Obama’s Plan: Focus on Healthcare, Part 2

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Dec 12, 2008

In my last post, I discussed some recent research conducted by the New England Journal of Medicine regarding Electronic Health Record (EHR) solutions in light of President-elect Obama’s proposal to invest $50 billion in these technologies. In this post, I’d like to broaden the scope of the discussion to include market dynamics, Google’s and Microsoft’s roles, and what the future may hold. As before, you can access a more robust audio/PPT webinar, which also includes some discussion of enabling technologies.

(Webinar note: although I briefly mention the importance of back-file digitization strategies in deploying an EHR — including capture hardware and software — this element should not be understated. Healthcare remains a paper-intensive vertical market, and strategies for digitizing the paper-based information that will continue to be created are at least as important as capturing the mass of legacy documents that are already in existence.  To this end, InfoTrends perceives growth in distributed capture hardware and software, which allow these paper documents to be ingested by EHRs closer to their point of origin.)

There seem to be two somewhat-competing camps in the healthcare records space:

  • EHR (Electronic Health Record) vendors, which for the most part include CCHIT-certified software  and solution providers. These are often large DM or ECM vendors and their partners, VARs, ISVs, or other firms with a focus on healthcare solutions. Their solutions are targeted to healthcare providers (this is important), whether that is a small private practice, an MRI facility, a Children’s Hospital, or a health insurance organization.
  • PHR (Personal Health Record) vendors, which are generally limited to Google and Microsoft for the time being. Unlike EHRs, PHRs are targeted to consumers, providing a secure, central access point to all of one’s medical information. Positioned this way, PHRs would provide a central access point for consumers as well as for their respective healthcare providers (and their EHRs). It seems probable that PHR vendors will promote Web-based standards for accessing and updating this personal data, hopefully in encrypted fashion, between EHR-enabled providers.

One giant red flag that has not yet been ironed out is PHR vendors’ liability relative to the Health Insurance Portability and Accessibility Act (HIPAA) due to their consumer-oriented technology. It’s unlikely that mainstream consumers will provide all of their trusted medical data to a vendor — as well-known as their brand may be — without assurances about security, privacy, and liability. In contrast, EHR solutions, which are hosted by a healthcare provider, are automatically covered (and in fact promoted) by HIPAA.

Notwithstanding these concerns, let’s consider the benefits of having standard electronic protocols and access points for working with medical information:

  • Accurate access- your PCP, your specialists, and you are always looking at and updating the latest information
  • Easy collaboration – your son needs an x-ray at 3am? A radiologist in Europe is already awake and can access the image with the click of a button.
  • Clinical support – rules-based warnings and alerts can keep doctors from missing key lab results, prescribing dangerous medications, or otherwise committing unintentional malpractice

This last point deserves additional discussion, especially as the growth of “case-based medicine” continues to astound medical researchers and providers. Using highly-refined statistical algorithms coupled with large amounts of standardized (and anonymous) medical data, physicians’ medical diagnoses and prognoses can be assisted by (not replaced by) these modernizations. Some of these benefits are evident from data in my last post, but for further information on this provocative topic, I recommend jumping to page 81 of Ian Ayres’ Super Crunchers.

Regardless of your opinion on the recent election’s results, it’s critical to understand areas where government outlays will be focused in the next 4 years, and healthcare technology has definitively been pegged as one of them. In a future “Obama’s Plan” series, I’ll focus on the “green” technologies for the office, another area where the President-elect has promised substantial government investment.

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