non communicate amongst ane another, or whether standards should hold out adopted that "bust" the silos yesteryear merging the information into a mutual warehouse (centralized database) that spans multiple unrelated healthcare organizations, agencies too practices.
Some argued that silo-busting centralization has benefits that include narrowing the number of places the information reside, improved auditability, too the mightiness draw too study access attempts too actual reads (i.e., "access/read tracing") to a greater extent than effectively than private computers.
Others (including me) argued that silos bring existent value, equally long at the PHI they incorporate tin hold out readily too securely shared amid "trusted partners," a model which I telephone yell upward "controlled silo-crossing." I proposed a new too cost-effective means to create this through a federated, node-to-node, publisher/subscriber model we've developed, which is described at this link too elsewhere on this blog. Using this method for controlled silo-crossing provides major benefits, including the following:
Two entities are public wellness agencies and research (academic) organizations. Two others are Health Information Exchanges (HIEs) too the National Health Information Network (NHIN). They all ask PHI from multiple silos to, for example, position populace wellness emergencies through biosurveillance (e.g., unsafe medications too medical devices, pandemics, bioterrorism, etc.), equally good equally to prepare evidence based practise guidelines.
Another entity that wants to cross silos is healthcare providers who desire to give their patients the best possible care by, for example, sharing PHI through patient centered medical homes, which I utter over at this link.
In addition, patients who empathize the problems inwards healthcare would equally good back upward silo crossing. For example, anyone knowledgeable virtually the serious noesis gap inwards healthcare—which I utter over at this link—would realize how of import it is to bring interdisciplinary teams of clinicians, their patients too researchers part information too collaborate to promote ever-better (higher-value, to a greater extent than cost-effective) care, too yesteryear having payers offering fiscal incentives to practices running certified medical homes.
To assistance realize this vision of controlled silo crossing, nosotros ought to focus on revamping our civilization into ane inwards which value (cost-effectiveness) to the consumer is the upmost importance, too inwards which delivery of such value is a collaborative effort that is highly rewarded. The results, over time, would include:
Discussion continued at this link
Some argued that silo-busting centralization has benefits that include narrowing the number of places the information reside, improved auditability, too the mightiness draw too study access attempts too actual reads (i.e., "access/read tracing") to a greater extent than effectively than private computers.
Others (including me) argued that silos bring existent value, equally long at the PHI they incorporate tin hold out readily too securely shared amid "trusted partners," a model which I telephone yell upward "controlled silo-crossing." I proposed a new too cost-effective means to create this through a federated, node-to-node, publisher/subscriber model we've developed, which is described at this link too elsewhere on this blog. Using this method for controlled silo-crossing provides major benefits, including the following:
- Minimizes information loss. Busting silos leads to the loss of of import information—i.e., information details too terminology/semantic nuances—because "local" information standards unique to unlike silos are destroyed inwards favor of "global" information standards required yesteryear monolithic centralized systems, equally I utter over at this link.
- Gives PHI command to the owners of that information. Both providers too patients should bring their ain silos too bring command over who is allowed to cross them. That is, patients ought to authorize the individuals too organizations that bring the correct to obtain their PHI from their ain PHRs too from their providers' EHR/EMRs. The authorized parties should: (a) buy the farm exclusively information that meaningful/useful to them, (b) bring that information delivered to them from whatever silos inwards which they reside, too (c) receive that information after it has been translated too transformed for role inwards their ain respective silos. Also, if silos were busted, it presents the thorny number of who should hold out inwards accuse (be the boss) of the merged data?
- Provides potent information security. Personally identifiable PHI inwards the physical possession of the parties owning too controlling it is inherently to a greater extent than secure than allowing third-party vendors to contend that information inwards centralized databases residing off-premises. This relates to the number of "public cloud" safety equally I utter over at this link.
- Enables auditing too access/read tracing. Auditing too tracing are handled effectively using node-based software residing inwards private computers.
Two entities are public wellness agencies and research (academic) organizations. Two others are Health Information Exchanges (HIEs) too the National Health Information Network (NHIN). They all ask PHI from multiple silos to, for example, position populace wellness emergencies through biosurveillance (e.g., unsafe medications too medical devices, pandemics, bioterrorism, etc.), equally good equally to prepare evidence based practise guidelines.
Another entity that wants to cross silos is healthcare providers who desire to give their patients the best possible care by, for example, sharing PHI through patient centered medical homes, which I utter over at this link.
In addition, patients who empathize the problems inwards healthcare would equally good back upward silo crossing. For example, anyone knowledgeable virtually the serious noesis gap inwards healthcare—which I utter over at this link—would realize how of import it is to bring interdisciplinary teams of clinicians, their patients too researchers part information too collaborate to promote ever-better (higher-value, to a greater extent than cost-effective) care, too yesteryear having payers offering fiscal incentives to practices running certified medical homes.
To assistance realize this vision of controlled silo crossing, nosotros ought to focus on revamping our civilization into ane inwards which value (cost-effectiveness) to the consumer is the upmost importance, too inwards which delivery of such value is a collaborative effort that is highly rewarded. The results, over time, would include:
- Ever-better personalized evidence-based guidelines for prevention too aid that patients too their providers role to improve results too lower costs yesteryear reducing waste, fraud, abuse, errors, omissions, ineffectiveness too inefficiencies would hold out dramatically reduced.
- Providers would hold out to a greater extent than effective inwards diagnosing/testing, treating too preventing wellness problems inwards their patients, too would arrive at financially yesteryear doing so.
- Providers would non bring to worry virtually malpractice suits yesteryear next the evidence-based guidelines too offering audio justification for rendering alternate plans of care; this would equally good lower malpractice insurance premiums too the pressure level for wasteful "defensive medicine."
- Patients/consumers would hold out ameliorate able to contend their ain health.
- Payers would non bring to pay for depression value (expensive, unbeneficial) procedures too tests.
Discussion continued at this link
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