Monday, February 25, 2008

If Google Wants to Help Healthcare

They would develop an open source, freely available tool for probabilistically matching patient identities and managing patient record duplicates. If Plaxo can do it with my contact lists, why can’t Google do something incredible with patient identity? I’m pretty sure a patient is a person and sometimes vice versa, so the concepts for identity should cross over, right?

I appreciate Google’s recent involvement with PHRs, especially anything to enhance their portability. Like our dear and respected colleagues at the Cleveland Clinic, we also use Epic’s MyChart product. It’s very impressive-- extremely functional—and our patients love it. But, it’s not truly a personal health record because our patients can’t personally port their personal data between personal care settings, not even to other Epic sites without a great deal of trouble. I sincerely extend my compliments to Google and the Cleveland Clinic for addressing the portability of data between PHRs. I hope that, within the scope of their project, they also focus on the portability of those past medical history forms, family history forms, current medications, etc.—i.e., the redundant and repetitive manual collection of which plagues all of our patients in every care setting.

But… If Google really wants to help healthcare, and can do so with only a minor investment and extension of their existing computing skills, they would build an open source software service for patient identity matching and duplicate management that could be downloaded for local use or be used in an ASP, “software as a service” model.

Encounter-based healthcare, where we’ve been stuck for hundreds of years, starts when a patient and a provider come together. Patient identity management doesn’t matter much because we tend to focus on the health issues right here, right now. On the other hand, longitudinal lifetime-based preventive medicine and healthcare, which is where we need to go as an industry, fundamentally requires the consistent and reliable identification of a patient throughout their lifetime. I’m preaching to the choir, right? But, if I’m preaching to the choir, why do we still struggle with this issue as an industry, which is one of the most fundamental building blocks to effective healthcare?

At their request, I facilitated a meeting with a large hospital system a few years ago who was also struggling in various ways because they lacked a master patient identifier. They were trying to cost-justify their investment in an enterprise master patient index. In the meeting, we calculated the average costs per incorrect patient identification. We calculated their lost revenue from billing, delayed A/R, etc., but kept that in a separate section of the spreadsheet, purposely, because we were really trying to appeal to the physician leadership of the company, not the CFO, by emphasizing patient quality of care and safety. At the end of the reasonably sane process for estimating the benefits to their system, ignoring the billing benefits, we then extrapolated the costs to the entire healthcare industry in the U.S. -- $24 billion annually and that was in 2002. BTW, the hospital system justified their investment in a master patient index.

So, Google, do the country a favor— apply those incredible brains and capabilities and build a free, open source tool that we can be used locally or as a secure ASP to more effectively manage patient identities. Design it so that it can also extend to a national, voluntary patient identification system, across all EHRs and PHRs.

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