Connection Tops Collection - community health information networks - Industry Trend or Event

Health Management Technology, August, 2001 by David J. Brailer

Peer-to-peer technology lets caregivers access necessary data, upon request, without using a repository.

The medical and economic impact of not knowing a patient's complete medical history is profound. Studies have indicated that the average doctor only knows about six to 10 prescriptions that a patient is taking, and that one out of 10 admissions to a hospital is caused by not having patient information available in the ER.

When treating patients in the areas of immune deficiency and infectious disease, I often had patients that were taking an average of 15 medications at any one time, prescribed by up to four different doctors. Patients usually knew about half of the medications they were taking. If they couldn't remember the names of the other prescriptions or if they forgot to bring their medicine bottles with them, I called the other physicians to request that information, which could take weeks. My ability to help patients was impacted because I didn't have all of the information that I needed to do my job.

Collecting Data

Medical practice today still entails sorting through a stack of lab reports, trying to find information on a specific patient. Healthcare has made huge gains in providing intelligent diagnostic and therapeutic knowledge devices, but lack of information on a particular patient can hinder the entire process. Health information technology investment efforts have chipped away at this problem, but have fallen short of any real solution.

Gathering a patient's complete medical history has become such a problem that the healthcare industry has transformed itself to find an answer. Most notable has been the emergence of managed care, integrated delivery networks and attempts at community health information networks (CHINS).

The original intent behind managed care was not utilization control, but rather for these organizations to keep track of their members' health information and better steer the direction of care. However, because managed care organizations often deal only with claims and billing data, this has become similar to managing an automotive manufacturer using only the dealer invoices.

Integrated delivery systems emerged from the provider side as part of their attempt to gain a more complete set of information surrounding a patient. Even though integrated systems contain multiple treatment sites, they are often not efficient in communicating patient information across geographic boundaries.

One of the largest efforts for hospitals and health systems to share patient data was to form CHINS. A major goal of CHINS was to build centralized, mainframe-driven databases that would contain all the medical records on every patient in that community. It would also incorporate all of the different access rules and policies regarding different users and different levels of access.

The thinking behind this approach was correct because the goal was connection, but the effort failed for two reasons: The cost of building the infrastructure to collect data was enormous, and the centralized repository approach created competitive and security issues around who controlled and had access to the information.

Data warehousing and electronic medical records also have attempted to solve problems via data collection--building a database that supposedly contains all of the patient information needed to make accurate treatment decisions. Both technologies are a necessary part of transforming the healthcare system because of the types of information that can be collected. Most of these systems were built on the assumption that physicians would be the key users. But unless a physician is considered an "innovator" in information technology, these products may take more time to use than manual notes and dictation systems, eliminating the perceived value among many physicians.

What type of solution will deliver value to physicians, hospitals and health systems? One that is easy to implement and use, is cost effective and focused on connection of data, not its collection and distribution. That solution is peer-to-peer technology, a technology that can provide the data that a physician needs on demand and also monitor and audit data usage.

Connecting the Data

By utilizing the wealth of information available through the Internet, peer-to-peer technology presents an alternative to the centralized repository providing a secure system for locating and identifying patient records, thereby improving the depth and accuracy of clinical information available around the point of care. Members of the network can pull files off each other's computer systems by accessing them through the Internet, and the requesting clinician is able to gather patient information from other systems online and store it in a centralized database or server. There is no repository.

For example, if you go to a Web search engine and type in the word diabetes, you will get thousands of references to websites that mention diabetes. You can also be specific about search criteria by using multiple search options. When the search engine returns the URLs, those sites are brought to you on a demand basis, not through a repository, and the browser assembles all the different sites on the Web where there is information. In this basic example of peer-to-peer data sharing, the user decides how he wants to use that information.