I am a fan of John Halamka, Mr.Healthcare CTO and hope to be able to become like him. In his recent blog post, Mr. Halamka talks about cloud computing and how cheap computers deriving their power from the cloud can help cut costs in the healthcare industry. In my previous blog post on Accelerating the adoption of EHRs (Electronic Health Records), I was kind of alluding to leveraging the power of “the cloud app” to speed up the adoption of EHRs. I wondered why a 3rd party vendor cannot build an interface to either Google Health or Microsoft HealthVault and give away such an application to primary care facilities. As was pointed out in the comment, McKesson’s Relay Health division, in fact, has been closely working with Microsoft in developing such an interface which will allow easy import of health records into HealthVault. This is a great first step. However what I proposed is something different.
Consider the diagram below. I have drawn it on a real napkin to emphasize the fact that this is a rough, grossly simplified draft of my understanding of the healthcare setup based on my interactions with various touch points.
The typical “actors” here are, the individual, the primary care doc’s office, the dentist’s office, the big insurance companies and of course the Internet which connects everything. HealthVault is the new kid on the block.
You visit a doc for the first time and you have to fill out couple of sheets of paperwork with the same set of standard questions. If you move to a new practice, you do this all over again. Just remember not to write your SSN. The doc’s office does not need SSN. They are not paying you social security. All the information you handed over goes into a “system”. Each primary care facility or practice may have a proprietary system which hopefully is developed to a set of standards. I know we have HIPPA and other regulations pertaining to medical records, but my point is that, your information is fragmented among various systems.
The current set of solutions provided by Microsoft HealthVault or Google Health involve the following steps:
1. You, the individual, have to create an account (free) on HealthVault.
2. You have to fill in the standard set of questions and submit your information to the system. DISCLAIMER: I have not created an account on either system so I don’t know the exact set of questions/forms you need to answer or fill out.
3. You will have to authorize the pulling (or downloading) of your health records from various providers. Your insurance company, your primary care facility, and any other healthcare providers that you may have interfaced with.
And step 3 is where I see a problem and unless we redesign the workflow we will never be able to achieve the goal of EHRs for the majority of the population. The very fact that you the individual has to create an account on HealthVault or Google Health assumes that you have access to a computer and are fairly competent in the use of one. That is a whole lot less number of people than there are in the country. Of all the computer savvy folks only those who want to take control of their data will be able to pull information into HealthVault.
Although this is a great first step, I think, we should turn the idea around and sell HealthVault as a free data repository solution to primary healthcare centers where most of the data collection happens. The folks at these primary healthcare centers, have no choice but to maintain the data collected in some form. So why not just store all that information in HealthVault? Granted the health records are *your* records and *you* should be responsible for them, but currently you have no control or easy access to this data anyway. Shifting the responsibility of moving the data into the cloud from individuals to those who already are engaged in the activity will greatly accelerate the move toward EHRs. Imagine the cost savings. The various providers will not have to maintain proprietary systems. They can better deploy such funds toward developing competitive advantages and providing better services to beneficiaries. And your records will be in a central repository.
I know I have grossly simplified the processes but we have to start somewhere and let this, the shifting the responsibility of moving data into HealthVault, be the first step toward a giant leap in Healthcare reform. Just ping me if I can help in any way 😉