A common cause of annoyance for patients is filling out the same forms over and over again. While just about every adult has experienced this issue, the deeper problem is a single patient will almost always have more than one physician or caregiver. This means the repetitive form filling is really the tip of a much more serious problem of data in silos, with each physician and hospital treating the patient from scratch, exchanging information via faxed notes or (mostly missed) phone calls.
Patient Case Example:
Take the simple example of a female middle aged patient who suddenly experiences chest pain after dinner one night. She goes to the nearest emergency room and has a rapid and extensive evaluation. Let’s say the results did not point to a heart attack, but there were indeed some abnormalities on the ECG. The patient ends up being discharged home with the ED physician writing gastroesopheageal reflux as a possible cause, and instructing the patient to follow up with a cardiologist and their primary care physician. The next morning the patient will call the cardiologist and show up in his office that afternoon. In their hand is…..nothing, but they do remember the abnormal ECG they had in the ED.
The patient has no records from the hospital’s ED and unfortunately does not have the PCP’s ECG from last year showing the same abnormality. The cardiologist gets a new ECG, and puts them on a beta blocker and aspirin. The next day the patient goes to their PCP carrying….nothing. The PCP sees the pill bottles and assumes they must have had a heart attack and orders more labs and sends them for a cardiac CT. All this for a simple case of gastroesophageal reflux? It’s not unheard of.
PHRs – Microsoft’s Announcement at HIMSS
Personal health records (PHRs) are the patient component of electronic health records (EHRs) and both Microsoft [Health Vault] and Google [Google Health] are designing software platforms that use them as the key to communication among physicians and hospitals. The concept is simple: any individual can create a free account and store their health records online and give various entities (doctors, hospitals) permission to access them. In this instance, however, Microsoft’s deep enterprise roots gives it a major advantage in hospital integration.
This was demonstrated at HIMSS when they announced Microsoft HealthVault Community Connect to complement their PHR. This software platform seamlessly connects the hospital’s clinical and registration records to the patient’s personal Health Vault. For example, this allows the patient to log in and pre-register for appointments and fill out all their forms on-line – before they walk in. Hospitals can develop custom “portals” where verified patients can log in to view and download their information – patients can also give permission for the hospital to automatically populate their PHR as soon as they are discharged.
The patients’ physicians can also access the same web portal. So in our example, the cardiologist would have been able to see the ER physician’s impression of GE reflux as the source of chest pain and the unchanged ECG and stopped there. Even more impressive, if the cardiologist’s office uses one of the many ambulatory EHRs that already integrate with Microsoft’s Health Vault, such as Allscripts, they could directly enter the information from the patient’s PHR into their office EHR. If they do not have Health Vault integration, they can download it as a text (XML) file or print it out and scan it into their EHR.
Microsoft and the Cleveland Clinic Study
As if the potential for this type of health integration was in doubt, Microsoft and the Cleveland Clinic held a press conference on Monday to announce the results of a pilot project to assess the effects of data sharing on chronic diseases. In this case study, more than 250 patients enrolled, many with diabetes or hypertension. They self-monitored at home with glucometers, blood pressure monitors, scales, etc with these devices uploading patient data to their HealthVault. Since 2008, the availability of this data to the physicians was associated with a 26-71% increase in the time intervals between doctor appointments, while heart failure patients came in more frequently, which was actually felt to be beneficial for those patients.
Microsoft also has a mature hospital data integration platform named “Amalga” which sits atop existing hospital clinical systems and allows for a single point of analysis. Physicians can tailor how they view clinical information (labs, etc) instead of using the stock interfaces of EHRs, financial people can perform analysis of payment trends, and just about any type of data can be manipulated.
While other “business intelligence” products are available for the enterprise, Microsoft says Amalga is a new category of hospital software due to the extensive hooks it has into the hospitals’ existing systems as well as the real-time data stream it can generate. Amalga was of particular interest to me since it is the current incarnation of a “Azyxxi”, a software package that was written in-house where I trained at Washington Hospital Center and an example of a group of physicians who started out by solving a local problem in their emergency room then very successfully sold their product to a large software house. This may also be seen as a sign that the increasing attention of the IT industry to the health sector may herald even more rapid and clinically significant innovation.