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Monday, April 28, 2014


(Not a real logo, just an allusive BobbyG Photoshop quickie)
In light of my last couple of posts dealing with the continuing issues of EHR dissatisfaction, there's interesting post on THCB.
What an EMR Built on Twitter Would Look Like
WILD PREDICTION: It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.

This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.

Here’s the bottom line: how can we improve technology when doctors seem so resistant? They are not happy with their EMRs, and rightly so, because they were built to do too much for too many.

Current system is inefficient
The EMR has become essential for documentation, billing, medical reasoning, and communication, among other things. Currently, documentation is built on a system of daily progress notes. If I consult a cardiologist about a case, he needs to go through each note, containing narratives, laboratory values, vital signs, and physical exams.

A patient with a seven-day hospital stay may have twenty notes that need synthesis to put together the story–this can take hours per patient!

In an age where more providers are involved in a patient’s care (whether due to duty hour restrictions, or the increasing presence of specialists for every problem), this inefficiency is not acceptable...

One THCB commenter noted a company proposing to do this very thing.

From their FAQs:
  1. Is Medyear secure?
    Yes, very. Medyear is HIPAA-compliant and would not be able to accept your clinical records in the first place if it did not meet strict government regulations (HIPAA) and standards (Blue Button) for handling healthcare data. Moreover, we apply very powerful database technologies that allow us to secure information at a granular level. No system is perfectly secure, but we obsess over security so you don't have to.
  2. Is my information private?
    It depends on you. You can share your information however you want. You might share with a friend, a doctor, an insurer, a stranger, or with science. You might share just one small part of your health record, or the entire thing. You might share for one hour, or one year. Your privacy is your prerogative, and its up to you to decide.
  3. What is the logo a snowflake?
    We are all unique as individuals, like snowflakes. So we know our body and our lives best. It is up to us to take charge of our healthcare destiny. Medyear is a people's movement to claim our uniqueness and let the healthcare system evolve around us, to suit our unique needs.
  4. How is Medyear related to health reform?
    Many of the key changes in the law and regulations that now make Medyear possible did not exist a few years ago. The government has played an important role by implementing policies like HIPAA-HITECH, Blue Button, Meaningful Use, and Affordable Care Act. As such, we embrace government leadership.
  5. What's in it for patients?
    Typically people will share health information for one of two reasons: to give help, or to get help. Perhaps your sharing can help a family member manage a chronic condition because you have had it yourself. Or perhaps you are the one who needs to share information frequently, in order to get the best medical care possible. Whatever the reason, empathy powers when we share to help, and empathy powers the help we might also someday receive.
  6. What's in it for doctors?
    Medyear allows patients and healthcare professionals to collaborate directly and privately through Consults. The Consult works a lot like other types of encounters (phone calls, office visits, emails). But instead of recapping your health issues, fumbling with paper records, or expressing concerns in one sitting, you can simply share the information you've already collected. This makes everyone's life easier.
  7. What's in it for scientists?
    Scientists working at the very bleeding edge of research need LOTS of data to make important discoveries that lead to the life-saving drugs or procedures of the future. But getting this valuable patient information is not easy, and often when data is obtained it is without patients knowing. With many people perhaps we should just let people share their data voluntarily.
  8. Where can I get my records?
    In late February, the US Government has published a directory, known as Blue Button Connector of the healthcare organizations that currently adopt Blue Button. Over time, it is estimated that over 500 organizations - from small clinics, to lab companies, to large hospitals, to the largest insurers - will adopt Blue Button and be listed in the registry. If your healthcare provider is listed, you simply provide them with your Medyear address and your records are securely transmitted into you private Medyear account.
Intriguing stuff. You have to applaud people for attempting viable, disruptive, value-adding things. This is not materially different from the "Health Record Bank" idea I've written of before (scroll down in the linked page).

I just have a couple of concerns. As I noted in a comment (fixed my typos):
For both “Covered Entities” and (now with the Omnibus Rule) their “Business Associates,” EVERY time “protected health information” (PHI – specific legal definition) is, created, viewed, updated, transmitted, or deleted, there must be a date-time stamped transaction log of the event identifying the authorized person who “created, viewed, updated, transmitted, or deleted” the PHI.

Moreover, once an episode of care note is finished and “locked” for billing, it becomes a legal record, “updates” to which can only be done via appended addenda (and those too must be HIPAA-logged).

No small undertaking to make an app such as the one proffered here fully HIPAA-compliant. Yes, some of the PHI “tweets” are their own “transaction log entries,” but that is likely to not be the entire story. Anyone developing or using such an app had better have done their legal due diligence.
Medyear may claim to be "HIPAA compliant," but I'd want to review the gamut of their Business Associate 45.CFR.164.308 et seq documentation. The audit log requirements here would span multiple individuals and organizations. I don't just sanguinely assume that clinicians using a service like this would uniformly not be in violation of their own Covered Entities' HIPAA Policies (and, we must recall, "privacy" [164.5 et seq] is separate from "security" [164.3 et seq]. ePHI privacy is subject to the potential HIPAA-trumping laws and regulations of every state in the U.S. (not to mention the international privacy ramifications). 

Moreover, being able to connect and merge various individual time-sequential, subject-disparate medical "tweets" into efficient and necessary synthesized clinical "views" is likely to be a significant RDBMS challenge that is no different, really, than those at the heart of traditional EHRs. Anyone routinely using Twitter knows that tweets fly by at warp speed. Medyear clients (in particular, clinicians) will need near-instant access to reassembled "old" pertinent information "100-500 screen-scrolls down" at the point of care. Moreover, might there not be the equivalent of random "inbox overload" with medico-legal liability concerns? I'm just sure my Primary wants to be hammered 24/7 with "medical tweets" ranging from the consequential to the trivial.

Nonetheless. let's wish these folks well. Whatever helps.

I couldn't help one other THCB comment:

They appear to be privately held. Time for a VC-assisted IPO?

More to come...

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