Security without usability isn't better healthcare

I spend a lot of my time understanding how information is stored, accessed and protected as part of my role as a IT analyst. I always am astounded at how little of what is standard practice in many industries as not filtered over to health care and/or life sciences (Pharma+Biotech+academia).

The recent hub-bub about ACA (AKA Obamacare) has completely yelled over the real transformation opportunity in healthcare. Up until the recent deadlines and political fights regarding ACA "everyone" was really concerned about meaningful use. The TL;DR version of the MU legislation is this: make information available to care providers and patients.

So what are we really talking about here? It is really pretty simple; it is information management and the processes that guard against mis-use while enabling productivity.

Lets be honest the EHR/EMR solutions implemented at most organizations do not enable productivity or protect information. Doctors hate them because they do not fit their work patterns (see here), hospitals are have significant issues with data protection (see here) and importantly it is not mitigating the biggest risk to patient outcomes (and hospital liability) (see here).  

It is time to re-think the information silos in healthcare.

So if a single poorly accessed EHR is not the answer, what is?

I would argue that we need to think about this based on information flow and how we expect the value to be delivered. In this case patient care.

An interesting model to think about is the Canadian delivery model. For example; Ontario E-health has determined it is neither cost effective nor timely to build a single system for every hospital.  At the moment, 70% of all physician practices and hospitals already have some sort of EHR system in place. So rip and replace is not an option, the reality is we need to make lemonade.

Since Ontario funds the hospitals through direct allocation of tax revenue, it is loathe flush that money down the drain. 

Therefore the best approach is to control the data itself (including digital images, prescription history, surgery, etc) and letting the individual hospitals control how they view and use the data. 

In other words- Make it easier to access information based on who you are and what you need the information for!

Focus on the Information exchange layer

Consolidated Information Management layout for Patient care focus. 

So how do we do this without moving to brand new systems and shiny new toys?

The same way every other industry is doing it; especially low margin high risk industries such as Oil and gas, Insurance and Manufacturing. Keep the clunky but very secure system and take advantage of the new technologies that enable information sharing. Instead of all-in-one solution add an ECM or portal to manage rights, search and presentation. It will be more cost-effective than doing nothing or rip and replace.

This structure controls movement and access to patient data, allowing for quick access to the appropriate information based on job and location.  It provides a structure that takes advantage of the current investment in a secure database yet provides a flexible layer that is designed to convey information in context for end users. 

This may not be the best system or the system that you would design from scratch with an unlimited budget, but it gives a long term flexibility AND doesn't require a rip and replace of your current EMR/EHR. It should provide very good, highly usable healthcare at a reasonable cost.

The way they are going about the change may not be splashy but it will work for both patients and doctors- that’s a great thing. The one thing it won’t fix is the doctors who refuse to use it-and that is a bad thing.

There is additional cost involved in this model but if teh doctors and nurses do not use what you have now.....would salvaging that investment be better?

Love any comments or critique of the model.