Wednesday, November 22, 2017

HIE Future is bright - Automated not Manual

I think it is important to celebrate what we have today in Health Information Exchanges. They are not fantastic yet, but they are far better than what we had a handful of years ago.  However there is a bright future for the Health Information Exchange too. I want to expand upon the future transition from Manual to Automated, as a trend that is already underway.

Manual HIE

Today we have Health Information Exchanges that enable Providers to send Directed Secure E-Mail messages to other Providers. This s a conscious thought, usually when referring a patient, or when a patient asks for this to be done. This is basic PUSH capability. The word basic should not be viewed as easy or trivial. There is a huge progress that gets us to the point of being able to say that this capability exists and is mostly ubiquitous.  We should celebrate getting to this point. But we should not stop here.

The Query model of Health Information Exchange also enables a Provider to publish a document they created under the hope that someone might find it useful. This is available, but who really has the extra time to publish something under the hope that someone might find it useful in the future.  But this Query model does have documents that are available, and those documents are found to be useful.

Most of these documents are not documents that are written and published. Most of these documents are documents that someone asked if they existed, and then the document was created. So even in a Query model, it is a manual step of someone asking if a document exists, followed by a document being assembled at that time.  This is either "On-Demand", or "Delayed-Document-Assembly".   In the case of "On-Demand", a prototypical document is published as available, which when Retrieved causes a fresh document to be created from current information. In "Delayed-Document-Assembly" a prototypical but specific document potential is published, which when Retrieved causes that specific document to be created. The big difference is that the "On-Demand" is made from current information, where "Delayed-Document-Assembly" is made from historic information.

The manual part in this case is that the recipient is manually choosing to Query the network to see if anyone has documents available for a specific patient.

Manual is not bad. Manual is the first step. We must go through Manual to get to Automated. It is time...

Future is Automated

In all of the Manual use of an HIE, there is a conscious effort to take action and use the HIE. This is really bad User Experience. What we really want is that the HIE capability, availability of patient data, is automatic. There should be no effort to consciously use the HIE. If the HIE can be useful, the 'system' should just use the HIE.

  1. When a Patient is scheduled for a appointment or procedure; the 'system' should gather all the data available. Not just gather it, but process it into useful information, perhaps using a new mXDE profile from IHE.
  2. When a Patient is at a registration desk; the 'system' should gather all the data....
  3. Inappropriate activities are detected and appropriate authorities engaged. Such as Providers using break-glass, unusual billing patterns, or drug seeking patients. These patterns would not be noticeable within any single organization, but can when viewed across a region.
  4. When a decision on a CarePlan is made for a Patient, the 'system' should look for potential experts in the local region, that are covered by the patient's health plan, and have characteristics that the patient has expressed.
  5. When a CarePlan progresses, the members of the CareTeam should be appropriately notified. What is appropriate notification will depend on their role. Some will see the Patient show up in their census. Some will have time on their schedule reserve to review the CarePlan activity...
  6. When a clinical research project is initiated, and where the Patient has expressed interest, that Patient's pre-arranged preferences (on the blockchain using smart-contracts) for participation will engage. That is the Patient will express interest, and conditions. This might mean that the Patient allows their fully-identified data to be used, partially-deIdentified data to be used, etc.. Including conditions of contact, conditions of notification. The preference might be to just notify the patient and nothing more.

I expect many more automated use-cases. These however are ones I know are actively being worked on. Like how about an automated analysis of treatment to discover better outcomes, and promote the plan of care that got that better outcome?

The Future is bright, but it must be appropriately designed

The point of Automated is that the HIE needs to move from something we think about, to something that is automatically used, but used in an appropriate way. Used in a way that is comprehensively more productive, more privacy respecting, more safety protecting, and more efficient. All of these must be considered. We can't automate and give away Privacy. We can't automate and give away Safety. We can't automate and give away better treatment outcomes. We can't automate and give away financial efficiency.

What is your ideas on how HIE can be made more Automated? Please post comments...