All posts in Healthcare

The importance of standardization in an industry, cannot be under stated, without standards, we would not be having many of the stuffs we enjoy now. And it is the lack of standardization which is holding back Healthcare Informatics from exploding.

Make no mistake, I am not saying that healthcare informatics lack in standards, no it does not. But the process of implementation and educating the industry on what needs to be implemented and complied with is what is lacking. Take HISA (Health informatics Service Architecture) for example, its a worldwide ISO standard, (ISO 12967), its a great standard, it details out the description, planning and development of new health information systems architecture; the integration of existing electronic health systems, both intra- and inter-organizationally; using architecture that integrates common data and business logic into middleware; which is then made available throughout whole information systems.
3 main parts:
– Enterprise Viewpoint
-Information Viewpoint
– Computational Viewpoint

The only issue with HISA, is that it is too generic, and not specific, meaning, it is not meant for someone to just “pick it up” and start implementing within
healthcare sector. Its almost right to say that its the “TOGAF standards” for Healthcare Informatics. TOGAF as most people know is too generic and often
requires extensive amount of tailoring, experience and requires other supporting standard like ITIL, CMMI, Agile, PMI and others to go along. Same in
healthcare informatics. We should be having the following list as the core standards on top of HISA (being the horizontal standard):
– HL7 for Clinical Application to Application protocol
– DICOM for Radiology Application integration
– ASTM / LOINC – for Lab Application integration
– CCD – as for Medical Records Format
– ICD 9/10 – for Diease Code
– MIMS – for Drug Code
– SNOMED CT – Comprehensive clinical health terminology
– EN 13606 – Electronic Health Record Communication
– IHTSDO – International Health Terminology Standards Development Organisation (IHTSDO)

The above set of standards, should be the recipe for any planning, development, deployment, and change management of healthcare projects, particularly
focusing on medical records, hospital information systems, EHR and EMR, integration or upgrading.

Note:
CCD (Continuity of Care Document) is by ASTM & HL7
CCR + CDA = CCD (Something like this)
Paving path towards a Healthcare Enterprise Architecture & Technology [HEAT] standard…

Consider the following scenario:

Scenario 1:
You have cash in Bank A. Bank A has been your preffered bank for many years.
One day when you were traveling out of town, you ran out of cash and had to take cash out, Bank’s A ATM machine was not available. What do you do? Naturally you would look for another bank’s ATM, in this case Bank B and take out your cash, for a small nominal fee.

Scenario 2:
Consider yourself applying for a bank loan for a property purchase. The bank which you are applying to, will be able to access a centralized repository where all current loan, payment history, current financial health of the applicant, and all other financial information of the applicant is listed, a summary of all bank’ data. With such a information, the bank is able to review and decide if the applicant is eligible to get the loan.

Consider both the scenarios above to be applied patient’s healthcare record, in this case, electronic healthcare record (EHR).

Scenario 1 in EHR:
You have been visiting Hospital A for many years, and have all medical records there, in electronic format.One day when you were travelling out of town, you fell sick and had to visit Hospital B. After many tests, Hospital B can’t find anything wrong with you and they require all your previous medical records. Using a ETM
(EHR Teller Machine), you simply go to this machine, pay a nominal fee and print all your medical records needed and pass it to doctor in Hospital B.

Scenario 2 in EHR:
Consider yourself applying for a life insurance policy. Of course you will be sent for a medical examination. But on top of this, with the “ETM central Network of data”, where all records from across all health institutions are available for the insurance companies to view and summarize, and further decide to approve your insurance application or not.

Both the scenarios are not impossible to achieve. What is even more important is that, we got to stop talking about Application to Application integration, and start talking about Application to the “EHR Teller Machine Cloud” integration. With this, regardless of where we are, what “device” or software is being used, we will be
able to access the medical records seamlessly.

The easiest way to do this, is to bring the ATM machine and ATM network model into EHR model. If we continue to hope that all EMR/EHR/HIS to one day be integrated, it is unlikely to happen. All we need is these data to
be pumped into a central repository, which then be printed out in a ATM like machine called ETM. Yes, it re-introduces paper into the Medical Records, but it ensures sharing of medical records. There might be some who wonders, why re-introduce paper when we have Apple launching Healthkit with its Apple Watch,
Microsoft having Healthvault, Jawbone’s UP etc. But when it comes to healthcare, consumers (patients) behavior is different, adoption rate is always low. Refer:http://www.forbes.com/sites/zinamoukheiber/2014/11/24/i- asked-20000-doctors-about-fitbit-and-apples-healthkit-and-heres-the-answer/

Health technology adoption only happens during a trauma or on need basis. Meaning, only when accident occurs, and only when the victim’s medical record is critically needed, people tend to think about the importance of getting victim’s medical record to provide a wholesome treatment. And this works out well for the ATM like model. (think of petrol kiosk (gas station) when you run out of petrol/gas & think of ATM machines when you run out of cash on hand.)

Continue to hope for pure 100% App to App medical records integration is a lengthy process. Imagine the jump from 2G telco networks to 3G, we had 2.5G, or better known as GPRS technology. (Which exsits till now).

Consider this ETM in the similiar way. Next article in this series will include the technical view point and feasibility of getting this done – coming soon.