tag:blogger.com,1999:blog-3503957686158274288.post4435786086104190527..comments2024-03-12T12:32:15.598-05:00Comments on On Health Care Tech & Policy: Arguments for a Universal Health RecordMargalit Gur-Ariehttp://www.blogger.com/profile/08777722834145614546noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-3503957686158274288.post-9510538383063336832012-02-01T19:06:13.688-06:002012-02-01T19:06:13.688-06:00I am starting to regret my kneejerk decision to no...I am starting to regret my kneejerk decision to not go to HIMSS this year :-(<br />Y'all have a round of pink Martinis on me.... :-)Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-27811666946485813522012-02-01T18:43:34.454-06:002012-02-01T18:43:34.454-06:00Can't wait to hear more about this at HIMSS, H...Can't wait to hear more about this at HIMSS, Heather. I'll be interested to hear about the Brazil connection as I have some contacts and an interest in driving these kinds of solutions there. <br /><br />A relevant, however shameless, plug. We'll be talking about exactly these types of plug-and-play platforms at the eCollaboration Forum at HIMSS12. Agenda's been published. Hope to see you all there! http://collaborativehc.org/ecollab12/ecollaboration-forum-agenda/<br /><br />In regards to the conference, I spoke with Josh Newman, MD in charge of health strategy at SalesForce today, and they get it, and with payment reform here in the US, see it as an inevitability toward these types of open platforms.Leonard Kishhttp://www.collaborativehc.orgnoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-83975731857177090282012-02-01T06:37:07.871-06:002012-02-01T06:37:07.871-06:00If I may there is an existing standard already in ...If I may there is an existing standard already in use for reporting by the us governement and also by the library of congress the finish healthcare and some others. You would just have to add an export capacity in this format from your EHR. And you can add on top of it protocls like HL7 etc.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-32396461815524144772012-01-25T04:05:44.725-06:002012-01-25T04:05:44.725-06:00I understand that a mega database might seem desir...I understand that a mega database might seem desirable, although I'm not sure that will actually solve our wish to achieve the 'right triplet' - right data, right time, right place. Do we *really* want everything available all the time? That's a hell of a lot of data to trawl through everytime we access a health record. <br /><br />On the other hand, shared access to standardised and up-to-date, curated lists (eg Problem/Diagnosis lists, Adverse Reaction lists, Medication lists, Alerts), plus pithy and timely communications (such as discharge summaries, specialist letters and referrals) would revolutionise patient care. Note that I specified that these need to be standardised, so we really know what the data means, and can safely compare apples with apples.<br /><br />Jurisdictions, such as the Australian national program (NEHTA), are avoiding a single database - preferring clinicians and organisations to keep their own local clinical records in great detail. However NEHTA are leading work to provide a central Personally Controlled Electronic Health Record (PCEHR) that will hold key document summaries and, in addition, provide an index that will allow clinicians to find the details in local repositories when they need it.<br /><br />Maybe as we learn more how to share health information the environment will change, but for a myriad of political and technical reasons, it is unlikely that a single database will happen soon. Expect it to occur in incrementally, if it occurs at all - perhaps organisational, then maybe regional scope expansions might happen. National repositories I predict are not likely, and international, won't happen.<br /><br />Data can be liquid if is based on standardised definitions and we share it sensibly/appropriately - hence our work on archetypes in CKM, to ensure that the data can be both stored in detail in a local EHR and can be safely exchanged.<br /> <br />The current adhoc way of defining data in each proprietary system should be ringing alarm bells if we start to share any atomised data. That is why we are currently locked into sharing (largely non-computable) CDA documents at present.<br />So, while that does enable some sharing of health information in the short-term, relying on non-computable document-based records precludes leveraging the data for other purposes such as clinical decision support, aggregating data, comparative analysis etc which will become increasingly valuable as we accumulate health information over time.Heather Lesliehttps://www.blogger.com/profile/08892704359684457998noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-59617354625268464102012-01-23T23:28:56.323-06:002012-01-23T23:28:56.323-06:00I think I need to write a followup post to this. P...I think I need to write a followup post to this. Perhaps a bit more technical. <br />I am not thinking about a single platform, only a single data repository. Large EHR vendors would provide platforms and smaller guys would plug into those platforms, all accessing and modifying the same raw data in real time.