Transcript Nationalized Health Database

Nationalized
Health Database
Brian Husar
Brittany Boyer
Keeley 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 Massachusetts
the 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
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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&feature
=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
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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.