The Cyber Patient

Navigating Virtual Informatics

Rebecca Mendoza Saltiel Busch

• Publisher: Productivity Press
• Year: 2019
• ISBN:
  9780429953712
• Edition: 1
• Topic: Medizin
• Subtopic: Gesundheitswesen, Verwaltung & Pflege

With the use of electronic health records (EHR) transforming the healthcare industry, the use of information technology in the maintenance of personal health records poses a range of issues and opportunities for every medical organization, The Cyber Patient expertly walks readers through the elements required for an efficient, well-run healthcare record management system, while reflecting the U.S. government's goal of achieving widespread adoption of interoperable electronic health records to improve the quality and efficiency of healthcare while maintaining the levels of security and privacy that consumers expect. The author also provides an update as to where the industry stands in their push of interoperability and the increased use of data as an analytic tools.

Providing an application readers can adopt as a model, this important book examines the infrastructure of electronic health records and how government criteria have impacted and will continue to impact both private and public marketplaces. This valuable resource also addresses how auditors, controllers, and healthcare providers can keep up with the market's continued move towards an interoperable e-health world, without neglecting clinical and financial accountability in the delivery of healthcare.

As e-health continues to develop and transform, The Cyber Patient thoughtfully prepares professionals to plan and implement an effective EHR as wel as internal controls system within any clinical setting.

Chapter 1

Navigating Health Informatics within the Cyberspace

This is just the beginning, the beginning of understanding that cyberspace has not limits, no boundaries.

Nicholas Negroponte

American Architect—the founder and Chairman Emeritus of Massachusetts Institute of Technology’s Media Lab

Introduction

The cyber-patient or cyber-health consumer uses Internet technology to interact with the “seller,” or cyber-healthcare professional to facilitate the consumption of healthcare services, while simultaneously protecting their health information and identities.

This new way of interacting creates a number of critical challenges not experienced before. These include:

1. How do cyber-patients access and use their health information to make informed treatment and purchase choices?

2. How do cyber-patients and providers ensure they are dealing with authenticated identities and not stolen or misrepresented ones?

3. What complications are introduced by unequal ages or sophistication of technology tools?

4. How is the purchase and sale of healthcare services exchanged between cyber buyers and sellers, and how do insurance companies get linked in?

A brief overview of how other industries have evolved into a self-service economy can serve as a guide into answering these questions.

Self-Service Economy

Either to meet consumers’ desire to seek control of their environment or to reduce suppliers’ costs, numerous industries have developed self-service solutions. The key to this trend is less about dumping back office functions onto the consumer, but rather, as the consumer engages as an active participant in their services, they will become more informed about what they are consuming, and thus improve their ability to make choices the next time they engage. For example:

■ Fast Food Industry: At McDonalds, with the purchase of a soft drink, the seller hands the consumer a cup to fill themselves. Through this, the seller reduces time (and cost) spent filling up the drink, and the consumer gains greater control over their experience through drink choice and through setting the mix of drink versus ice. This simple step has been expanded through use of mobile phone technology as consumers now order using a smartphone mobile application program (app) and then just drive by and pick up the order. Again, sellers reduce activities the consumers particularly value, and consumers gain greater control.

■ Travel Industry: Flyers now make their own reservations online instead of using a travel agent. They save time and see all of their options on line, and the seller reduces time spent reviewing those options.

■ Automotive: Self-service pumps have replaced gas station attendants. The consumer enters their own credit card, fills the tanks, and cleans their own windows. The experience reduces the costs to the supplier, which in turn reduces the price of gasoline for the consumer. Another added value perspective: When you get out of your car and walk around it, or wash the windows, you have an opportunity to observe the condition of your car, giving you the chance to notice a new scratch or the even the status of your tires.

■ Online Shopping: Amazon, for example, creates a forum in which users can rate products, compare features, and get questions answered by others who have used the product.

■ Transportation: Uber has created a rating system whereby the drivers can rate the customers (eventually, perhaps, using those ratings to decide whether they want to pick certain passengers up or charge higher prices), and customers rate their drivers, which could lead Uber to discontinue using that driver.

Self-service healthcare will roll out in two phases. The first is electronic interaction between a patient and a provider. For example, the provider grants electronic access to laboratory test results via an online patient portal. The patient can immediately research the test, the results, and the impact, and have a better informed, deeper conversation with their provider. This will also allow the provider to be more productive on the follow-up treatment regime. In the second phase, a community of users will emerge, sharing experiences with treatments, providers, and insurers, allowing for better decisions on cost and treatments.

