Useful IT. Bringing Health Record Transfer into the 21st Century.

I read the Life as a Healthcare CIO blog on occasion, mostly because as a former radiographer, health care records integration and other non-diagnostic IT use in healthcare is a passing interest of mine. Within the last hospital I worked at the systems didn’t communicate – not even close, as in there was no effort to make them do so. This intrigues me, as since I’ve entered IT I have watched technology uptake in healthcare slowly ramp up at a great curve behind the rest of the business world. Oh make no mistake, technology has been in overdrive on the equipment used, but things like systems interoperability and utilizing technology to make doctors, nurses, and tech’s lives easier is just slower in the medical world. A huge chunk of the resistance is grounded in a very common sense philosophy. “When people’s lives are on the line you do not rush willy-nilly to the newest gadget.” No one in healthcare says it that way – at least not to my knowledge – but that’s the essence of what they think. I can think of a few businesses that could use that same mentality applied occasionally with a slightly different twist: “When the company’s viability is on the line…” but that’s a different blog.

Even with this very common-sense resistance, there has been a steady acceleration of uptake in technology use for things like patient records and prescriptions. It has been interesting to watch, as someone on the outside with plenty of experience with the way hospitals worked and their systems were all silos. Healthcare IT is to be commended for things like electronic prescription pads and instant transfer of (now nearly all electronic) X-Rays to those who need them to care for the patient. Applying the “this can help with little impact on critical care” or even “this can help with positive impact on critical care and little risk of negative impact” viewpoint as a counter to the above-noted resistance has produced some astounding results. A friend of mine from my radiographer days is manager of a Cardiac Cath Lab, and talking with him is just fun. “Dude, ninety percent of the pups coming out of Radiology schools can’t set an exposure!” is evidence that diagnostic tools are continuing to take advantage of technology – in this case auto-detecting XRay exposure limits. He has more glowing things to say about the non-diagnostic growth of technology within any given organization.

But outside the organization? Well that’s a completely different story. The healthcare organization wants to keep your records safe and intact, and rarely even want to let you touch them. That’s just a case of the “intact” bit. Some people might want their records to not contain some portion – like their blood alcohol level when brought to the ER – and some people might inadvertently lose some portion of the record. While they’re more than happy to send them on a referral, and willing to give you a copy if you’re seeking a second opinion, these records all have one archaic quality. Paper. If I want to buy a movie, I can go to netflix, sign up, and stream it (at least many of them) to watch. If I want my medical records transferred to a specialist so I can get treatment before my left eye oozes out of its socket, they have to be copied, verified, and mailed. If they’re short or my eye is on the verge of falling out right this instant, then they might be faxed. But the bulk of records are mailed. Even overnight is another day lost in the treatment cycle.

Recently – the last couple of years – there has been a movement to replicate the records delivery process electronically. As time goes on, more and more of your medical records are being stored digitally. It saves room, time, and makes it easier for a doctor to “request” your record should he need it in a hurry. It also makes it easier to track accidental or even intentional changes in records. While it didn’t happen as often as fear-mongers and ambulance chasers want you to believe, of course there are deletions and misplacements in the medical records of the 300 million US citizens. An electronic system never forgets, so while something as simple as a piece of paper falling out of a record could forever change it, in electronic form that can’t happen. Even an intentional deletion can be “deleted” as in not show up, but still there, stored with your other information so that changes can be checked should the need ever arise. The inevitable off-shoot of electronic records is the ability to communicate them between hospitals. If you’re in the ER in Tulsa, and your normal doctor is in Manhattan, getting your records quickly and accurately could save your life. So it made sense that as the percentage of new records that were electronic grew, someone would start to put together a way to communicate them.

No doubt you’re familiar with the debate about national health information databases, a centralized location for records is a big screaming target from many people’s perspectives, while it is a potentially life-saving technological advancement to others (they’re both right, but I think the infosec crowd has the stronger argument). But a smart group of people put together a project to facilitate doing electronically exactly what is being done today physically. The process is that the patient (or another doctor) requests the records be sent, they are pulled out, copied, mailed or faxed, and then a follow-up or “record received” communication occurs to insure that the source doctor got your records where they belong. Electronically this equates to the same thing, but instead of “selected” you get “looked up”, and instead of “mailed or faxed” you get “sent electronically”. There’s a lot more to it, but that’s the gist of The Direct Project.

There are several reasons I got sucked into reading about this project. From a former healthcare worker’s perspective, it’s very cool to see non-diagnostic technology making a positive difference in healthcare, from a patient perspective, I would like the transfer of records to be as streamlined as possible, from the InfoSec perspective (I did a couple of brief stints in InfoSec), I like that it is not a massive database, but rather a “faster transit” mechanism, and from an F5 perspective, the possibilities for our gear to help make this viable were in my mind while reading.

While Dr. Halamka has a lot of interesting stuff on his blog, this is one I followed the links and read the information about. It’s a pretty cool initiative, and what may seem very limiting in their scope assumptions holds true to the Direct Project’s idea of replacing the transfer mechanism and not creating a centralized database. While they’re not specifying formats to use during said transfer, they do list some recommended reading on that topic. What they do have is a registry of people who can receive records, and a system for transferring data over the wire. They worry about DNS-style health-care provider lookups, transfer protocols, and encryption, which is certainly a large enough chunk for them to bite off, and then they show how they fit into the larger nation-wide healthcare electronic records efforts going on.

I hope they get it right, and the system they’re helping to build results in near-instantaneous secure records transfers, but many inventions are a product of the time and society in which they live, and even if The Direct Project fails, something like it will eventually succeed. If you’re in Healthcare IT, this is certainly a way to add value to the organization, and worth checking out.

Meanwhile, I’m going to continue to delve into their work and the work of other organizations they’ve linked to and see if there isn’t a way F5 can help. After all, we can compress, dedupe, and encrypt communications on-the-wire, and the entire system is about on-the-wire communications, so it seems like a perfectly logical route to explore. Though the patient care guy in me will be reading up as much as the IT guy, because healthcare was a very rewarding field that seriously needed a bit more non-diagnostic technology when I was doing it.