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Google Health: the beginning or the end of ehealth as we know it? February 21, 2008

Posted by Hans in : news , add a comment

Google announced the launch of a pilot project in collaboration with the Cleveland Clinic to provide select patients access to their medical record using the Google health platform.

According to the Associated Press, Google will:

begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools.

I think we’ve all known that something like this was coming. I’m just surprised that Google decided to jump directly in with such large undertaking. I would have predicted (and even suggested) starting with something a little less ambitious.  Does Google’s entry (and Microsoft’s Health Vault) change the ehealth landscape?  Is this the "tipping point" where we get to see tangible progress in ehealth that benefits patients?

Regardless, I think Google’s involvement will provide more publicity to the entire field, and also provide some additional competition to the industry. I’m curious to see how the established parties will respond.

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A new architecture for EHRs? February 5, 2008

Posted by Hans in : analysis , 4comments

Amidst the efforts to develop the elusive electronic health record (EHR) and to modernise our health care systems are many technical challenges that need to be addressed.  One significant challenge is integrating information from a variety of difference sources (i.e., lab systems, pharmacy systems, scheduling systems, directories, nursing and physician notes, etc) and to present this information in a coherent, user friendly fashion.  In the past, I’ve participated in some of the technical discussions regarding potential solutions and let me tell you that there are no easy solutions.  We’re talking about massive amounts of data needing to be transferred between different points.  Then we also need to talk about how to take this data and make the information accessible to the health care provider (and ultimately the patient) at the time and place needed.

From my understanding, much of this integration work has gone along the path of developing systems that function as "dashboards" by collecting and aggregating information from various sources.  I discussed this concept with Khaled El-Emam in the past and he indicated that database technology isn’t yet sophisticated enough to do massive real-time push updates.  It can be done on a small scale, but the model doesn’t scale.  I noted this point when the University Health Network (UHN) started moving towards an enterprise clinical data ware-house.  The original thought was to update all of the hospitals clinical systems in real time as new patient data was created.  Unfortunately, practical limitations forced the real-time aspect to be abandoned.  I wasn’t privy to the final solution, but I’m told that the solution that was agreed upon was batch updates nightly for things that were time dependent and weekly (or even monthly) updates for other types of data.  We’re talking about a single hospital corporation having difficulty updating its own systems – granted, UHN is one of Canada’s largest hospital corporations and has three main hospital sites with over 10,000 staff, so we’re not talking about a small organization.

I was notified of a proposed alternative method of integrating information within an electronic health record by Vitaly Latush.  He outlines:

"an alternative approach to implementation of a nation-wide easily accessible electronic health record solution based upon the "publish-discover" paradigm successfully used on the global scale to manage immense volumes of non-integrated information available through the Internet"

His main argument against the current architecture/model is that integrating data from all of the different data sources is far too complex because it is based on exchanging data based upon standardized rules.  Latush suggests that a model based on how the Internet currently operates is far more efficient and ultimately more effective.

In this alternative model, he suggests that data sources, be it physicians in an office, labs, or hospitals should only be responsible for "announcing" that new data is available and then providing access to this information.  I would assume that some sort of RSS technology (or a derivative) would be used.  Instead of waiting for some program or system to take this data and integrate it into a dashboard, users would search for information, like they do on Google or any other type of search engine.  Health information would be aggregated by some sort of unique patient identifiers or other keywords.

Latush suggests the following advantages of this model over the existing architecture:

  1. Minimum integration effort – searching for information is now the main function
  2. Based on *proven* Internet principles
  3. Does not require new technologies or skills
  4. Can be built on top of existing health information systems very easily
  5. Facilitates incremental incremental improvements of the functional EHR
  6. Suited for unstructured data manipulation
  7. Cost-efficient in terms of up front cost and maintenance
  8. Self-organizing

 After reading the white paper, I have to admit that the idea is interesting and deserves some investigation.  Here are some thoughts I have about this idea:

Again, this idea sounds very interesting.  From my understanding of things here in Ontario, I believe that some of these concepts may be adopted already or at the very least being discussed.  As the health system moves toward regionalized and integrated models, the need to share information becomes greater.  Regardless of your thoughts on this specific proposal, I think the value is in the discussion and generation of new ideas.  As well all know, health care is important but sometimes takes a back-seat to more "sexy" things like new technologies or recent events.

I highly recommend you read Vitaly Latush’s blog post on this topic or read his white paper, titled "EHR 2.0 – new Electronic Record concept".

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