In the spirit of David Letterman’s top 10 lists here are our takeaways from the San Francisco iHT2 event this past week.  http://ihealthtran.com/sanfranciscohome.html

1. IHPs (large integrated health providers, like university systems, etc), are by and large going with EPIC for EHR solutions, thereby automatically forgoing a degree of flexibility and any chance of real near-term interoperability.

2. The historical problems of security, reliability, and control with Cloud-based solutions are being rapidly overcome, and the cost savings from hosting data and applications in the Cloud are becoming so compelling that increasingly complex medical organizations and systems will require the Cloud in order to be effective and efficient…..or risk becoming extinct.

3. The HealthCare system, as usual, is the last great industrial complex to accept collaboration and efficiencies based on advances in information technology.

4. There has been a dramatic shift in the last two years toward the use of mobile and portable devices in all aspects of care, and this will only increase.

5. Nobody can really define the phrase  ”HIPAA compliance,” it is best approached and understood as a process, it is not just about security.

6. 30% of the vendors sponsoring were cloud-oriented.

7. Edge, last-mile connectivity in a HIPAA compliant fashion was a common pain point from small patient practices to large integrated health providers.

8. Cloud-based or service platforms having the ability to be more nimble and in turn handle the growing complexity of connectivity, interfacing, and interoperability are available and should be considered.

9. The cloud mitigates the need for traditional software upgrades and release cycles.

10. CIO’s and CMIO’s are opting to outsource for best-of-breed services and applications.  Driven by skilled resources in healthcare IT becoming increasingly scarce and more robust SaaS/cloud-based options being available.

I have had the unfortunate experience of having my wife of over 30 years pass away recently from pancreatic cancer. She lived for 18 months from her initial diagnosis. Prior to that she had been a very healthy 62 year old.  During the course of her illness, she was treated in five different hospitals, was under the care of over 40 physicians, and had numerous surgical and diagnostic procedures. One might say,  ”Well, this was certainly an edge case.” But hasn’t experience shown that it is the edge cases that bring out the flaws in the system? While I participated in her long and painful journey I came to realize that in spite of all the assertions made about information exchange and interoperability in healthcare, they are almost nonexistent once you go outside the four walls of a hospital.

The fact is, unless the patient or their family takes responsibility for the information that different hospitals and doctors will require when they come on board, they will have no reasonable way to have access to that data. During my wife’s illness, on numerous occasions, I had to hand carry DVDs, CDs,  or memory sticks so that other physicians could see the results of CT scans and radiology reports. I had to manually maintain a spreadsheet of her medications since there was no centralized system that was kept up to date, even where she was being treated. Obviously, the more manual recording the greater the chance for error, not to mention lost time.

I am writing this blog as a call to action. While many are wringing their hands over healthcare costs, in my opinion IT Vendors and Hospital Administrators are doing a great disservice to patients and medical personnel by not forcing their vendors to make it a high priority to improve interoperability and information exchange. As we all know, there are a number of high level committees and organizations that are working on this problem. However their progress is slow and the need is now.

Many of them have not even thought through how the Cloud can be a game changer.

The reality is that if Apple can provide iCloud so that users can upload all their content of different types to a single user ID and then deliver it to multiple devices, it is not so far fetched that the same capability could be applied to patient records. Patients typically have single identifiers. The notion that information stored in the Cloud is neither secure nor easily accessible has been proven to be a myth. View this video link from a researcher at Johns Hopkins.

http://www.dreamsimplicity.com/community/saas-video/communityteam/video/1277-cloud-computing-in-medicine?utm_source=twitterfeed&utm_medium=twitter

In addition, there are companies who provide low cost HIPAA compliant secure messaging solutions that can be implemented in minutes that will securely transfer data to and from the Cloud as well as between applications hosted in the Cloud.

It is my belief that if as much attention and investment is focused on medical information exchange as has been placed on making billing systems interoperable, we will have not only improved patient care  but a more efficient use of our medical resources as well.