Healthcare Infrastructure Data Models
Option 3 — Health Record Banks
Think Google Health or Microsoft HealthVault with an actual business plan. The patient controls access to their data and pushes it or allows it to be pulled at their request. Admittedly, I hadn’t heard of this concept until the founder of the Health Record Bank Alliance told me about it, so I can’t say this model is just around the proverbial corner.
When we philosophize from our arm chairs about how healthcare should be, one particular theme always bubbles up: the patient should control their health and their health information. But have we accomplished that, even with the concept of a Patient-Centered Medical Home?
Right now, our healthcare system is centralized. This means that if we go to a well-organized institution, our information and services will center around us as long as we don’t leave. But if the industry follows the disruptive innovation pathway laid out by Clayton Christensen in The Innovator’s Prescription, we will eventually arrive at a decentralized model of healthcare. That means the hospital-centered healthcare will become passé. It also means we need to find a way to deliver patient health information to the practitioner on demand. As in, it is stored with the patient, not the provider.
Personal Health Records (PHRs) would seem to be the obvious solution to this. Due to a lack of record portability and motivation, they have turned out to be duds even to data geeks like myself. I once logged every time I picked at my fingernails and what I was thinking about at the time in order to figure out how to break the habit (willingly), but I logged into my Google Health account (RIP) exactly twice.
The portability issue will be resolved, and thank Meaningful Use for that. Motivation, though? Most of us don’t actively track our health status. We wake up, we subconsciously determine whether we have it in us to survive the day, and then we get moving. A Health Record Bank could potentially provide motivation in the form of payment opportunities.
Let’s say you received a micropayment every time an organization queried your health record for research, public health assessment, or even marketing information. Not enough revenue to generate a career, but it could buy you coffee every now and then. All you’d have to do is maintain your record like you do your checking account. Would that be something you’d be interested in?
Record portability? Yes. Public Health assessment? Yes, with payment. Consider it an incentive payment going to the right people.
Given these three models — the centralized repository, the federated query, and the health record bank — which is the one that will be used moving forward? Even though the proponents of these models act like they are competing models, are they not complimentary in some fashion? Centralized repositories are great for in-depth analysis once the data is actually gathered. Federated queries are good for a small network to share data. Health record banks motivate the originator of information (the patient) to give up the data and spread it in addition to establishing ownership.
An EHR in the hands of the majority is the first step to setting down this path, where these models can interact. But make no mistake, it is not the last. Eventually, EHRs will become the processing tools to send information for expert analysis, not from which to extract information.
Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s Medical and Practice Management Suite and EHR design and development.