<br /><br />(see the rest of my combative/frustrated/not very well thought out comments on G+, and I do apologize)Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-1210233314881847742012-01-23T23:22:14.995-06:002012-01-23T23:22:14.995-06:00I love your uhr blog post, but why not a single da...I love your uhr blog post, but why not a single database? Why "have the right health information available at the right place at the right time", instead of have all the information at every place at all times?<br />Why does it need to flow instead of just accumulate? Flowing implies possibility of errors, mishaps, lost in transit, etc. <br />Why move it in this Internet age instead of accessing one authoritative copy from everywhere?<br /><br />I understand the privacy concerns, and I do understand the established industry concerns, but we are deluding ourselves thinking that having multiple copies of our information floating around is somehow safer than having everything in one place. Is this a uniquely American concern?Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-38876140235926055202012-01-23T22:58:48.986-06:002012-01-23T22:58:48.986-06:00It is so pleasing to start to see this kind of con...It is so pleasing to start to see this kind of conversation starting to occur. <br />There will never be one single database, but we can start to work on a universal platform, where applications can plug & play and access standardised data from other systems. <br />I blogged about this back in 2010 - http://omowizard.wordpress.com/2010/08/23/gimme-an-uhr-yes-please/ - and there is certainly momentum gathering in this direction. See also the CIMI initiative - http://omowizard.wordpress.com/2011/12/15/why-the-buzz-about-cimi/<br />The work that we are doing in the openEHR Clinical Knowledge Manager - www.openEHR.org/knowledge/ around creating standardised EHR content definitions is also garnering interest, especially in Europe, Australia and Brazil. This work is certainly one candidate as a means to progress the CIMI work forward as well.<br />I'll be bringing it to HIMSS next month if anyone is interested in finding out more about this Health2.0 approach to EHR content.Heather Lesliehttps://www.blogger.com/profile/08892704359684457998noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-69444439662826774362012-01-23T12:04:16.648-06:002012-01-23T12:04:16.648-06:00In terms of platforms, you're right, it has to...In terms of platforms, you're right, it has to start with the data. And the first step in realizing some ideal platform will be ensuring effective exchange and structuring of the data. But I can't buy into the idea that a single, unified database would be the best solution to this problem. The definition of the data will be constantly changing constantly, we'll need folksonomies vs taxonomies. The data needs to assemble around the patient, in my mind, not some database that happens to have patients in it up in the sky.<br /><br />In this age of bottom-up solutions via social media that has led to the Arab Spring, we can organize ourselves and perhaps our data much better than a more static, top-down solution ever could. <br /><br />You must see this video. Have you ever talked with Gary Johnson @CLOUDHealth http://www.youtube.com/watch?v=afMjZgvtsp8 ? He has some very different, more bottom-up approaches that you may find interesting, although perhaps, today, as politically impossible. But I'm with John, let's not ever let that stop us!Leonard Kishhttp://twitter.com/leonardkishnoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-16448609846065536022012-01-22T22:29:58.910-06:002012-01-22T22:29:58.910-06:00Thanks, John.
I would love to see one of those car...Thanks, John.<br />I would love to see one of those cards in use here.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-78424653142672685892012-01-22T17:28:41.073-06:002012-01-22T17:28:41.073-06:00An easy to grasp, clear and compelling case for un...An easy to grasp, clear and compelling case for universal simplicity. Outstanding. There was a time when I would think it hasn't a chance, but that was before the Arab Spring, the dissolution of the Soviet Union, the fall of the Berlin Wall and the election of a Black president. <br />Keep writing. (And for my part, toss in a biometric national ID card to go with it.)Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.com