Interview: Molly Joel Coye

Mike Dougherty, LEADING QUESTIONS: Looking Down the Road, Health Leaders Magazine, Nov. 2003.

This article is an interview with Molly Joel Coye MD MPH, the founder and CEO of HealthTech.  Her comments contain no surprises and are a welcome reaffirmation of the excitement surrounding the health IT field.  First, her opinion about future trends in health technology:

"…increasing consumer demand will meet a truly exploding pipeline of clinical devices-both implanted and worn-that will be used to replace natural functions to support, function or aid in treatment as chronic disease takes its toll."

On the future of electronic patient record (EPR):

"The electronic patient record is one of the three or four components important in the next three to five years in IT. The first stage is development of regional platforms for data sharing. Regional platforms often begin with eligibility lookup, claims lookup and eventually claims processing, and progresses to clinical data sharing beginning with laboratory and pharmacy and working out from there. There’s a growing national awareness of the urgency of the need for better information in healthcare. If, in the next two years, most of the necessary clinical data standards are established, we will be entering a new era as vendors sell IT systems that are compatible with the standards. The use of the EMR should grow steadily over the next five to eight years, and ultimately will be the most important piece of the puzzle of advancing quality."

November 25, 2003 | Filed Under e-health, electronic-health-records, future-healthcare, health-it, personal-health-tech | Comments Off 

IBM and UCSF

Press Release, IBM teams with UCSF to link university’s research and clinical data, Nov 17 2003.

The three-year collaboration…will use the power of information technology to bridge clinical and genomic research — across UCSF departments and throughout its research and clinical sites. This approach marks a major departure from the way research is conducted in most academic medical centers today and is considered crucial to continue to advance medical diagnosis and to find new genetic and environmental causes of diseases. The collaboration is a result of a competitive proposal process.

UCSF and IBM will develop an advanced clinical and genomic information management program, allowing scientists from different disciplines to work with physicians to seek the genetic links implicated in their patients’ illnesses. One of the team’s goals is to develop a Web-based system that is readily accessible to physicians with little information technology training. The IBM scientists will work side by side with their physician-scientist counterparts on site at UCSF. The technology infrastructure will be designed to protect the security and privacy of patient health information.

Bio-IT World has an article about the collaboration here.

November 25, 2003 | Filed Under genomic-data, health-it | Comments Off 

Health Information Infrastructure

Panel Suggests Electronic Health Records, Yahoo News, Nov. 20, 2003.

[T]he Institute of Medicine [here]…an arm of the National Academy of Sciences…is chartered by Congress to advise the government on medical matters.

To improve the use of electronic records, the institute recommended that the government help create data standards for the secure collection, storage and dissemination of medical information electronically.

That would form the basis for a network that would allow widespread exchange of critical health information, said the independent group, which advises the government on medical issues.

The report urges the government to model the system after the airline industry’s air traffic and weather information systems.

This recommendation is contained in a report published yesterday by the IOM entitled, "Patient Safety: Achieving a New Standard for Care."  (read it online for free).  It is one of many reports filed under the IOM’s Health Care Quality Initiative.

UPDATE: Bio-IT has posted an article on this report by the IOM:
Brian Reid, IOM Report: IT Key to Patient Safety Reform, Bio-IT World, 11/20/03.

November 21, 2003 | Filed Under electronic-health-records, health-it | Comments Off 

Health Informatics

Bio-IT World has a series of three new articles entitled "Strategic Insights: HEALTH INFORMATICS":

KATHY ORDOÑEZ, Targeted Medicine via Molecular Diagnostics. Bio-IT World, Nov. 14, 2003.

JEFF AUGEN, Making Information-Based Medicine Work. Bio-IT World, Nov. 14, 2003.

AMNON SHABO, Integrated EHR: The Final Frontier. Bio-IT World, Nov. 14, 2003.

November 16, 2003 | Filed Under electronic-health-records, health-it | Comments Off 

EMR Protections

Lets imagine that in ten years from now there is a genome sequencer in every medical doctor’s office.  The price of whole-genome sequencing has plummeted to $500 with the development of new technology.  Since $500 is in the range of other, often less effective diagnostic tests, it is the policy of your insurance company to shell out for this simple procedure.  As part of your regular physical exam, your doctor not only listens to your heart & lungs, takes your blood pressure, maybe draws some blood, but also takes a swab from the inside of your cheek and sequences your genome from those cells.  In an hour or so, all three billion nucleotides of your genome are automatically attached to your electronic medical record (EMR), which is standard fare for doctors in the future (not enough shelf space to do otherwise: your genome alone would fill approx. 200 volumes at 1000 pages each).  In addition to your genome, your EMR contains your complete medical history: every cavity, every medication ever prescribed, every stitch.

A repository (i.e. a database) located somewhere, perhaps at the office of the company which developed the EMR application or the office of a company specializing in genetic data storage (or possibly as part of a nation-wide, centralized project), houses your EMR along with the EMRs of millions of other people. 

The information contained in your EMR may contain information that
you would not want your boss or health insurance company to know, it is
conceivable that you may not want to know some of the information
yourself, especially since genetic sequence data can be predictive
(then again maybe an advanced diagnosis will allow for better disease
management).

What kind of legal protections do you and your EMR have? Who can
legally look at this information and what actions can they legally take
from such knowledge? Can you get fired (or not hired)? Or dropped by
your insurance company (or not accepted to begin with)? Can a medical
researcher use the information in your EMR to aid in the discovery of
disease etiology (which may help you or others in the future)?

Maybe you live in Germany
and during a mandated medical exam to become a teacher, your doctor
identifies you as a candidate for a debilitating degenerative disease.
As a consequence of this information, your employer does not hire you
for future fear of having a less productive and more expensive employee
due to illness.

Or maybe you are an epidemiologist trying to unravel a complicated
disease that strikes a small population with criminal severity. Some
evidence suggests the disease is a genetic disorder. Other evidence
suggests the disease appears in some individuals after taking a widely
prescribed drug. Luckily, the indications of the disease are well
characterized. With the information contained in millions of EMRs, it
is hoped the cause of the disease can finally be discerned.

Or maybe you are a policymaker
today trying to determine what level of protection to afford persons
divulging medical information. What kind of recommendation does one
make? Personal medical records create possibilities of damaging
livelihoods if mishandled by either allowing access to those likely to
abuse it or not allowing access to those which desire to make good use
of it.

October 16, 2003 | Filed Under e-health, health-it, policy, privacy | Comments Off 

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