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Transcript of Embedded Health Data Chips for Interior Alaska A Feasibility Study.
Embedded Health Data Chips for Interior Alaska
A Feasibility Study
Expert Panel
Graduate Advisory Committee
Dr. Robert Perkins, Advisor Dr. Ming Lee Dr. Leroy Hulsey
Embedded Health Data Chips for Interior Alaska
A Feasibility Study
Prepared for theEngineering and Science Management Program
Presented by UAF Masters Candidates Lien Huang
Steven RoscoviusFrank Toth
Overview Study Statement Introduction to Tanana Chiefs Conference Background and Options Criteria and Analysis
Stakeholders Economic Legal and Ethical Social Program Schedule and Costs
Conclusion
Is there a problem?
Feasibility Study
Is there a better way? We are challenged to explore new
technology But we are bound to do it ethically
and morally
Task Force
We approached this as a task force Tanana Chiefs Conference (TCC)
Chosen for its unique health care situation
We were challenged in our study Discovered that numbers and dollars
may not always sum up the story
Tanana Chiefs Conference
Mission Statement Tanana Chiefs Conference provides a
unified voice advancing tribal governments, economic and social development, promoting physical and mental wellness, educational opportunities and protecting language, traditional and cultural values.
Tanana Chiefs Conference
The Department of Health Services Mission Statement
TCC Health Services, In Partnership With Those We Serve, Promotes And Enhances Spiritual, Physical, Mental And Emotional Wellness Through Education, Prevention And The Delivery Of Quality Services.
Chief Andrew Isaac Health CenterJim Kohler - Director 15,000 beneficiaries 43 villages $44 million health budget
1.5% for data management and communications $660,000 Electronic Health Record was implemented in February
2005 Health data management is vital and continually
challenging Quality of care and proper reimbursement Affects pharmacy, lab, radiology, continuity between
providers, scheduling, and billing Communication with 43 different villages
Challenges Flat budgets with double digit cost increases Staff shortages
What is the problem?
Identification of patients Unconscious Disabled No identification Very young Elderly
What are some options?
Do Nothing Radio Frequency Identification Chip Personal Data Assistant Devices ID Cards
Do Nothing
No apparent costs Are there hidden costs?
No change in current situation
RFID Chips
New technology Implantable Does not require batteries Type for consideration is ID number
only Can’t lose it
Personal Data Assistant Carry your entire medical history
X-rays Diagnostic scans Medical notes Lab tests
Compatibility Issues Exist Can be lost Rural use?
ID Card A card embedded a unique ID number Quick check-in Cheap Easy to lose Do you want another ID card?
The Best Option Ranked in 4 categories Categories scored by weighting
Initial capital costs for implementation 15%
Information stored on the device 10%
Availability of the device in an emergency 40%
Practicality of using the device for special needs individuals
35%
Scoring
Options Rank Score Rank Score Rank Score Rank Score SCORE RANK
Do Nothing 4 0.60 1 0.10 1 0.40 3 1.05 2.15 3rd
RFID 2 0.30 2 0.20 4 1.60 4 1.40 3.50 1st
PDA 1 0.15 4 0.40 2 0.80 1 0.35 1.70 4th
ID Card 3 0.45 3 0.30 3 1.20 2 0.70 2.65 2nd
CAPITALCOSTS
STOREDINFO
CATEGORIES AND WEIGHTS
TOTAL
SPECIALNEEDS
35%
EMERGENCY
15% 10% 40%
VeriChip
Chip was originally developed to track livestock and wildlife
October of 2004, FDA approval for human implantation and use as a health device
VeriChip
Approximately the size of a grain of rice
Implanted into subcutaneous fat takes less than 20 minutes
Performed by physician Contains 16-digit unique number Scanned using VeriChip device Information via the internet
VeriChip
No reported complications or side effects
At least 10 year lifespan Some have concerns with
magnetic resonance imaging (MRI) Reversible with minor surgery
VeriChip
Who would benefit the most? Impaired speech Memory loss Loss of consciousness Chronic illnesses Common names Mistaken identities
VeriChip Case Studies
Alzheimer's Care in Palm Beach Infant Abduction Brittan Elementary School Mexican Attorney Generals Office Hackensack Emergency Program
NJ
Alzheimer's Care
2-year project 280 patients Starts in May, 2007 Provides emergency department
staff easy access to those patients’ identification and medical information
Infant Protection 116 abductions from health-care facilities in
the last 22 years Infant mismatching Halo – infant protection systems
Chip is in bracelet
Brittan Elementary School
Sutter, California RFID tags embedded in student
badges tracked students throughout the
school Ended by parental pressure
Mexican Attorney Generals Office
Originally reported by AP in 2004 18 members are tagged Controls access to secure areas
and to restricted data Combat corruption
Hackensack Emergency Program
Average increase of more than 1.5 million visits per year 2.7 million were made by persons
living in institutional settings such as nursing homes or prisons
At the same time the number of emergency departments have decreased by about 12.4 percent
Emergency Room Visits
Option for more detailed study
Trial Period 5 Years 1500 people that would most benefit
from this technology Mental or physical handicaps, dementia,
elderly or very young
Full Scale After trial
Is it feasible?
Need to analyze Stakeholders Economic Legal and Ethical Social Program Schedule and Costs
Stakeholders
Economic
Trial period Capital Costs
Medical Scanners Training RFID Chips
Annual Costs Fee
Full Scale
Economic Capital costs
Medical Scanners We estimated 43 scanners for the villages
plus 12 to cover the facilities in Fairbanks 55 scanners needed.
