DIDW: Unique Characteristics of Healthcare: An Information Business
Tuesday, September 12th, 2006Here’s my rough notes from the second morning keynote on Day 2, please expect rough writing. My comments / editorializing in brackets prefaced with “SJCâ€
Scott Wallace: The National Alliance for Health Information Technology
Huge problem, no identity management in healthcare
“When you’ve seen one hospital, you’ve seen one hospital.” Little standardization between hospitals.
Healthcare information is all personal. Information known about you regarding health does not change over time for employment, insurance, etc. Once disclosed, it is gone forever. Your reputation can be fundamentally affected.
Economics of Personal Healthcare
- All I want - full access
- Others should pay for it - Insurance
- I’m not paying for others - Medicare
The healthcare triangle is the relationship between the provider, the patient, and the payor (insurer). This leads to complexity in the way the information systems are constructed.
We all outsource healthcare which means information must be shared in order to get good care.
Information must be shared for exams, diagnostics, etc.
All this information exists in paper but paper tends not to move around: (Lab, Doctor’s office, hospital, nursing home) - Labs tend to do the best job.
Electronic in the healthcare industry means you faxed something.
30 years ago you had a family doctor, only hospital when near death. But today there are specialists, distributed care, and much more sophisticated information. (Static X-Ray vs. 64-slice CT)
Healthcare is desperately in need of tools to manage this info.
Rand did a big study: “Healthcare is the nation’s largest, most inefficient information enterprise.”
Access, Errors, Quality, Efficiency
Access:
Kaiser Family Foundation puts 16% of the population: 44 million people as uninsured. Highest rate of spending per capita and lowest rate of access.
Errors:
We kill 98,000 people a year in victims of healthcare. 250,000 doctors - (doctor’s always deny they killed anyone)
Thinks part of the cause is bad information systems
Quality:
Rand - Patients recieve the appropriate care 53% of the time. Why? Information can’t be shifted appropriately. $500B a year is wasted in healthcare.
Another report, To Err is Human, - Information needs to follow a patient around from doctor to doctor.
Information flow problems are caused in part by paper systems. Lots of waste has to do with information needed being unavailable. How many times have you had a test repeated because the info wasn’t available or trusted?
Why still paper based in healthcare?
- Systems
- Economics
- Security and identity
Systems:
No innovators in healthcare, no iPods. Physicians intolerant to change. Big IT innovation in healthcare is still not huge (average large healthcare IT company does 1.5 billion in revenue). Support requirements, etc. scare people away
Economics:
Economics are resistant to change. The purchasers aren’t the beneficiaries (10% goes to providers). Fee for service, no quality differential, no efficiency reward.
Children’s hopsital in LA. Did 140million IT deployment. Took acute care cases and made them ambulatory, allowed folks to keep patients out of hospital. About 8 months after they finished the deployment they were nearly bankrupt so everyone else is afraid to deploy for fear they will reduce their business. This is a big impediment.
Fee for service: Doctors get paid the same across markets regardless of how good or bad they are. This stifles innovation. If you as a doctor only get paid by use, you don’t want to cut down the number of uses.
Security and Identity:
Classic problem of how to share and who to share with.
“if we are worried about privacy in healthcare why do we have gowns that open in the back”
Privacy means keeping secrets. We have blinds on bathroom windows because we want privacy. In healthcare when they say privacy they mean confidentiality: limited disclosure towards only specific people.
HIPAA issues - Look into electronic health records to protect data confidentiality you get much better poll results from consumers. Speak in a language of confidentiality, not privacy.
Some Identity Issues
- Policy
- Stakeholder Engagement
- Technology and Clinical Practice
Policy
Identity links to confidentiality
HIPAA - created lots of state laws to be more severe than the federal base. Things mandated in one state might be illegal in another state
Legislation to block unique ID - wanted to create nation healthcare ID to track your healthcare information. Two years later HHS was told not to work on it by congress.
Big debate in healthcare now is do we have a national system or a regional system
Need appropriate protections and sanctions since the data is so critical. Need to prove if you get leaked healthcare information that you didn’t use it. Stealing banking info gets you in jail, less clear if you steal someone’s healthcare information.
Stakeholder Engagement
Consumers are completely disengaged from this problem. They think there doctor has all the relevant information. The average group practice doctor has 3000 patients. Consumers don’t know how little their doctor’s know about them.
Only way to get consumers engaged is to discuss convenient information. No need to show insurance card over again or discuss medial allergies.
Clinicians are worried about accuracy and completeness of information which often leads to repeating tests. False positives and negatives if information is wrong is a huge problem.
Technology issues
Unique or algorithmic matching? Still sense that nation ID is necessary in some circles but algorithmic matching is viewed with a skeptical eye.
Need to inform the policy debate in the public and congress
Must defer to the policy consensus - so many standards, engineers need to agree that some standard is needed.
Question Steven Spraig (sp) - Wave Systems - Trusted computing opportunity with the PC’s hardware ID. All PCs will have a common method for identity within a hospital. How can these standards be brought into awareness in healthcare?
Healthcare IT people are extremely cynical since they’ve been burned in the past. Tone down your message to something you really know you can do.
nahit.org
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