Models of Health Data Exchange and Interoperability that Work

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Interoperability of Electronic Medical Record systems in healthcare is hot topic right now and rightly so.  The promise of our health data / records being available at the point of care (across the different tiers of care) has been seen as a solution that could solve some of the problems healthcare faces, however, we are far from realising that solution.  EMR systems sit in silos in hospitals, GP surgeries and other clinical settings not being able to communicate to each other.  Where they can communicate and exchange data, it is only for a limited geographic region and not available ubiquitously to all involved in one’s care.

Those that build these systems now promise APIs to open up access, however you still require health data exchange hubs or middle ware to move this data around.  A typical integration project will involve an EMR vendor, PACS systems, a systems integrator and some sort of patient portal provider.  This is a costly process but a useful one nonetheless – making sure that data about a patient is available across a clinical / care setting is essential.  It doesn’t, however, solve the problem of what happens if a patient moves outside of a care setting to different geographic region where there is yet another clinical EMR and patient portal.  What happens to the data that was held about the patient in the EMR in the hospital, GP, clinic they were at before?  How does the patient get access to that data?  Suddenly, patient portals don’t seem like the best solution – they are a stop gap at best.

To me, it seems like current discussions about making health data interoperable aren’t addressing the core issue – how do we get the data to the patient and make them mobile with it?  Patients are the most under used resource in this interoperability war that we have going on and yet there are successful models of making health data available at the point of care that put the patient at the heart of the solution.

So what works?

For years, here in the UK, every parent has been given a Personal Child Health Record that they keep and bring along with them to every appointment with a healthcare professional that their child has.  It has all of the health data about the child, from immunisations, allergies, tests / screenings & medication.  A parent can present this at the point of care and health professionals know all there is to know about the child and can treat them accordingly.

A few years ago I moved from Leicestershire to Warwickshire and for whatever reason GP records for my wife and I weren’t transferred to our new surgery in Warwick (although the GP surgery in Leicester are adamant the records were sent over).  This caused us all sorts of issues and delays in getting treatment, however, for my son it wasn’t a problem because we had his Red Book and therefore the GP could get all of the information he needed for him from there. Given this model of interoperability and exchange of data works and health professionals trust parents to carry their child’s health records with them, why hasn’t this been applied to the wider care setting for everyone?

Citizen Personal Health Accounts

The government here in the UK talks about allowing every citizen to access their full health records at the click of a button, detailing every visit to the GP and hospital, every prescription, test results, and adverse reactions and allergies by 2018.  They could attempt to integrate all of the EMR / clinical systems across all clinical / care settings and somehow aggregate data into a single viewable portal – but hasn’t that been tried before?  How successful was that approach?

What if there was different approach?  Using a model that we know works because it has been used and trusted by health professional for years. What if we started with giving citizens an online personal health account, where they are the owner / data controller?  What if citizens could share their health records / data with health professionals / carers in the health network at the point of care?  What if health professionals / carers could access shared health records / data from anywhere (different city or even country), through any device with a browser?

The above is not something that we have to wait for to be delivered in the future – it is something that is available now with services like Medelinked.  By putting the patient at the heart of the solution and using models that are known to work and accepted in healthcare today, you can start to deliver a truly integrated and patient centred health service that reduces the burden of IT / integration costs.

Written by Jas Singh, CTO at Medelinked

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