The use of personal health records as a corollary to current initiatives

Statement of Problem:

One of the fundamental necessities for the proper delivery of healthcare is the rapid and accurate dissemination of a patient's medical information to associated providers, laboratories, hospitals and other healthcare institutions. The lack of such services reduces efficiency, increases costs, impairs outcomes and can be responsible for increased morbidity and even mortality in the unforeseen instance.

Current initiatives by federal, state and local governments in association with charitable and not-for-profit institutions, hospitals, insurance companies and large physician practices are attempting to address the problem through specialized incentives and programs but are still in the process of establishing a common ground from which to build a foundation.

Target participants such as physicians, physician groups and midlevel providers, have expressed reluctance in the past to incorporating new technologies such as electronic medical records (EMR) or personal health records (PHR) due to fears of productivity loss, decreased revenue, legacy fees and perpetual dependence on established systems.

Government agencies, eager to utilize stimulus monies to facilitate adoption of these technologies by constituents, are in a good position to help introduce and overcome initial costs but may be unable to offer complete long-term solutions into the foreseeable future without continued dependence on grants, aid and other programs. At some stage in the process costs will need to be shifted to the end-user.

Individuals affected by this technology initiative, such as patients and families, have received little formal education regarding such things and are naturally skeptical of adoption.

The creation of a statewide medical records system/repository as currently envisioned is progressing but may be hindered due to discordant goals, objectives and expectations by participating member agencies, entities and individuals.

Solution:

As with most complex problems, GLIA believes that only through mobilizing and focusing resources from the private sector will this problem be eventually solved.

The desire to lower costs, increase efficiency, improve the quality of life and the expectation of a reasonable financial return will be the guiding tenants for the eventual completion of this effort.

Grants, aids, charitable donations and continued fiscal offering by government agencies can serve to raise awareness but cannot cover the costs of long-term hardware & software upgrades, security needs, maintenance and support; keeping in mind also that for an EMR to be successful a provider will demand nearly 24/7 uptime, security and accessibility.

Regardless of the complexity, any problem can be made manageable if reduced to its component parts and addressed accordingly. While more difficult to manage, it is not felt that any one company possesses all the necessary skills to meet this challenge.

Through identification and by-in from skilled companies and individuals each component can be completed then incorporated into the whole and the process moved forward.

An element of education, in the form of an integrated marketing effort, must be considered a key element of this project. The target of this effort must be the end-user(s): patients, providers and physician groups.

A designate project leader needs to be responsible for orchestrating the overall management of this effort.

Acceptance from government, industry, academics/education, healthcare and private citizens must be complete and unwavering.

Participants:

The role of government –

The Federal Government has already put in place stimulus money to be used as seed capital for providers looking to incorporate EMR's into their office settings. While this does not provide for covering the long-term costs of such technologies, it does offer a way to ease the burden of “making the leap” to computerized medical records.

The Federal Government has also begun the process of setting standards for information transfer, storage, utilization and security. This will, in time, prove useful by eliminating redundancy and increasing efficiency. However until such standards are created, the fear by many of committing to something that may eventually be found to be “out of compliance” is genuine and can hamper development.

The State Government in Juneau has begun to address this issue through agencies of its own. With stimulus money available the State may now be in a position to direct and oversee the introduction of these products to the marketplace (Senate Bill 133). It is also felt that their efforts could be utilized as a voice of awareness throughout the state of the need for this type of technology and as a force to address legal hurdles that may be encountered during eventually incorporation.

Native agencies supported by or affiliated with government can also serve their constituents through identification of their special needs arising from geography, lifestyle, funding, etc. and provide expertise in these key areas.

The role of industry –

Industry and the private sector, it is felt, should be the prime mover in this effort. Firms facile in the areas IT, storage, security, software generation, project management, telemedicine, communications and data transfer should be recruited as needed to address key elements of system design.

The role of academics -

The value of incorporating the academic community in this effort is two-fold. The first is the capability for specialized departments to augment key industry positions in the development process and also to introduce students to high-tech opportunities with Alaska in the hopes of increasing retention and the development of a strong technical infrastructure within the state and local communities.

The role of medicine -

The medical community; functioning as eventual end-users, are required partners at all levels of development to assure acceptance and compliance.

The role of the individual patient –

As with the medical community, the individual patient will also be a targeted end-user and therefore should be included. Education in the form of marketing and other initiatives should be used as tools for this acceptance. Means to overcome concerns about security, privacy, cost, control, etc need to be explored.

Conclusion:

GLIA believes that the creation of a statewide medical repository/distributed EMR system can only be accomplished through the development of a comprehensive program that calls upon many disciplines but is anchored firmly within the private sector. It is also felt that a two-pronged effort focusing on EMR's to hospital and physician groups and PHR's to individual patients will be the most efficient method for introduction.

SB 133 addresses the problem from the position of hospital & provider. Now what is needed is a corollary effort that focuses on getting the end-user (individual patient) “on the grid” as well. The more people that are willing and accepting users of this technology will make the eventual task of linking it all together a much simpler task.

GLIA also believes that while complex, this effort can be accomplished if broken down into its key elements then initiated by a coordinated push from many different levels and at the same time.

It is only through the meticulous process of introduction, education, agreement, consensus and commitment from the aforementioned groups that this will succeed.

GLIA, through product conception and design, is attempting to foster these commitments now.

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Mark W. Moronell, MD FACC is CEO of GLIA, LLC. He can be reached at morozea@hotmail.com

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Allowed: ktuu.com