Yet more on Open Mobile Health Exchange

Karen Edwards-Crawford said:

Better access to patient's medical records would be a great improvement. There are times when I can't even get records from a facility that is only five mile away. What's up with that?

So many reasons why we can't routinely share data in the interests of the patient: legal, social, political, economic. Sometimes, just a failure of imagination! However, the technical barriers are mostly solved or nearly so. The real challenge is developing a social consensus that this is something we ought to do and agreement on how we should all behave so that patients (and their data) don't get abused. We've made great strides with sharing laboratory results for diabetes among providers (and the patient - a key ingredient!), but uptake by the healthcare industry is slow. Many of the key decision makers, especially on the insurance side, are wary. They are more worried about losing their franchise in the future altogether than improving quality and reducing costs now. They also want a "one-size-fits-all" solution that will solve all their operational issues at once. And, they believe their competitive advantage lies in cost-center control rather than quality improvement. So, they are holding out for a mandated solution that their competitors must do at the same time they do, that fixes all the ills of the health care system (not just one or two conditions, no matter how important), and that someone else will pay for. The net result is that they're leaving hundreds of millions of dollars on the table, doctors like Karen Edwards-Crawford are frustrated, patients get care they don't need and don't like, costs go up for everyone, and the government mandates more and more controls.

There is some good news. Some small insurers and provider groups around the country (like FirstCare in Texas) have figured out that they can see big benefits in the short run (this fiscal year) by making small targeted investments in intelligent, proven health information exchange programs for critical areas like diabetes. These payers and providers are positioning themselves to thrive no matter what comes out of reform legislation and no matter how long it takes to get the bugs out of massive comprehensive medial records programs. So, it feels like two steps back for every one step forward, but maybe we are inching towards a better place! It certainly has kept things interesting for solutions providers like Vermedx.

More on Open Mobile Health Exchange

Michael Henry wrote:

Given the current state of technology, one would think we would each be wearing a thumb drive on a lanyard around our neck that any medic could access almost instantly. I suppose privacy concerns are the greatest factor precluding that.

Good point. Actually, we're getting a bit closer with a document standard called a CCD which defines the structure for what might be in the thumb drive. Privacy is probably no longer the limiting factor. Making sure the data on the drive (or more likely, the web repository) is up to date is a bigger issue.

Open Mobile Health Exchange

Getting information about specific patients' current situation is one of the biggest problems in clinical decision support. Perhaps what's needed is a simple short messaging protocol that allows Twitter-like text strings to be both machine- and human-readable. I wish I thought of it, but the good folks at microsyntax.org get the kudos.

OMHE (Open Mobile Health Exchange), pronounced "ooommm," is an open-source microsyntax for text messaging (mobile SMS), Twitter®, medical devices, and other "short text capable" systems.

OMHE has a short list of standard messages and commands like

wt=182

to transmit a current weight or

getphr

to request a copy of your personal health record. The target audience includes cell phone users entering personal info on the go, distributed data collection devices like blood glucose monitors and pedometers, and patient services like personal health records or disease management nurses. I think this idea may have real utility in a variety of settings, and being open-source is a big plus.

More can be found at http://code.google.com/p/omhe/

AMIA Year in Review

This just in - your blogger is bursting with pride as the American Medical Informatics Association released the AMIA Informatics 2009 Year in Review: A compendium of notable publications and events in the field of biomedical informatics. There we are, second in the list of studies about decision support for patients: Littenberg B et. al. The Vermedx Diabetes Information System reduces healthcare utilization. Am J Manag Care. 2009 Mar;15(3):166-70.

Professor Masys of Vanderbilt, who compiles the list, puts a heavy weight on randomized controlled trials in picking the entries, as well he should. Thanks for including us!

Diabetes Quality of Care

AHRQ (the US Agency for Healthcare Research and Quality) recently published an analysis of the quality of diabetes care across the country. The numbers are (still) not good. 7.4% of Americans (16.5 million people) have been told they have diabetes. (Probably another 8 million don't even know it.) Among seniors, the rate goes up to 18.3%.

Only a third of diabetic patients have had the 3 basic tests (an A1C test, an eye exam, and a foot exam) in the last year. The AHRQ didn't even report on cholesterol, kidney function, urine tests or the fact that good care requires 2 to 4 A1C tests per year - not just one.

So, we're still not applying the good science we have about diabetes to the benefit of Americans with the disease. Why not? Lots of reasons including access to care (read health insurance), patient factors (language or cultural barriers, fear, ignorance, illegal residence, etc.), conflicts with other health and personal needs (work, family, etc.), and poor systems of care. We still don't use the tools we have (computers, checklists, flowsheets, reminders and the rest) to ensure that basic needs get met with regularity.

There is hope as more and more people realize the tremendous waste of lives and money associated with sloppy care. The solutions are fast, cheap and easy, but they do require thinking about systems of care, not just visits, and about small investments that yield big savings.

The full report is available for free: Soni, A. Diabetes Management: Tests and Treatments among the Adult U.S. Civilian Noninstitutionalized Population, 2007. Statistical Brief #269. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st269/stat269.shtml

The National Association of Managed Care Physicians

The National Association of Managed Care Physicians (NAMCP) will be hosting the annual Fall Managed Care Forum in Las Vegas this week. I'm honored and excited to be on the program on Thursday, November 12 at 1:30 at the Bellagio. I'll be talking about "Treatment Improvement and Cost Savings in Diabetes Care" and how the Vermedx Diabetes Information System improves the quality of care for patients and providers while saving the payer over $2,400 per year.

You can learn more about the meeting at www.namcp.org.

See you in Vegas, baby!