17 settembre 2012 di bakaburg1
This was a comment to an article found on Technology Review about the consequences of a ever more connected world.
Compliments for the article, this topic is exactly what I’m planning to devote myself to after graduating.
I am both a doctor and a web developer. The inefficiency of the current health data storage and communication system is striking. This is especially true in Italy (my country) where most of the clinical data is still hand written and there are amministrative absurdities such different health data management software for different departments in the same hospital that are unable to communicate among them, with duplication and in the worst case inconsistency of the data.
In my country there is a complete lack of political will (and knowledge) to tackle the problem.
Me and some collegues are about to conduct a study to assess which are the issues at the root the problem.
From what I can see there are mainly 4 topics that need to be tackled in the field of health data management systems:
1. User Interface and Experience: many of this softwares are extremely poor coded, unaware of the latest technologies and standards (the majority are server based intranet systems that run on dedicated, old, Internet Explorer builds). Health workers are not the most technologically savvy people in the world, and especially doctors have many troubles with computers, so they prefer to stick with written patients records.
It’s clear that the same patterns and guidelines on which the modern web is built on should be applied in this field too. The software has to be build around the user, not the opposite. This has to be true for professional software too.
2. Infrastructure Management: yes, i’m speaking about the cloud. In my opinion, if we want to maximize the quality of the system we cannot rely on in house IT experts, for two reasons: the qualification of these people cannot be assured nation wide. The alternative to in house technicians are support people sent in by the software company; but this would cut out from the market start ups and small companies that cannot provide such services and private health workers that cannot pay for the extra support.
Offering a cloud service for health care, could drive down the cost and improve the quality of the system.
3. International Standard Protocol for Health Data Communication: in a globalized world it’s clear that as people travel, their medical data should travel with them. At the moment every management software dispose of data storage and communication in their own proprietary way. I think instead that a standard protocol should be created to access the data. This could have two effect on the health software development: to separate interface from storage, splitting the market in two and increasing competition and therefore quality and to allow access to the data worldwide, in a private and anonymous way.
Patients will be able to access their data wherever they are. Data will not be centralized in one place, decreasing security issues. By decoupling storage and interface it will be up to the clients to fetch and join the data in one meaningful document, like browsers do now with the internet.
4. International Standard Protocol for Health Data Classification: For the same reasons a standard classification pattern for medical data is needed, like xml and html are for data on the internet. The biggest effort in this direction is the International Classification of Diseases of the WHO, now approaching the 10th edition. I suggest to go further and include not just diseases but the medical terminology as a whole. This way, health data could be stored in a standard, language agnostic, coded way, accessible world wide, with maybe the WHO providing a databases that works as a dictionary to decode the terms in every language. Such dictionary could be built and then translated via crowd sourcing.
I would like everyone to envision the consequence of the implementation of such standards. The health care system could become a world wide network like is the internet now-a-days.
Among the benefits:
– Patients will have their data where ever they are, even if it is fragmented between their general practitioner, their oncologist, the local hospital and the hospital in Austria where they underwent leg surgery after a skying accident.
– Easier communication and collaboration between health workers, locally, nationally and worldwide. Imagine your doctor asking for help about your case to an overseas collegue. He would be able to send all of your data anonymously in an easy and efficient way, wherever this doctor is in the world.
– Researcher could query and access world wide health data, anonymously, exponentially cutting the time and the effort for retrospective studies. One nice implementation could be the automatic creation of diagnostic guidelines by analyzing the data of thousands of patiences using simple database queries.
– By making the system open and standards driven it will allow the sprouting of a extremely dynamic market that will drive innovation and quality.
Of course the main issues against this project are security and bureaucracy. But as you said in your article we should implement the same security systems that are used in the online banking and government communications.
On the bureaucracy side my plan is to join the WHO (World Health Organization), with the aim to create a consortium akin to what the W3C is for the internet, that will take care of creating these standards, and then use the power of the UN and the WHO to force the adoption worldwide.
It seems impossible, but all big stuff were born small.
From the Web
- It’s the Patient, Stupid (thehealthcareblog.com)
- Big Data and the Dawn of the Super Researcher (blogs.loc.gov)
- The Perils of Highly Interconnected Systems (technologyreview.com)