Idea: This is a healthcare reform leapfrog opportunity for a secure compact critical combined electronic personal and medical record implemented for federal employees and families seen at Dept of State (DOS) Health Clinics.
Dept of State Health Clinics exist worldwide and can individually be considered to be remote small office practices providing preventive and primary care services to a highly mobile population of federal employees and family members from many government agencies. There is no unified medical record system that allows the individual or medical provider immediate access to important health information that might be critical for a provider to know, or that facilitates continuity of care.
A leapfrog opportunity exists for the federal government to demonstrate its ability to leverage current technology and standards and create for this population a secure, compact, electronic personal health record (PHR) directly linked to the 17 critical elements of a medical continuity of care document (CCD). Such a compact integrated PHR/CCD could then be placed in the public domain as open source software for use by Electronic Health Record developers within the federal government (e.g. VA, Indian Health Service, DOD) and private sector.
Potentially, this software, encrypted and password protected, but easily accessible to both the individual and health care provider, would facilitate decision making for healthcare needed within the clinical visit. An immediate benefit might be the prevention of unintended adverse reactions and overdoses. For example, with immediate visibility of all medications, both over the counter (perhaps found within the PHR) and prescribed (found within the CCD), drug-drug interaction detector software would warn both the patient and provider on potential dangers of current medications and proposed medications.
Potential for cost reduction is immediate, both tangible and intangible. Medical information collected in a standard fashion improves decision-making potentially preventing the prescription of interacting medications that can lead to unintended overdose deaths, killing in last published data approx 40K Americans/yr (equivalent to motor vehicle deaths). Medical intelligence also improves. Aggregate de-identified information from a world-wide array of health clinics provides surveillance data for diseases that might have national public health importance. For each individual treated, best practices could be established based upon ‘real-time’ assessments on treatments that truly work in the population treated, while adverse treatment outcomes are more readily identified with cessation of those treatments. With the shift to help the patient get the immediate care needed through the combined PHR/CCD concept, current funds allocated to create hopeful linkages between large electronic record systems like VA, DOD and others, would be re-allocated so that the focus would be appropriate secure import and export of PHR/CCD defined data into whatever electronic record meeting national certification standards. Certification standards could then focus on appropriate import/export of minimal PHR/CCD data rather than the more costly attempts to standardize larger systems in ways that might be irrelevant to the direct care a patient needs.
The federal government, by demonstrating to the nation its ability to create a highly focused product that demonstrates a more efficient medical record system, would set the standard for improved data quality at lower cost; data immediately relevant for patient-provider decision-making, documenting treatment actions, and tracking outcome, would naturally be of very high quality. With the patient able to enter information into a PHR while the clinician documents only the critical information in a CCD, administrative burden of healthcare in the US becomes far less; with the computer able to generate all most all reports possibly needed for improved healthcare through use of high quality data collected for direct patient care (and appropriately de-identified for any derived reports needed for quality management). The efficiency of healthcare would be greatly improved for all citizens receiving care within and between the federal health insurance plans, TRICARE, VA, Indian Health, MEDICARE and MEDICAID.
Citizens, with immediate access to important health information, much that they could directly control, all that they could see, would be direct beneficiaries. Time now needed to collect critical health information, which might have been generated within many facilities and by many providers, would be eliminated. Patients, with health information at their fingertips, would better be able to control their healthcare and related costs. The overall documentation costs current in our healthcare system could be eliminated.
The remote small practice worldwide location of DOS Health Units with current PHR/CCD standards in place provide an immediate opportunity (within one year) to demonstrate the ability to have a secure compact PHR/CCD operationally used, with a migration strategy over the following year for integration into other federal direct care systems (DOD, VA and Indian Health Service). With software and documentation in the public domain and open source, all health-related software vendors could take the software while national certification (CCHIT) currently in place could be used verify the ability to import, export and use PHR/CCD data.
Just within Dept of State, savings might be fast. Current medical record keeping systems would be replaced by a much smaller system focused on PHR/CCD data, with less storage problems and greater capability to operate over small bandwidth world-wide. The immediate focus on the needs of a remote small office to care for a highly migratory population would sharpen data collection needs with higher quality data. These data could then be used for better decision making; needed to assign people to locations able to care for known health needs and decreasing the number of high cost medical evacuations.