My thoughts this morning turn towards maintaining and accessing a patients record, more particularly my own health record. There are many solutions/apps now to capture all sorts of information from a smart phone or tablet and also very mature messaging standards such as HL7. There are also many technologies that allow information to be stored and shared on line and increasingly with more capability around access control.
So, am I being simplistic when I explore some of these technologies (as I have started to do more recently) and join these dots together .........the first dot if you will is the recognition that in most western countries we can access the internet almost anywhere. I can have an account such as google plus, create some circles which effectively manages my access control and consent issues and upload data from my health practioner to my google plus account and share it as I see appropriate. Ok it may benefit from some dedicated indexing within the google space which I am sure google could manage. I can use the camera to capture data but I think health providers should record my google plus account information in their PAS systems and upload either my content or hyperlinks to my content which they maintain on my behalf. The fact is that most data is digital or can be made digital. Why not make it bi-directional so that I can upload content and get an opinion or even refer my record to get a second opinion. I could also save trips to the hospital to get my wound checked by uploading images from the comfort of my own home and steer them towards my care provider even using notifications to alert people of their availability. It should even be possible to start utilising home based diagnostic or monitoring equipment docked or worn about the person and wirelessly upload this data periodically or in real time to my on line health engine which in the future has the ability to create workflows automatically as abnormal results/observations are detected. You can see the benefits for those with disabilities, of chronic ill health, for the elderly or for those who want to keep close tabs on their health maybe as part of a training plan for a sporting event like a marathon.
So let's look at the benefits. Well most headaches around data regard access and consent and to my mind we are building increasingly more difficult hurdles to jump as those guardians responsible for data protection feel obliged to protect data almost now at the detriment of being able to usefully access it when required . I travel a lot and God forbid it is possible that I may need to seek medical attention anywhere in the world. I also want my health record to be longitudinal and reflect my history from birth to death, so yes I am suggesting that parents create accounts for their children, even if they start with capturing jabs etc as it really helps in later life when the child becomes the adult and doesn't have to hunt around the attic looking for an inoculation card from 20 years ago. It would also be useful to capture boosters, travel meds, tetanus etc. I'm sure you get the drift and can also then link this record to driver license maintenance, employment screening for occupational health such as eye sight tests. When you actually put your mind to it the benefits of linking data availability to consumption can have loads of benefits. Just one other example that springs to mind. I had an uncle with diabetes who wore a bracelet indicating as much. If you replaced this bracelet with a physical digital key that a paramedic can use to access this patients record on line in the shopping centre should they become disorientated due to hypoglycaemia then much more specific and relevant care could be provided much earlier which is vital in an acute siutation. Sadly as my uncle become more elderly and living alone he became less able to manage his blood sugars and ultimately died as a consequence of entering a diabetic coma. If technology such as the contact lens that will check blood sugar levels automatically or other similar monitoring technology was available and more widely used then people like my uncle as well as those that cared for him would undoubtedly have benefitted.
It is also demonstrable that health providers will benefit. You could potentially shift a lot of the ownership of records to the patient along with the responsibility. Most patients will ensure they keep this well maintained. Billing and compensation could also be speeded up as the data along with potential e-claim forms could be completed and submitted on line resulting in faster compensation.
I would also argue that google is already part of many peoples health plan, how many of us google an ailment and self treat as a consequence .... I don't have the data other than anecdotal through conversation but since becoming a parent I can testify that googling a symptom and acting accordingly not only saves me a fortune in GP visits but no doubt saves the state as well. Don't get me wrong, visiting a GP or A&E is always going to be the backstop should you be concerned and common sense is always required in judging when to consult a medical practitioner in person.
So, this is my brain dump on this matter for the moment at least. I know some big companies such as Microsoft have considered Health Vault technology but my feeling is that stakeholders from within the industry and the benefactors such as those suggested above need to drive this forward as arguably a national initiative is required with some IT giants of this world such as google and let the industry players align accordingly. Interoperability between hospital systems which themselves are maintained in isolation is not the future in my opinion! The patient and the public need to become more responsible for their data and how it gets used in this world where increasingly the funding for care will be allocated directly to the patient or their GP and they will pick and choose where to be treated based upon availability, competence and budget.
