Question from Scott Mace, senior technology editor at HealthLeaders Media:
Who should define the concept or process of a standardized patient ID?
The lack of a commonly-agreed upon patient ID remains a serious headache for healthcare IT. Without such a common patient ID standard, healthcare providers spend considerable time, effort and money aligning various patient IDs in various silos created by healthcare IT vendors, providers, payers and government, and few if any of these silos are talking to each other.
Part of this originates from amendments to HIPAA that forbid the federal government from defining a national patient identifier. Privacy advocates inserted this prohibition and fear that increasing government surveillance makes it imperative that patients not be required to use someone else’s credentials, but should be able to self-assert their identities, so they may use their own pseudonymic identities in a way that maximizes privacy yet minimizes the potential for patient fraud or thwart such efforts as eluding prescription drug monitoring programs.
A group called the Internet Identity Ecosystem Steering Group (IDESG), established by the National Strategy for Trusted Identities in Cyberspace (NSTIC), created by President Obama in April 2011, is trying to solve these problems. The group is posing a series of interesting questions: Who gets to create databases of the activities of real people? Who gets to query those databases? Is everyone that is allowed to query real-person databases subject to federal regulation?
IDESG needs to attract more important stakeholders in order to solve this problem. Otherwise, the problem will be solved by others who may be dominated by vendors, such as the Commonwell Health Alliance or other particular interests that do not represent all important stakeholders.
Question from Rasu B. Shrestha, MD, Chief Innovation Officer at the University of Pittsburgh Medical Center
Where does innovation fit in at a time of ‘do more with less’ in healthcare?
It has been said that the trouble with our times is that the future is not what is used to be. There is no doubt that change is coming to the world of healthcare and healthcare information technology; both in the very way we practice the noble profession, as well as in the way information technology contributes back to healthcare. We live in an era in healthcare today of ‘do more with less’. Reimbursements continue to decline, whist there continues to be a steady march from volume based healthcare to one that celebrates value. Arguably, this is the perfect storm for us to push for more innovation.
The healthcare industry is currently experiencing one of the greatest periods of consolidation in the last century. Consolidation is happening across hospitals, physician organizations and insurance companies. Meanwhile, healthcare reform is here, and it’s here to stay. The Patient Protection and Affordable Care Act of 2010, also generally called the Federal Healthcare Law, represents one of the most significant regulatory overhauls of the U.S. Healthcare system since the passage of Medicare and Medicaid in 1965. Even if we look at these two massive market and industry dynamics together, we see a need – perhaps an imperative – for us as an industry, to do more with data, to innovate, and to think outside the box in the very ways that we are providing care to our patients. It is indeed at times like these that we need to “double down” on innovation and leverage healthcare information technology to truly transform the way we are practicing medicine. We have a dire need to use data intelligently to push the needle forward and embrace the opportunities of value based healthcare, where quality, collaboration and care coordination are of paramount importance.
Baby boomers started turning 65 in 2011. By 2030, the number of Americans age 65 and older will double to about 71 million. In the U.S., we are also living longer. Compared to only 100 years ago, life expectancy has increased by almost 30 years.
Because we are living longer, two generations now make up the aging population. Currently, the fastest growing segment of the population is 85 and older, and by 2030, one in five Americans will be considered a senior citizen. What happens when we all live to 100?
Today, more people want to live independently, and stay in their home – the trend is called “aging in place.” But a new group of boomer seniors is bucking the trend and choosing houseboats, RVs, and even couchsurfing. Another trend for senior women is homesharing – women teaming up as “senior roommates” so staying in the home is financially feasible. In the U.S., four million women live in households where two women are at least 50 plus, and this statistic is expected to rise.
The Center for Disease Control defines “aging in place” as the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.
Eighty percent of seniors have one chronic disease, and half, have two chronic conditions. By the time seniors reach the age of 85, they may have three or four chronic conditions. One area of particular concern is Alzheimer’s Disease. At current rates, the number of seniors with Alzheimer’s is projected to triple by 2050.
