Health Record Banks: Sustainable Health Information Infrastructure AND Privacy William A. Yasnoff,...
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Transcript of Health Record Banks: Sustainable Health Information Infrastructure AND Privacy William A. Yasnoff,...
Health Record Banks: Sustainable Health
Information Infrastructure AND Privacy
Health Record Banks: Sustainable Health
Information Infrastructure AND Privacy
William A. Yasnoff, MD, PhD, FACMIManaging Partner, NHII Advisors
World Healthcare Congress on Consumer ConnectivityCarlsbad, CA
February 23, 2009
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“The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States”
- Institute of Medicine, Crossing the Quality Chasm, 2001
“The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States”
- Institute of Medicine, Crossing the Quality Chasm, 2001
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Sustainable HII & Privacy
I. Defining the GoalII. Critical Importance of PrivacyIII. Solution: Health Record Bank
Functions & Operation Rationale Business Model
IV. Next Steps
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Health Information Today Scattered Records
Each person's records are scattered at whatever locations care has been given
Mostly paper Information sharing not effective
Cumbersome, expensive, time-consuming, and fallible
No mechanism to collect patient information from disparate sources
No responsible institution Each patient's complete records (from all
sources) are not available for care Need to create these institutions
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Health Information Today (cont.) Consequences of health information deficit
Medical errors common – 44,000-98,000 preventable deaths/year
(just in hospitals) Quality poor
– only 55% of adults receive recommended care (RAND study)
Costs out of control– rising >10% annually– consuming an increasing proportion of
GDP– now $2+ trillion/year and growing
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Goal: Comprehensive Patient Information at Any Point of Care
All medical records must be electronic Combine multiple scattered records
into complete “master” record Enable rapid review
Graphs Charts Enhancement of relevant information
Automated reminders to improve quality and reduce errors
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II. Critical Importance of Privacy
“Anything you do to make information more accessible for good, laudable purposes will simultaneously make it more accessible for evil, nefarious purposes”
- William A. Yasnoff, New York Times, 2/18/07 (p. 16)
“Anything you do to make information more accessible for good, laudable purposes will simultaneously make it more accessible for evil, nefarious purposes”
- William A. Yasnoff, New York Times, 2/18/07 (p. 16)
Therefore, privacy is a much greater concern as more health records are electronic.
Therefore, privacy is a much greater concern as more health records are electronic.
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Privacy & Patient Control Surveys of “information hiding”
2006: 13% of consumers 2007: 17% of consumers
Consumers already control information in their records
Without control, too many will opt out OR politically force system shut down
Choices are today’s system or consumer control -- complete information without consent is not (and should not be) a viable option
Patient control essential
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Privacy Requirements Patient Control
Essential for trust Forces stakeholder cooperation
Trusted Institution Local governance (now) Government regulation (later)
Trusted Architecture Secure repository Operate like classified military
system
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III. Solution: Health Record Bank (HRB) Secure community-based repository
of complete health records Access to records completely
controlled by patients (or designee) “Electronic safe deposit boxes” Information about care deposited
once when created Required by HIPAA
Allows EHR incentives to physicians to make outpatient records electronic
Operation simple and inexpensive
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Clinical Encounter
Health Record Bank
Clinician EHRSystem
Encounter Data Entered in EHR
Encounter Data sent to
Health Record Bank
PatientPermission?
NODATA NOT
SENT
Clinician Inquiry
Patient data delivered to
Clinician
YES
optional payment
Clinician’s BankSecure patient
health data files
Health Record Bank Operation
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HRB Rationale Operationally simple
Records immediately available Deposit new records when created Enables value-added services Enables research queries
Patient control --> Trust & privacy Stakeholder cooperation (HIPAA)
Low cost facilitates business model Allows EHR incentive options
Pay for deposits from existing EHRs Provide Internet-accessible EHRs
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HRB Business Model Costs (with 1,000,000 subscribers)
Operations: $6/person/year EHR incentives: $10/person/year
Revenue Advertising: $6/person/year Queries: ? Reminders & Alerts: >=
$12/person/year– “Peace of mind” alerts– Preventive care reminders– Medication reminders
No need to assume/capture any health care savings (!!)
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IV. Next Steps
For-profit HRB startups For-profit HRB establishes
community non-profit for governance Consumers Physicians
For-profit operates HRB under contract from community non-profit Pays fee to non-profit for
governance Provides EHRs or EHR incentives
to physicians
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Health Record Bank Organization
Customer Support
MarketingOperations
HRB Operator Board of Directors
Management
Health Record Bank Operator (for-profit)
regulate via contract
% of revenu
e
RESPONSIBLE FOR: Policy Governance Oversight
RESPONSIBLE FOR: Obtaining Capital Operating HRB
Executive Director
Other Staff(Optional)
Community Non-profits
Community Board of Directors
Many communitiesuse single HRB
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Questions?
William A. Yasnoff, MD, PhD, [email protected]/527-5678
For more information:www.ehealthtrust.com
www.healthbanking.org www.yasnoff.com