Transcript Towards a Wearable Medical Record Social, Legal, and Technological Issues The Question From LinkedIn’s Digital Health Group: Personal Medical Records and wearable device While cloud based.

Towards a Wearable Medical
Record
Social, Legal, and
Technological Issues
The Question
From LinkedIn’s Digital Health Group:
Personal Medical Records and wearable device
While cloud based computing could be a solution for
future, what prevents designing a wearable
computing device to carry personal medical records:
is it the volume of data, methods of data transfer or
legal bottleneck? With very high capacity solid state
memory being available perhaps volume of data
should not be a problem. Appreciate comments from
group members.
Background
• Issues with paper records
– Hard to file and retrieve
– Not portable
– Results not always shared, or coordinated, across
multiple healthcare providers
• Appropriate care
– Requires knowledge of existing conditions and
medications
– Can mean life or death in an emergency
• Patient proactivity
– Requires understanding one’s conditions and
medications
State of the Art
• Some personal medical identification includes
USB storage (Pinterest)
– Not universally carried or universally recognizable
– Security issues prohibit USB-based uploads
• PPACA (“Obamacare”) requires electronic
storage of medical records
– Adoption has been a slow and difficult process
– Limited interoperability of EHR (Electronic Health
Record) format and information between systems
– No single, accessible-by-all-providers, database
exists
Technical Issues
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Volume of data
Inconsistent data formats
Inconsistent lab data
Device security
Bandwidth issues
Regulatory standards (or lack thereof)
Data Integrity Issues
• Protection from accidental loss or change
– Electromagnetic fields
– Radiation
– Temperature/ Water/ Humidity
• Protection from deliberate loss or change
– File modification or deletion to hide/disguise
medical conditions or possible malpractice
– Malware attacks
Data Security Issues
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Patient privacy
Record ownership
Outside threats
Loss or theft of device
Personal Issues
• Do I want to (have to) wear this identification?
• Who will have access to my data, and what
can they do with it?
• Do I have any input into my medical record?
• Can I access and analyze my own medical
data?
• Is my health data correct and secure?
Data Location Issues
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Facility-based
Home-computer based
Device-based
Cloud based
– Issues of availability, security, data integrity
– Issues of signal, bandwidth
Record Maintenance Issues
• Records need to be organized in a
meaningful order to be useful
• Different datasets and presentations are
needed by different people at different times
• Who is going to add the data? (Can it be
uploaded directly from medical devices?)
• Can the raw data be uploaded?
• How should interpretations be uploaded (and
attached to their images and clinicals)?
• In what format(s) and structures should data
be uploaded?
Solutions Discussed: Health Vault
Microsoft Health Vault (http://healthvault.com)
• Issues with getting images, labwork uploaded
– Not all providers a part of the network
– Patient-owned, and data upload/record change
must be expressly permitted by the patient
– Patient-level (i.e., nonsecure) image formats (i.e.,
does not support DICOM or PACS/RIS)
• Device data must be manually uploaded
• Part of the issue may be the lack of custom
apps
Solutions Discussed: Smartphone Apps
• Many people, worldwide, have access to
smartphones and cellular data networks
• The capabilities of the smartphone platform
are still being discovered
– New apps and devices use iPhones as spectrum
analyzers for urinalysis, local microbe detection
– Existing apps and devices use iOS platform to
manage blood glucose, weight, blood pressure
• Issue: Access doesn’t mean ownership
• Issue: Much cellular is still “feature phone”
(voice and text only)
Solutions Discussed: Taltioni (Finland)
Taltioni http://www.taltioni.fi/en
• Free (run by a non-profit cooperative)
• Patient-based PHR
– We are also working on context-sensitive decision support
aids (http://www.ebmeds.org/web/guest/home?lang=en )
and, in similar lines to Taltioni, some of these are intended
for citizens.
If we are able to bring these two together and link them with
the official health documents (http://www.kanta.fi/en/ ) we
might have something new in our hands (unless our Data
Protection Ombudsman gets involved...).
– Janne Lahtiranta
Solutions in Progress: HL7
In Brazil we are launching a solution for the area of
​public health and private, we are providing a cloud
system to record the information health of people
safely and digitally certified.
This system will work in offices and integrates with
hospital management system and all service
providers to support diagnosis and therapy protocols
through HL7.
In Brazil the bottleneck has been overcome and cool
in the infrastructure does not exist problem.
The solution of our company consists of applications
including cloud CRM (Customer Relationship
Management) for healthcare.
Alexandre Schumacher
More About HL7
HL7: Health Level Seven
• Name derives from the seventh (application)
layer of the OSI model
• A set of standards for health data exchange
between disparate systems
• Covers framework, protocol, syntax,
document structure
• Includes areas of medical conditions, clinical
decision support, pharmacology, health
records, finance/billing
Conclusions
• A wearable patient health record that includes
patient data locally is probably infeasible
– Despite large storage capacity, security issues
and file format incompatibilities may make the
data inaccessible to healthcare providers
• Current cloud-based systems have inclusion
and compatibility issues to work out
– Data and reports from incompatible EHRs
– Inclusion of medical images, in their original
formats
– System, network, and data security
Where Do We Go From Here
• Wearable authentication tokens
– One-time code generators such as those provided
by RSA SecurID
– Patient token provides read access to all provider
data about him, and write access for patientgenerated data
• Provider authentication tokens
– Needed to access patient data
• Two token access
– Could be required to modify specific areas of the
patient record
Resources
• LinkedIn Discussion
• DICOM
– http://www.mccauslandcenter.sc.edu/mricro/dicom/
– http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354356/
• PACS
– http://en.wikibooks.org/wiki/Basic_Physics_of_Nuclear_Medicine/P
ACS_and_Advanced_Image_Processing
• RIS
– http://en.wikipedia.org/wiki/Radiology_Information_System
– http://searchhealthit.techtarget.com/definition/RadiologyInformation-System-RIS
• HL7
– http://en.wikipedia.org/wiki/Health_Level_7
– http://www.interfaceware.com/hl7.html