These patents cover the
emerging area of networked prescription management. Although I've written
extensively on these topics elsewhere and these patents are pretty
straight-forward and comprehensive, I thought it would make sense to give a
sense of the background and overview some of the key concepts I believe are
driving high-impact healthcare information solutions today and in the near
future.
The concept of network-centric
prescription management (over dedicated secure distributed physician
prescribing networks run by a common set of directory services), was the
result of work I began in the early 1980's, while a graduate student at
Columbia Presbyterian in New York.
My focus then was developing an
integrated national healthcare network which supported networked clinical
applications. Such "Smart Applications" would run over "Smart Networks"
through a wide-variety of existing and emerging wireline and wireless
network-edge devices. These network applications would have the
potential to create a true "win-win" between the multiple competing interests
of the many healthcare stakeholders, including -- physicians, patients,
providers organizations, and all of the many third-party intermediaries,
including -- payers, employers, insurance companies, managed care
organizations, prescription drug benefit companies, pharmaceutical companies,
HMOs, CROs, IDNs, etc.
The one of the key principles was
the concept of "Virtual Pooling" of patient-specific patient-centric data from
the various primary data elements which are fragmented and balkanized within
multiple legally independent and geographically dispersed organizations.
I had come to realize early on that the conundrum of healthcare information
was a bit like the banking situation in the 1920's. When people "ran on
a bank" what they were really saying was --
"If you don't have
my money right now, then give it to me, right now! ...
But if you
have my money, I'll come back to get it when I need it!"
What is a physician
really asking when he goes through the process of repeatedly asking the same
questions to the same patient each time they meet. And the nurse, and
the pharmacist, and the referred specialist, etc. Espceially when we
know all they are really doing is constantly rebuilding a poor replica of
secondary healthcare information on each patient encounter that is only valid
at that point of time (if at all). What they are saying is --
"If you don't have
your information right now, then give it to me, right now! ...
But if you
have your information, I'll come back to get it when I need it!"
In other words, if,
for example, a physician could tap into a network that would give him access
to the most up-to-date patient information directly from the keeper of that
data (eg lab data from lab companies, insurance info from insurance companies,
prescription data from pharmaeutical companies, prescription history from
pharmacies, plan inforomation from the plans, etc.) ie, the primary data
sources he needs, and do it anytime, anywhere, then he would no longer bother
building and rely on that secondary record of hear-say masquerading as
clinical information. Actually, in most cases it wouldn't be the
healthcare provider accessing this data directly but rather their application
which would be accessing the data from the network to process.
It all they have
today, but why?
Concepts of a
"Computerized Patient Record" (CPR), "Electronic Patient Record" (EPR), or
"Electronic Medical Record" (EMR) were floating about but they were
originating within single large institutions and where built on traditional
MIS paradigms that assume the existence and availability of data within the
organization. Unfortunately, this is not the case with the US Healthcare
System. A typical patient encounter generates multiple parallel
processes thoughout multiple organizations, each responsible for a small piece
of the puzzle, which then mustg be collected and analyzed by a physician
becore he makes a decision which started the cycle all over again.
One example of how
"off track" people were at the time, was the concept of the "Personal Health
Information Card". This card could be carried around by the
patient and would contain all of their medical records. Very cool idea,
except how does the information get into that card. If health card
information were centralizable, then there would be a healthcare information
problem to solve in the first place.
The good new is that
most of the relevant information is already electronic. The bad news is
that it's all locked up in proprietary databases on proprietary systems owned
by different organizations.
The problem is that
the information is already electronic but that it is all over the place --
balkanized in multiple proprietary databases ...
This "Virtual Pooling" would only
occur on-demand, so that it always contained the most up-to-date clinical
information. And the patient-specific information would only be captured
and distributed according to the "Who, What, Where, When, and How Long" opt-in
rules established by each patient.
These Patient Controlled Rules,
along with Physician Controlled Rules, Application-Specific Rules, and Data
Source Specific Rules, would be administered by network directory services.
Applications would verify the appropriate user, the appropriate data elements,
where those data elements are, how to get them, what form to send them, etc.
After each clinical encounter, new data could be added but this particular
instance of this particular collection of data of a particular patient at a
particular time and place would disappear. This "Transient Virtual
Pooling" of patient-specific data, I originally named the "Virtual Patient
Record". Given all the subsequent internet obession with "all things
virtual" it might have be a bit more precise to call this the "Transient
Patient Record" rather than the "Virtual Patient Record". (Just another
one of a very long list of mistakes which I must take responsibility for ...).
The applications would use the
network directory server to access required (1) physician-specific
preferences, (2) patient-specific preferences (3)
information
pt & med info directories don't
store the primary source data, instead they identify where on the network that
informatiton lives and how the aplication can access it. iportant disticntion
