In response to my recent note about mash-ups and Web 2.0 (link here), Adam Peters submitted the following comment:
Another area where mash-ups could make a big difference is PHR's. I can see blending content from different providers of medical information, medication information and possibly targeted advertising (there's no such thing as a free lunch) as services connected via a web or PC based PHR.
To extend the model to a healthcare organization, the application could allow home-based access to all or parts of the EMR and clinician access to the PHR. The user and healthcare organization would choose what to share and what to keep privileged. In this case the health information provided to the user would be based on clinical diagnosis in the EMR as well as currently prescribed medications and of course lab test results.
These types of services can be provided without a great deal of difficulty and they are secure. Ever bank on the web? Chances are your bank isn't providing all the content on that page. A third party hosts the web services that access your account, perform the authentication and conducts the transactions that post immediately to your account. If you can feel secure about sending your financial information of the web you should feel secure sending health information. Your account number is much more valuable to hackers than your ICD-9 codes from you last doctors appointment.
This is an extremely interesting comment from Adam and I want to extend some of his ideas and perhaps stimulate further discussion about this topic. I have posted a previous note about the personal health record (PHR) that you can read here.
Let's work with Adam's idea that a health system would create a web-based PHR, accessible by patients, by extracting selected data elements from the EMR, perhaps with a nightly sweep, and copying them to the PHR. Data that could be replicated in this way to the PHR might include lab & pathology results, radiology reports, clinical and operative reports, and a list of prescribed medications. It is understood that certain reports such as a newly diagnosed tumor would not be made available to a patient prior to a physician visit for a discussion of that result.
Now things get very interesting. What sort of mash-ups could be created that would enhance the value of the PHR from the perspective of patients and healthcare consumers. Stating the question another way, which extracts from other medical content web sites could be integrated with the health system clinical data. Here is a list of ideas that come readily to mind:
- Consumer-oriented descriptions of the side-effects and contraindications of medications, perhaps accompanied by a photograph of the actual tablet for identification purposes (see DrugDigest Pill Images here). Such information could be displayed when the patient right-clicks any of items in the list of current medications
- Descriptions of the indications and interpretations of various lab tests performed on a patient with special emphasis on those that are abnormal. Mash-up information could be obtained from a web site like Lab Tests Online here.
- When definitive diagnoses are recorded in the PHR, particularly relating to serious chronic diseases, web links to self-help groups and other resources (e.g., WebMD Type 2 Diabetes Support Group, link here).
- For malignant neoplasms and other chronic diseases, links to controlled clinical trials such as this site.
- Many PHRs already have a medication reminder. Integrating such an application with the list of prescribed meds from the PHR would allow the application to be preloaded with drugs names/images, doses, and alarms.
I hasten to add here that such PHR mash-ups could only be developed with serious attention to the quality of the data that is integrated with the core clinical data copied from the EMRs to the PHR. However, this goes without saying.