As the population ages, the number of available caregivers in a senior’s informal network is expected to decline from eight people to four by 2030. Divorce and nontraditional family structures will also blur lines of responsibility.
At the same time, healthcare cost cuts have shifted responsibility from the hospital and longterm care to the home. So, while more seniors are at home, their family members are spread out geographically which makes coordinating care challenging.
“The home will become a major part of our health care,” says Unity Stokes of StartUp Health.
Technology is playing an increasing role, and Vadim Cherdak, founder of eCare21.com, sees a huge opportunity for disrupting senior care. He is currently working on building technology solutions specifically for home care. He says that while hospitals have leading 21st century technology, the majority of home care is stuck in the 19th century:
“This is a huge and growing market from a business point of view, and there is very limited amount of technology really applicable to seniors.”
His plans include an affordable remote monitoring system for family caregivers that will connect all types of medical devices, sensors, and wearables.
Digitally savvy millennials will increasingly look to sensors and wearable tech to keep track of parents and grandparents.
We are only at the beginning of understanding how wearable technologies and sensors can improve health, including managing chronic disease for the elderly. – 20 Questions for Health IT
In “How Will Millennials Face their Parents Aging?“, Michael Humphrey says that “the image is of devices (everything from wristbands to clothes to embeds) far surpassing the wellness and health-tracking they do now.”
Goode Intelligence forecasts that by 2019 there will be 5.5 billion users of mobile and wearable biometric technology around the globe. Apple is the leading manufacturer of biometric-mobile devices, and HealthKit is said to have an “Emergency Access” feature where medical information can be shared through the “Medical ID” app. Apple has also partnered with EPIC and their MyChart app to capture physical vitals and other patient data, and make this information available to physicians via the EHR.
Sensara is a remote monitoring system and app that uses small, unobtrusive sensors to keep on eye on elderly family members and friends who live on their own.
Lively combines a safety watch and sensors for emergency response along with medication reminders and step counting.
BeClose says it takes less than 15 minutes to set up sensors to monitor a senior’s routine that can be viewed through a web dashboard. Emergency alerts are also provided via email, text message, or phone.
Although we have made advances in keeping the body alive, one in eight people over 60 suffers from cognitive decline including changes in thinking and memory loss. Seniors are afraid of losing their quality of life, and the risk of attempted suicide is a real issue among people with dementia.
Keeping seniors connected and social is an important part of brain health.
Tyze enables a family to create a private network centered around a particular person, their care, and the special events in their family’s lives.
“My sister is a whole person, not a patient or a diagnosis.”
“The Prize” is a $1 million life science competition dedicated to ending aging. Ours is one of a growing number of initiatives around the world pursuing this goal—the more shots on goal the better. Through an incentive prize, our specific aim is to nurture innovations that end aging by restoring the body’s homeostatic capacity and promoting the extension of a sustained and healthy lifespan.
Do you think technology should stop aging?
Pay now or pay later: how much consistency should EHR APIs have?
The JASON report calls for EHRs to expose all the data through an API. But variability is one of the key barriers to interoperability in healthcare. Vendors do things differently. Providers do things differently. Individual doctors do things differently. Exposing all the existing data merely exposes all this variation, and sorting through the data will be a gargantuan – and $$$Expensive – challenge. So instead, we could try and standardize things up front to reduce the variability, and therefore the cost of leveraging the data. But standardizing is expensive (and slow) – the more we try to standardize, the more it costs to get there – and what happens to the legacy data? The optimum is probably somewhere in the middle: standardise what you can achieve, and leave the rest. The problem is, in order to really find the optimum, we need to agree to what the use cases we’re going to focus on for leveraging the exposed data….
Given your interest in patients and families, how satisfied are you with the CCDA as a means for data exchange with patient oriented apps?
Partially satisfied. I would really like to see HL7 standards created that make it possible for the patient to become the custodian of their own data. That’s really only possible if standards for data migration are created that enable a patient to securely pull complete data from all their sources of choice. Those sources would include not just EHRs, but the whole of health information technology. The patient could then choose when and how much to share using other existing standards, such as CCDA, or these new standards.