Friday, August 21, 2009

Health Care System Parallels

I've been learning about the current health care reform from various blogs, Wikis and news articles as I prepare for entering the health care industry. I've paid particular attention to EHR / EMR / PHR system development discussions.

As I learn more about these systems I realize the parallel that exists between them and those in other industries, such as Real Estate. First, let me give you a watered down definition of the EHR systems that I found on Wikipedia. An EHR is "an individual patient's medical record in digital format that is capable of being shared throughout different health care settings." More succinctly, it's a patient's summarized and digitized medial records.

As you can imagine, there are are many concerns with digitizing these records. For one, their digital storage must be secure to insure HIPAA compliance. However, they must still be portable so that they can be shared with various providers as well as the ultimate record owners, the patients. They must be severable so that a patient may make any personal updates and keep for personal reference. Also, individual data consumers will need to be able to make changes to these records and share or synchronize them with other data consumers or health providers. So, the line of responsibility for the records' security as well as accuracy quickly becomes blurred. What's more, synchronization between the myriad of providers and data consumers can be challenging, to put it mildly.

These only scratch the surface of the questions and issues that must be answered as new standards are defined, adopted and implemented in the systems to come. There are many other complex issues that I won't mention but you can read about in this Wikipedia EHR entry.

Many of these issues are those faced by other industries that are also highly regulated, where personal information must be securely stored and shared, such as banking and real estate. One of the projects I undertook a few years back aimed to digitize and share the processes and documents for a real estate transaction going through an escrow office. For the typical 30 to 45 days escrow period many appointments must be coordinated and documents exchanged. Many of these documents contain sensitive information, including personal financial data and social security numbers. So, the safekeeping and tracking of the information is paramount. What's more, the information must be severable so that anyone involved in each sales transaction would be able to keep separate records of it, make changes to it and synchronize it with other data consumers. Given the multitude of individuals involved in a real estate transaction, synchronization is a challenge and sometimes quarrelsome.

Sound familiar to what I mentioned about EHR? It is.

I'm in no way insinuating that real estate data and health data are of the same value or sensitivity. Nor do I mean to imply that a solution in one industry is equally applicable in the other. However, once the current administration has decided on a particular health care reform path, it would behoove HIT executives and technologists to consult with industry leaders outside of health care who've struggled with many of the same questions for lessons learned and best practices in converting paper-based processes and systems to a digital, secure format.

What I propose is that we don't try to re-invent the wheel, but to take an existing one and improve on it.