Training Seamless Integration
RFID chips 1500 initial
Economic Medical scanners
$600 to $3,000 Estimate $50,000
RFID chips $200 plus hospital costs,
estimated up to another $200 Estimate initial cost $300,000
Annual fee $20 to $80 Estimate $100,000 yearly fee
Economic Costs of Trial
Present Worth (Discount Rate 6.5%)YEAR COST
0 $350,000
1 $100,000
2 $100,000
3 $100,000
4 $100,000
5 $100,000Net Present
Worth$765,000
Upgrade to Full Scale
Largest cost growth would be in the RFID chips. 3 to 6 million dollars to acquire chips
VeriChip and TCC could find common ground far below.
No additional scanners Possible increase in yearly fee
Benefits
Cost Savings Less errors Improved efficiencies
Improved Health Services Intangibles
Benefits
Cost Savings Lack of long term studies
Estimates of cost savings are difficult Rand study on electronic medical
records Although not a true parallel it hints at the
possible savings through increased efficiency and improved patient care
Benefits
Rand StudyNational Electronic Records
Potential Savings
HEALTH BUDGET
2 Trillion
INITIAL SAVINGS
88 Billion
4%
EVENTUAL SAVINGS
346 Billion
17%
Benefits From Full Electronic Records Initial
If 90% adopt health information technology $77 billion from efficiencies
Shorter hospital stays prompted by better-coordinated care
Less nursing time on administrative tasks better use of medications better utilization resources
$4 billion from improved safety primarily by reducing prescription errors
Benefits for TCC
Expected Cost Savings? With a annual health budget of $44
million, even 1% savings can be substantial
2% = $880,000 1% = $440,000 0.5% = $220,000
Benefits
Improved Health Services Intangibles
Better patient service Fewer mistakes Speedy care Less exposure to lawsuits
Legal and Ethical
Identification and Tracking Social Environment
Privacy & Notice by Institutions Security Data Storage Options
Identification and Tracking Social Environment
Passive – 16 digit Active – Up to 100 Pages of Text Tracking
Staff and Patients Substance Abuse Home Confinement for Inmates
Insurance Profiling
Privacy & Notice by Institution Griswold v Connecticut (reviewed
privacy) 1st Amendment - Right of Association 3rd – Prohibition of Quartering of Soldiers 4th – Secure in houses; Search & Seizure 5th - Self Incrimination-zone of privacy 9th – Fundamental rights not specifically
mentioned Health Insurance Portability & Account Notice of Privacy Practice
Note use of RFIDs
Security
Encryption – Small Chips Lack Scanning Range (4”; 2-3 ft; 10 ft)
Tracking Possible Dutch e-Passports
2006 AK Community RHIO Regional Health Information Org
Improve health record exchange Lower costs Prevent medical mistakes
Health Information Security & Privacy Collaboration Issues of Exchange Health Information Health care providers; Insurers; Health care
agencies
Data Storage-Option #1
Option 1 Patient file at TCC. Information requests through VeriChip
to TCC TCC retains ownership No additional notification or release
forms
Patient Information
Health Care Provider
Request for Records
VeriChp Request for Records
TCCPatient File
Data Storage-Option #2
Option 2: Patient file is stored at VeriChip TCC updates the patients file but
VeriChip owns the data storage used Additional notification and release
forms requiredUpdates
Patient Information
Health Care Provider
Request for Records
VeriChipPatient File
TCC
Data Storage - Option #3
Option 3: Similar to option 2 Patient file is stored at VeriChip TCC leases data server No additional notification or releases
neededUpdates
Patient Information
Health Care Provider
Request for Records
VeriChipPatient File
TCC
Current Legal Status
Current Law Federal State
Federal
No current laws govern RFID technology
Current Bipartisan Caucus Industry, DOD, and Academics Pharmaceutical authentication,
drug/product recalls, food chain safety, homeland security, supply chain efficiency
State 2005 – 12 states have introduced RFID
legislation Wisconsin
Legislation to prevent implants w/o person’s permission
California Legislation security/guidelines protect
privacy rights of individuals – govnr vetoed Two other bills pending
Social Analysis
Are there social issues in rural Alaska that are different from Fairbanks?
What are some of the issues? Remote population Language Culture
Customs Tradition
Points of Caution Village’s point of view?
Lack of pressing need Oral Traditional Economic
Skepticism Overall Based on history
Stigmas Individuals Communities
TCC Board
Approval Small budget to continue
What do we do?
Evaluating Social Concerns
How do we evaluate these concerns?
We need a acceptance plan Hire a marketing firm? Local surveys? Meetings with TCC? Meetings with village elders?
Program Implementation Creating a implementation team
Team will be composed of primary stakeholders
Key task will be developing and implementing acceptance plan
Investigate funding Negotiate with vendor
Pilot project? Evaluate the process Review
Program Implementation
Go / No Go Deploy the hardware Monitor the outcomes Re-evaluate
Implementation Tasks
Implementation Schedule
Implementation Costs
1st year Capital Costs
Initial + Annual Fee $450,000
Implementation Costs $34,990
$484,990
Is It Feasible?
What are the needs? What are some likely solutions? We have discussed some of the pros
and cons in health and economics We have considered some legal /
ethical / moral issues? We have identified social issues
Recommendation
Further Investigations are Needed Economic and Health issues
It will work Legal issues are not defined
Risk involved Social issues might derail
completely
Special Thanks To
Robert Perkins Ming Lee Leroy Hulsey Jim Kohler Perry Ahsogeak Rebecca Madison
Questions
THANK YOU