Saturday, August 15, 2009

You Are the Primary Key to Your Health Records

You are the Primary Key to your Healthcare

There is great hope that information technology can help reduce costs and improve healthcare.

Our healthcare providers, insurance companies and government bureaucracies have terabytes of health information. One cannot help but look at the mess and think that if there were just a way to organize it; one could turn this trove of data into a treasure chest of information.

Unfortunately, there are several roadblocks include accuracy, access, security and patient privacy.

Many of the problems start with privacy. One quickly realizes that people seeking to mine health data may nefarious motives. Marketers would love to have a go at health information. Political operatives could use the information to punish enemies. The police could use health data to catch criminals in computerized dragnets.

There has already been a number of scandals involving health personnel gaining access and selling the medical records of celebrities. How many times has someone made unauthorized access to your records?

Patient privacy is only the tip of the iceberg. The entities that made the major investment in accumulating this data have their own proprietary concerns. Corporations and even government agencies are jealous of their data and resist competitors coming in and snooping on the data.

It is harder to create a really good security system than it is to envision one. Even worse, there is always the fear that the people who created the security system left a backdoor.

Gaining access is just part of the problem. Having gained access to data, one will find the data stored in a variety of formats.
One of the biggest challenges of all is that people are mobile. As people move around in seemingly random fashion, it becomes very difficult to match up records to build a complete view of a person.

Many of the problems center around finding a good primary key to identify each person so that the people accessing the information can reassemble the records. It is common for people to make errors in recording social security numbers. A patient might intentionally give a wrong social security number. This messes up two sets of records.

The problem of making sense of the nation's health records seems insurmountable until one steps back and realizes the greatest truism in medicine:

Each person is their own primary key.

As I understand, good doctors don't depend solely on the paperwork. They often mark the body. For example, before amputating a foot, a doctor will mark the leg and will double check that mark before doing surgery. It is possible for paperwork to get shuffled, it is better to depend on the physical being.

The goal of the Medical Savings and Loan is to make each person the owner of their health resources. A consequence of this paradigm is that people end up owning their health records.

The flow of paperwork follows the money. When an insurance company or government agency picks up the bill, the information flows through that agency and become part of their proprietary record keeping system. When the money flows through accounts owned by the patient, the paperwork goes into the system used to pay the bills.

In my last post I introduced the healthcare advocate. This person helps policy owners set up the budget for their medical expenses. The advocate also helps the clients organize their medical records so that each person has a structured view of the health services that they've purchased through the years.

I wish to emphasize that the advocate simply accumulates and stores medical records. The records themselves are owned and controlled by the patient. So, if a person decides to leave a medical savings and loan, they can take the money they saved and their medical records. This is different from insurance where the medical records are proprietary to the insurance company.

By accumulating the data for each place in a common location owned by the patient, the Medical Savings and Loan effectively bypasses all of the roadblocks that exist in the big-insurance/big-hospital system. Since an accurate medical history sits in an accumulation owned by the patient, relevant data is already joined and checked for accuracy by the health care advocate.

As the data is owned and stored in a location of the patient's choosing, the system provides the security needed to protect privacy and allows the patient to control access.

On realizing the simplicity with which one can store and access medical records from multiple providers in the Medical Savings and Loan, one can't help but reach the conclusion that insurmountable obstacles that sit between us and our medical records indicates that third party payment systems are inherently unsound and that a patient centric healthcare model like the Medical Savings and Loan would be more sound.

You are the primary key to your health records. The ideal health information system is one that attaches the records to you. Third party systems treat make your health care data proprietary to the third party. A direct funding system would restore the balance and make you the owner of the data about you.


Reach Upward said...

In May I wrote this post discussing the problems with electronic health information. Your post better explains the basic structural ownership flaw in the concept of third-party health information.

The advocate would be providing a banking service. Instead of money, the account at the advocate's bank would contain health information that is owned by the individual account holder.

Just as we have evolved interfaces for monetary exchanges, our system would evolve interfaces for exchange of health information. This would resolve the critical ownership issue of the data.

y-intercept said...

This post was actually a reply to a comment you left earlier.

The current idea that third parties own individual medical records is antithetical to the whole concept of freedom and the free market.