Note: You’ll find more information on related topics at the DesignMED event in Anaheim in February 2011.

Providing better healthcare, for more patients, at lower cost is an ongoing mission. It sounds simple, but as we’re all well aware, it’s a daunting task. One way to meet this challenge, to at least bite off part of the problem, is to employ the widespread adoption of information technology in healthcare, at all levels.

IT adoption in the healthcare space has been quite slow. The usual villains are to blame—lack of infrastructure, minimal adoption of data-exchange standards and capabilities, inadequate security, and the typical adoption-inhibiting problems of difficulty of use, competing systems, and high cost.

One proposed solution is to implement an EMR-agnostic, nationally scalable medical records technology throughout the central Oregon healthcare infrastructure. Central Oregon was chosen as a “test site” because rapid adoption typically follows proven success, and rapid success is more likely at a regional scale using focused resources and scalable technology. Central Oregon serves this need.

Proxense has already garnered support from all the necessary constituencies, including hospitals, clinics, doctors, healthcare management, and elected representatives.

The technology will overcome the problems described above in the following manner:

• by supporting an Internet-based, centrally accessible records database which will support data exchange with any current EMR (electronic medical records) system.
• by providing an integrated hardware/software system to regional healthcare facilities; this solution will support information entry and exchange with any EMR, provide for required access control and security, and facilitate upload/download with a scalable, centralized healthcare database.
• by providing secure wireless devices to both patients and caregivers; this technology is the enabling foundation for healthcare IT, in that these devices support secure transport of, updates to, and exchange of patient core healthcare information, provide (and control) access to such information by caregivers, and enable automatic upload/download of patient information with facility-based EMR systems (which are in turn linked to a centralized healthcare database).

Central Oregon’s initiative is dubbed the Triple Aim proposal. When funded and implemented, it will create a repeatable, EMR-agnostic, nationally scalable example of healthcare IT success at a regional level, using technology that supports existing national initiatives for healthcare information retention and exchange, and provides rapid investment payback to doctors, clinics, and hospitals. It also ensures widespread adoption by patients. These criteria are all prerequisites for achieving the collective goals for President Obama’s National Healthcare Initiative.

Recent attempts at reform
Some intermediate steps have been taken to address the stated issues. However, none show significant progress to date. One example of an as yet failed initiative is the creation of regional databases of patient data (RHIOs). While a step in the right direction, the model fails in practice due to a lack of standardization, too narrow a scope, complexity and cumbersomeness in practical use, and generally insufficient security.

Another example, the personal health record (PHR), has also been tried, but without success so far. While the idea is attractive in concept, problems with how data are actually entered and/or modified, whose responsibility it is to maintain the information, how secure it is, etc., have severely limited the benefits of PHR systems. And in fact, PHRs have actually increased the workload for some by requiring data to be entered in multiple databases, while doing little or nothing to address underlying issues of accessibility, liquidity or interoperability.

For central Oregon, a high number of uninsured residents, a small business community, and rural demographics further complicate the search for viable solutions. Yet the region is representative of many similar communities across the country. And the nearly universal consensus by healthcare professionals from these regions (and most others across the country) is that a solution capable of dramatically overhauling/improving the system is not going to happen from the top down. Far more likely, a small number of experimental, innovative solutions will be created in the coming years by smaller, coherent economic regions (such as central Oregon), each illustrating components of a successful model. Those components include improved care, significant cost and efficiency improvements, and simplicities of use. These examples are then anticipated to serve as models for potential adoption by other regions and states, and thereafter serve as a model for implementation nationwide.

The Triple Aim initiative defines three primary goals such a system must meet:

• improve the health of central Oregonians
• enhance the patient experience (safety, quality and satisfaction)
• reduce the per capita cost

Central Oregon’s proposal
After extensive discussion, debate, and review, an EMR-agnostic, nationally scalable healthcare information management model has emerged in Central Oregon. The model fulfills the Triple Aim goals, is scalable (the system can easily be scaled up for as many users, locally, nationally, etc., as needed), and has garnered positive support from the majority of Oregon’s medical organizations, regional leaders, doctors, nurses, and medical executives from the region.

