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With Life And Death At Stake – Why Aren’t We Exchanging More Health Information?

Why is it that I can log onto my bank website and access all my financial transactions at the click of a mouse, including check images, statements, and reports for the past seven years – yet my medical records are locked up in medical provider offices and none of them are accessible over the web?  After all, it’s my data since it is about me. And isn’t it more important than financial information?  Financial data is just about money, but my medical data is a matter of life and death.

In many respects, health care is one of the most advanced and sophisticated practices in the world. Capabilities such as gene therapy, tissue culture technologies, biopharmaceuticals, nuclear magnetic resonance imaging and automated machines for remote dispensing of prescription medications are just a few examples of the sophistication. Furthermore, the health industry is one of the largest and represents 16% of the U.S. GDP (about 10% for the entire world) so there is no shortage of capital. Yet when it comes to adopting modern internet-style networking enabled for consumer access, the health care industry appears to be in the dark ages.  My doctor still keeps all my records on paper stuffed into a manila folder that is now about 2 inches thick (heaven forbid if it gets dropped on the floor and all the papers scatter or if there is a fire in the office).

This lack of consumer enablement is a bit of a puzzle. Individual organizations in the health care industry such as insurance companies, hospitals, and government agencies, make extensive use of computer systems and information analytics.  And the industry has also reached agreement on certain information standards such as HL7. Health Level-7 is a non-profit organization founded in 1987 to produce a standard for hospital information systems specifically in the clinical and administrative data domain. It was accredited by ANSI in 1994 and over the past 20 years has developed a very comprehensive interoperability framework. So we have the necessary core standards, the technology exists and is in common use. There is lots of money in the health care system to invest in computer technology, yet the predominant way that doctors share information is by fax or the postal system.  This dichotomy of high tech solutions for the big players and low tech operations for independent providers and no tech for customers (patients) when it comes to medical records suggests there is something structurally wrong with the overall health care system.

Over the coming weeks I will be posting a series of blog articles about data integration in the health care industry.  Specifically, I will examine the emergence of Health Information Exchange (HIE) organizations that electronically move clinical information between disparate and independently managed health care systems within a region, community or hospital network. A Health Information Exchange is similar to an Integration Competency Center with the primary difference being that HIEs operate as external shared service businesses while ICCs operate as internal shared service functions.

The topics I plan to cover include:

  1. Health Care Myths in the U.S.
  2. Which countries have the best health care?
  3. Why does health care in the U.S. cost so much?
  4. Is Lean Integration a Good Fit for Healthcare?
  5. Top 10 ICC Services for Improved Health Care
  6. Industry Secret – HIE’s are ICC’s

This list is changing based on reader feedback and comments.  Please come back to this posting from time to time to see the latest update.

Also a reminder, David Lyle’s and my new book on Lean Integration www.integrationfactory.com is now available from Amazon.  The book shows examples of how Lean can be applied to any industry, but it also includes several specific examples from the health care industry.

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4 Responses to With Life And Death At Stake – Why Aren’t We Exchanging More Health Information?

  1. Allie says:

    Hi, John -

    As much as I am looking forward to all of the articles, I must say that your first paragraph is one that makes most health informaticians bang their heads against the wall in frustration.

    Banking info /=/ health information. Health information is far more complex, and to most, far more sensitive.

    In addition, the types of information that need to be held for a complete patient record are far more than the average bank record – most bank information doesn’t include large image files!

  2. John Schmidt says:

    Allie, thanks for your comment. I agree that there are MAJOR differences between health data and financial data including security and privacy to name just two. But it sounds like you are suggesting that because health data is more complex, sensitive, and has special requirements like large image files – that is the reason that we haven’t achieved the same level of interoperability as banks.

    I maintain that if we can put a man on the moon and decode the human genome, then surely we can solve the health care industry information handling requirements. We have the technology, we have the standards, and we have lots of capital. What’s missing is the motivation. In future posts I plan to dig into the underlying structural issues in the industry that are putting up roadblocks and how Health Information Exchanges could make a difference.

  3. Hello Allie,

    You might be surprised about banks and image data. The “Check 21″ initiative from a new years ago ushered in the widespread practice of storing written checks as electronic images. Furthermore, many institutions digitize and save copies of their customers’ exact revolving credit terms and other account agreements. Much of this image information has already been integrated into various financial institutions’ consumer portals. Much of the rest is saved…just in case.

    Regards,
    - Jonathan Lampe

  4. Medbob says:

    Working in a medical environment, I can give you an answer right off the bat. The problem is the legal environment in which Health Care works.
    Tort reform is not only about costs, but also about access. Most Medical Systems are so highly regulated that the changes run MUCH slower than the “internet time” that we have grown accustomed to.
    It’s not unusual to see Windows 2000, Windows NT, and sometimes OS/2 at the core of some of these systems.
    Add to that the conservative nature of most health systems, and you have a very lumbering giant that is reluctant to make changes. The very fact that “life and death is at stake” is why things move slower.

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