Nationalized Health DatabaseBrian HusarBrittany BoyerKeeley McGowan

What Is It?

Government controlled

Tax-payer financed

Independently supervised

Comprehensive electronic health record system

The Current System Is Flawed

Increased proportion of individuals uninsured

Dangerous lack of communication

Resulted in neglect and errors in treatment

Generated roadblocks to research

Benefits

improve insurance programs

increase organization and privacy through improved legibility, accessibility, and security

expand medical care with improved quality, efficiency, and communication

advance medical research by studying trends in vast treatment databases

Initial Strides

Google Health“to provide users the ability to build online health profiles, download medical records from doctors and pharmacies, receive personalized health guidance, find qualified doctors, and share selected information with family and caregivers”

Blue Cross Blue Shield of Massachusettsthe first state to pass a mandate requiring the complete transition to electronic medical records by 2015

Insurance

Reduces paperwork, improves legibility Improved customer service

The Principal - using a database “30% more patients” getting help Preventative medicine responsibilities Drug reactions - pharmacists don’t always

check Sick patients don’t have to accumulate resources from

many offices/locations More efficient business - saves $, eventually this finds

its way to the consumer (less organization effort required)

Organization & Security

Mutually intelligible system Easy to update records

Many people already have access to medical records

Computers are a “neutral technology” (Thurman) Current system: “security through obscurity” Security suggestions: bank-like account monitoring

systems Access on a need-to-know basis

Clip from Grey’s Anatomy

Chinese woman needing stitches Language barrier “Are you allergic to any medications?” How would this be improved with CMD?

Clip from Grey’s Anatomy

System must be mutually intelligible Improved quality of medical care for everyone,

even non-English speakers

Quality of Medical Care

Attending doctor has access to all medical information Emergency situations Avoid malingering Complete medical picture - sometimes patients

forget Specialists & doctors away from home

Easier, faster diagnoses Fewer diagnostic tests - save $

Drug reactions Preventative medicine more possible

Clip from Grey’s Anatomy

15 year old girl having violent seizures Can’t communicate with doctors Run a “shotgun” of diagnostic tests How would a CMD improve this situation?

Clip from Grey’s Anatomy

Diagnostic tests are Expensive Time-consuming Often inconclusive (as in this case)

Less diagnostic testing means More efficient diagnoses Less employee time Saves money Often extra information saves lives

Girl twisted her ankle and fell causing an aneurism- doctors had to search for this information rather than it being at their disposal

The Second Opinion

Tara Parker-Pope Prognosis changes with second opinion

Philly eye hospital: 2nd opinions for eye disorders: changed prognosis 15% of the time, avoided surgery 30% of the time

Northwestern University: reviewers disagreed with 1st opinion 80% of time, avoided mast/lumpectomy 8% of the time

Many hospitals avoid 2nd opinions for cost, time, distraction reasons Physicians sometimes offended by request Huge stacks of paper to obtain, organize

CMD would ease the process of obtaining these vital medical opinions

Medical Research

Collective knowledge of diseases spurs research

Allow researchers to track certain diseases as well as patients’ responses to certain drugs

Enable treatment plans based on patients with similar histories

Analyzing historical trends in families enables doctors to assess risk for certain diseases and take appropriate preventative measures

Track which treatments are most effective depending on specific genotypes

Rob Kling’s Car Argument

What will be the future detriment’s of the database?

What is our responsibility in terms of weighing privacy against improved healthcare?

Privacy and Health Records

HIPAA Background http://youtube.com/watch?v=K3Bd3Z15-_M Patient’s right to access their own medical

records Patient’s right to amend any incorrect

information Patient’s have a say in how their healthcare

provider uses their information other than, treatment, payment and healthcare operations

Privacy

Who could access your records?• Insurance companies

• Future employers • Drug companies

Distribution

If obtained by the wrong person, a paper record can be faxed or copied, but an electronic record can be send out quickly and worldwide

Access to one portion of a person’s records may open up access to all portion’s of a person’s record that is unnecessary to that situation

Genetic Information Mental Health Records History of STD testing, pregnancy testing

Basic risks of Technology

When all records are stored in one place this creates risks such as: Power outages Forgetting passwords Sharing passwords/Guessing passwords Destruction of records

Proposed Security Measures

Audit Trail – electronic methods of detecting and recording the identities of anyone who accesses a record ex. UCLA and Brittany Spears

Encryption of external transmissions of record information

Implementing punishments for those healthcare professionals who abuse their access to people’s classified medical information

Firewalls - electronic barriers that isolate records systems from unauthorized access or penetration.

Problems with these measures

Such security measures are expensive Created many steps for an authorized person

to access the database can result in the forgetting of passwords or paper records of such passwords floating around in an office setting

Ways to make it work

OnFile http://youtube.com/watch?v=54QqnO9AbMk

MedFlash http://youtube.com/watch?v=bspsju40YvI&featur

e=related

Promoting Privacy/Security

Only health care professionals and research organizations that have applied and approved for special access to the databases would be permitted to use the information

Insurance companies would not legally be able to access the database for screening purposes

Digitized records are more secure – one can steal or fax a sheet of paper without leaving a trace

President Bill Clinton at New York–Presbyterian Hospital Admitted for heart surgery under pseudonym

Computer hackers and medical personnel alike attempted to gain access to his records

The hospital thwarted approximately 1,500 attempts by individuals to peek at the records of famous individuals

Options

Maintain current system of independent control

Digitize records

Allow individuals to control personal information

Implement universal health database

Bibliography

Freudenheim, Milt & Pear, Robert. “Health Hazard: Computers Spilling Your History.” The New York Times. 3 Dec 2006. 1 Mar 2008.

Gillette, Bill. “Payers at the forefront of adopting electronic patient health records.” Managed Healthcare Executive. 1 Mar 2006. 26 Feb 2008.

Lohr, Steve . “Google and Microsoft Look to change Health Care.” The New York Times. 14 Aug 2007. 3 Mar 2008.

Mass High Tech: The Journal of New England Technology. “Bay State Senate Bill Would Mandate Electronic Health Records.” 4 Mar 2008.

Oliver, Martin S. "Database Privacy: Balancing Confidentiality, Integrity, and Availability." SIGKDD Explorations. 4.2 (2002). 4 Mar 2008.

Parker-Pope, Tara. “Why It’s Hard to Get a Second Opinion (And How to Make Sure You Get One).” The Wall Street Journal. 1 Feb 2005. 26 Feb 2008.

Szwergold, Jack. “Big Brother and Healthcare.” Management Review 83.2 (1994): 5. Thurman, James N. “Proposed health database has privacy advocates in uproar.” Christian Science Monitor 90.167 (1998): 3.