The Infomediary Specialist

The emergence of the cyber-patient and the increasingly necessary role of informatics in healthcare are giving rise to a new breed of healthcare professional—the infomediary specialist (IS). As we shall see throughout the book, the domain of expertise that the IS will need to have and which providing effective healthcare requires extends from being an assistant to the patient and compensated by the patient to being an ombudsman for the patient compensated by the provider to being a deeply knowledgeable information technology expert who can assist in the design and development of a provider’s healthcare systems in a world where communities of patients and providers easily access and share non-confidential information—a role that might have traditionally been performed in an Information Technology department. As such, the IS, as referred to in this book, does not refer to an individual in an individual role. Rather, it refers to a breadth and depth of knowledge which will find its place somewhere in the healthcare continuum. The specific organizational structure or marketplace entity which will emerge to best provide this expertise is beyond the scope of this book.

Clinical Informatics

Clinical informatics (or health informatics) has several published definitions that involve the use of technology in managing and accessing health information. The following is an illustration of those definitions that have been summarized in the HIMSS (Healthcare Information and Management Systems ) TIGER (Technology Informatics Guiding Education Reform) Committee report dated June 2017¹: The report contains a listing of informatics definitions from several organizations. The respective source with each definition is noted below. Some appear to be very similar, others focused specifically on their niche area of the market. The consistent theme is that informatics is the science of processing information. The cyber-patient is simply about access to the science of information processed. The infomediary specialist is the scientist that facilitates access to the information within an applied science.

■ Biomedical informatics is the interdisciplinary field that studies and pursues the effective use of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision-making, driven by efforts to improve human health. Source: AMIA (American Medical Informatics Association²) white paper.

– The term “biomedical” can be broken down into several subfields of study. These include, but are not limited to, public health, the study of molecular and cellular processes (genomic sequencing), bioterrorist attacks, and applications such as the National Notifiable Disease Surveillance System.³

– The cyber-patient implication: Access to data on emerging public health conditions.

– Imagine a data driven bio surveillance system that detects mild immunosuppression conditions impacting newborn children within 30 days versus years.

■ Clinical informatics promotes the understanding, integration, and application of information technology in healthcare settings. Source: HIMSS.

– Healthcare stakeholders must have a strategy to effectively manage the collection, storage, and dissemination of data, as well as how to interact with the patient with their health information.

– The cyber-patient implication: Engaging with the provider in real-time, thereby avoiding long waits in the office. The key is to enhance face-to-face interactions without a hands on examination. The increased interaction between patient and provider will also provide better feedback on the current use of electronic tools such as patient e-health portals.

– Imagine an advanced health data driven patient, reviewing the criteria for the selection of a diagnosis code from the International Classification of Diseases index (the rules for when a diagnosis code is appropriate) and the provider having to explain why they chose that diagnosis code over another. If a provider selects an incorrect code for the presenting symptoms, the wrong code with the prescribed treatment will skew clinical analytics on future treatment regimens.

■ Health informatics is the interdisciplinary study of the design, development, adoption, and application of IT-based innovations in public health and healthcare services delivery, management, and planning. Source: AMIA and HIMSS.

– The cyber-patient implications: Getting access to all potential stakeholders in a medium that is productive and measurable. Testing the effectiveness of the healthcare episode, the quality of management, and short and long term planning of patient care.

– Imagine an environment in which all activities of daily living are reconciled with your health data and can be managed from your mobile technology, or cyber highways (online portals) for not one, but multiple second opinions on a proposed treatment regimen.

■ Health or medical informatics is defined as the scientific field that deals with biomedical information, data, and knowledge—their storage, retrieval, and optimal use for problem solving and decision-making. Source: Stanford Medical Informatics via Open Clinical.

– The cyber-patient implications (ongoing) is the engagement of the user and the ability to measure effective decision-making processes by the patient.

– Imagine mobile technology operating in real-time: The impact of a treatment plan, immediate feedback on the efficacy of the plan, and if it needs to be modified based on the most recent clinical data.

■ Medical information science is defined as the science of using system-analytic tools to develop procedures (algorithms) for management, process control, decision-making, and scientific analysis of medical knowledge. Source: Shortliffe, (1984). Medical Informatics journal via Open Clinical.

– The cyber-patient implications (ongoing) is how the individual can obtain access to those conditions that are actively being researched, the context and result of that research, and the authenticity of the data. Further, the organization should have procedures as to who can have access and when to the raw data.

– Imagine an interactive, dynamic electronic health record that integrates communications and discussions between the patient and the provider as one consolidated e-document, instead of segregated communication channels (healthcare patient record; emails; snail mail) or having a utility function in the capacit...