The model is based on the use of biometrically-secured proximity-sensing, meaning that processes are initiated by an individual being detected. The model, named ProxMED, includes these fundamental components:

• an Internet-based, centralized records storage/access (CRSA) patient records database, where each patient’s record includes a fully-secured component containing all their current and historical medical data (able to be modified only by caregivers with appropriate credentials), and an associated section where patients may enter/maintain any personal health-related information they desire.
• an integrated hardware/software sensor infrastructure installed at participating providers’ facilities. The system, functioning in conjunction with providers’ current EMR systems, improves EMR efficiencies, ease of use, and security, and enables them to seamlessly connect/utilize CRSA. This CRSA link effectively makes every EMR system part of a shared regional/national system.
• tiny, extremely secure, wireless devices provided to patients and provider/caregivers. The devices enable efficient EMR user interaction, improving speed/ease of use, lowering costs, minimizing errors and improving care at all stages. The devices enable automated, secure (biometrically-protected) access to EMR/patient data, stored locally and in CRSA systems, by both providers/caregivers and patients. Every patient device contains the patient’s core medical information.

An Internet-based CRSA maintains the patient records database. The CRSA then links out nationally.

By locating all patient data in a single (logical) location, ProxMED ensures access to it by any caregiver in the world at all times. And patients can view any/all information in their records. The devices patients and caregivers carry, referred to as PROXs, automate system security.

An individual carrying their PROX can view, and when appropriate, modify patient data with fingerprint swipe (biometric authentication). Additionally, this automation extends to how users interact and utilize the elements of their EMR systems. Note that ProxMED automates the specific functions, such as logging in and out, which have traditionally created resistance to EMR systems adoption.

ProxMED’s CRSA component is a secure, efficient, and integrated patient records data sharing infrastructure, housing all patient data, regardless of the facility or physician that originally entered it. And it’s implemented using existing technologies and infrastructure, in particular, the Internet, making the sharing of health information with a clinic across the country no harder than sharing it with one next door.

Healthcare reform efforts simply cannot ignore the inherent value and benefits of the Internet. However, that potential is as yet unrealized due primarily to a lack of data transfer standards, and the generally insufficient and/or cumbersome security options currently available. In addition, options for implementing the CRSA database include utilizing variants of Microsoft’s HealthVault, Google’s Google Health, or independent providers’ records systems.

From a patient’s perspective, the benefits of such a system are many. For example, upon their first visit to a participating facility, the patient is provided a PROX, and their core data is entered from either the facility’s EMR system, or manually. The PROX can then be used for any/all healthcare related items going forward. When the patient enters a different doctor’s office carrying their PROX, he simply swipes a finger across a reader. The fingerprint is wirelessly read and compared to a copy stored in their PROX. Assuming they match, the PROX then securely transmits the patient’s core data to the facility’s EMR system.

Next, the patient enters an exam room, and his records automatically appear on the computer screen. This process follows the patient from room to room, doctor to nurse to surgeon, etc. Patients can also access their own medical records (located in the CRSA database) using any PC with an attached reader and a fingerprint swipe.

When the patient visits another office, the same fully-automated process of swiping a finger and having their core data flow into the facility’s EMR system occurs. This helps form an invisible data “bridge” from one EMR system to the next, using the standardized manner in which patients’ core data is stored in PROX.

There are also many benefits for the provider/caregiver’s. First, errors (and time) are minimized as patients simply “swipe” upon entering the office. As treatment begins, the CRSA component of ProxMED ensures that data from any/all previous facilities the patient may have visited is always available.

A doctor or nurse approaching a PC is automatically logged in to the EMR systems (assuming appropriate credentials), and importantly, logged out automatically by walking away. A doctor performs his evening rounds in a hospital by picking up a tablet PC and having it automatically recognize and log him in. Then, as patients are approached, they are also automatically recognized and their records are displayed on the tablet. By replacing the current infrastructure of single-use antennas and specialized terminals with the ProxMED infrastructure, it’s cost-effective to monitor all patients.

John Giobbi is the CEO of Proxense.