Electronic Health Records Face Rapidly Changing Technology

State could challenge Microsoft’s de-facto monopoly on provider-to-provider database
The Lund Report

February 6, 2012 -- Technology is changing so quickly that state officials and advocates overseeing more streamlined transfers of health information in Oregon are scrambling to keep up.

2010 may not seem like that long ago, but from the perspective of a computer, it’s already the Stone Age. That was the year that the Community Leadership Council of the Archimedes Movement made recommendations on the state’s Strategic Plan for Health Information Exchange, which the federal government approved a few months later.

The Oregon Health Authority, through the Office of Health IT, has been developing the necessary policy, selecting a technology vendor and planning the implementation of the initial services with a focus on provider-to-provider communication to launch this spring. Although patients will be able to select a personal health record as Archimedes outlined, the Google product they referenced in recommendations went defunct.

“There is a rapidly evolving environment around Health IT in general, and Health Information Exchange specifically, and implementation of HIE across the country has moved more slowly than any of us anticipated back in the summer of 2010,” said Alissa Robbins, communications officer for the Oregon Health Authority.

Bill Andrews, a member of the Archimedes Leadership Council, said when Google cancelled its program last year, the public lost an option that was more consumer-focused. The strength and weakness of Microsoft’s program called Health Vault, as Andrews sees it, is that it’s more business-oriented, and government agencies also appreciate a more secure server that requires registered users to log in to access patient information.

Andrews says a hospital like Oregon Health & Science University could soon input data with distribution to the entire Oregon healthcare industry through a system that’s “secure, private and open only to licensed practitioners” so that they can only share medical information that’s been authorized by patients.

When Harris Corporation got the state contract for $2.8 million over two years to create what they’re calling a Direct Web Portal, it could recreate a Google-type product, in that it will allow enrolled participants the ability to securely send and receive electronic health information to and from any other enrolled participant. It should be online and tested during early March, and opened for general availability after March 22.

Microsoft’s de-facto monopoly over the medical electronic side of the industry did have the advantage of setting a standard, according to Andrews, who owns a health tech company called Parameter Developments.

“Electronics has bombarded the hospitals, and the biggest problem they have is to get the various computers to talk to one another,” he said. “We at first requested, and then required, that the various electronics be compatible.”

The second phase of the state’s effort could allow for query or lookup of patient records through “Master Patient Index Record Locator” services, EHR-to-EHR health information exchange and connectivity between federal systems.

“There’s no coordinated facility—not that it needs to be a big facility, but there should be a place where it’s all indexed,” Andrews said.

Education of patients is another key issue for Andrews and other members of Archimedes. How do you direct them to all the key resources out there while also informing people about a “buyer-beware” environment?

“The whole concept of patient centricity and web centricity was not my idea—it was the federal government’s idea during the Bush Era,” Andrews said. “The patient was losing control, so the patient was set up as the center, although there are other sets of laws that could throw everything for a loop.”

Current laws can provide some confusion if a patient owns their data, while the hospitals and the clinics are actually responsible by law and have to hold onto the patient’s records for set periods of time.

The dream of advocates was for a patient to be able to go in and find all of the latest and greatest information, but the reality is fraught with a series of ethical and logistical questions. The institution that’s offering the servers should be the first to check that the information being offered is correct, Andrews argues, but it’s ultimately the patient who decides what’s “trusted.”

To address the privacy and security concerns that Archimedes identified, the state of Oregon is developing an opt-out policy to allow patients to decide whether their information is shared electronically.

“OHA remains committed to a patient-centered approach focused on better health, better care and lower cost,” Robbins said.

In fact, HITOC’s Consumer Advisory Panel met Feb. 1, and a major component of its agenda centered on making certain that the work of the health information exchange and health information technology keeps the patient as the central focus.

Health IT will also be the focus of a Wednesday, Feb. 15, panel discussion by the Software Association of Oregon from 6 p.m. to 9 p.m. at the OHSU Center for Health & Healing at South Waterfront in Portland.

The “Healthcare IT Innovation Series” event will include OHSU’s Chief Medical Officer Dr. Charles Kilo and Eric Dishman, director of health innovation and policy for Intel.

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Comments

The above article is very confusing. First Oregon makes a poor decision by selecting Google Health as their patient record - a decision that most any other state or healthcare organization would have advised against. Now they are having a federal technology company Harris (who just got into the healthcare space less than two years ago when they acquired a health information exchange company) build them a Google Health-like product that they have never done before. And then one of the Council members named Andrews comments that Microsoft has a "de-facto monopoly over the medical electronic side of the industry" - a statement that is so uneducated because he should be embarrassed to know that Microsoft was failing so miserably in healthcare that 2 months ago they sold off all their healthcare software assets with the exception of HealthVault. If I resided in Oregon, I would be livid with the technology leadership they are providing. However, I am angry that my federal taxes are once again being wasted.

While Microsoft's de-facto monopoly may have set standards, they also stifled progression and innovation. EHR security and privacy are always big concerns when dealing with patient data. Thanks to Meaningful Use certification bodies and other 3rd-party certification organizations, there are industry standards to guide consumers. PHR security across EHR patient portals is another big concern among many in the industry as the rules for Meaningful Use Stage 2 begins to roll out.