Personal health records, mobile systems and smartcards

1. Personal health records, mobile systems and smartcards A.Hasman

2. Continuity of care • Because care is normally provided to a patient by different doctors, nurses, pharmacists, and ancillary providers, and, with the passage of time, by different institutions in different geographical areas, each provider must be able to know what others are currently doing and what has previously been done.

3. Personal and demographic information Emergency contacts Insurance information Problem lists Medications/allergies Immunizations Labs and tests Hospitalizations/surgeries Spiritual affiliation/considerations Care plan Data needed for continuity of care

4. Problem • Data needed for continuity of care are not always available or accessible • Institutional record structures are not always compatible • Patients are becoming increasingly anxious about the privacy of their medical records. Under current laws and practices, identifiable medical data are routinely shared with insurance companies, government, etc. • A personal health record maintained by the patient could provide a solution

5. Solutions • Record systems should be designed so that they can exchange all their stored data according to public standards • Building software compliant with public standards will enable connectivity and interoperability—even of diverse systems • Patients should have control over access and permissions • Patients' control will allow protection of privacy according to individual preferences and help prevent some of the current misuses of personal medical information

6. Personal Health Record • resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from the health care provider and the individual. The PHR is maintained in a secure and private environment, with the individual determining the rights of access. The PHR is separate from and does not replace the legal record of the provider.“ (AHIMA e-HIM Personal Health Record Work Group, 2005)

7. Provider-owned PHR • A provider-owned and provider-maintained digital summary of clinically relevant health information made available to patients. • There are several variants of this type of PHR, but they share the following traits: The PHR is read-only for the patient, and the provider supplies, controls and maintains the data, which the patient is permitted to see. • Patients have the right to request the modification of erroneous data

8. Patient-owned PHR • A patient-owned software program that lets individuals enter, organize and retrieve their own health information and that captures the patient's concerns, problems, symptoms, emergency contact information, etc. • This software can reside on a person's computer, or the PHR software can be Web-based. In that case, the health data and all of the screens for entering and viewing the data online are maintained by a third-party host • The limiting factor in this model of PHR is the laborious nature of data entry; it is time-consuming work for patients to create a database, even when they are the subject.

9. Types of PHR • Paper-based • Portable systems • PC-based • Internet-based

13. Mobility • Presence of computer systems and peripherals in the environment so that persons can be (indirectly) followed or located (via e.g. RFID, echo, IR) • Presence of sensors etc attached to the person and communication with the outside world (via cell phone)

14. Ubiquitous computing • Ubiquitous (pervasive) computing: computers in the world of people • Virtual reality: people in a world generated by computers

15. Technological developments • Micro electronics • Autonomous sensors • Wireless communication between devices • Wearable computing • Mobile telephony combined with PDA and Internet technology (GPRS,UMTS)

16. Home monitoring • A wide range of home monitoring technologies are currently developed or commercialized which support the elderly and their caregivers • Automatic monitoring of vital signs, the detection of drug intake, the monitoring of physical exercises and many more • Feedback by physician or nurse

18. Remote patient management • Patient will access their personalized content via an easy-to-use interactive television interface delivered via a cable or DSL TV connection, set top box and special remote control designed for older users.

20. Smart homes • Signals from sensors in the bed, if processed correctly, can determine if someone is in bed or not, can sense heart rate and detect breathing and normal movement. • Infrared (IR) motion detectors can be used inside each room or only in certain rooms to detect the client's activity.

21. Smart homes -2 • Low cost monitoring: lights on and off, inside and outside door openings and closings, kitchen cabinet door monitoring, garage door.  • Water usage: bath, dishes, bathroom sink, toilet, etc. • Ultrasound for determining the location of persons

22. From: Gerhard Tröster, ETH, Zürich

24. Fabric coils On-shirt textile connection to earphones

29. Mobile computer

30. Smartcards • Memory cards only • Portable micro-computers • Processor • ROM • EEPROM (electronically erasable programmable read only memory • Flash memory

31. Non-volatile memory • Flash memory (sometimes called "flash RAM") is a type of constantly-powered nonvolatile memory that can be erased and reprogrammed in units of memory called blocks. • It is a variation of EEPROM which, unlike flash memory, is erased and rewritten at the byte level, which is slower than flash memory updating.

35. Uses • Providing access to accurate information on a timely basis • It is estimated that up to 20% of healthcare tests are redundant simply because prior results are unavailable • Acting as portable memory • A smartcard can hold 64 kilobytes of information • Speeding manual processes such as hospital admissions • Patient admission requires patient verification, insurance verification, patient history and reason for admission

36. Uses continued • Managing the information flow within the system-at-large • Doctors of different specialties are usually not connected electronically to securely transmit data • Reducing fraud; streamlining administrative procedures • Fraud can be reduced by authenticating patients and their benefits • Decreasing expenses from patient verification to insurance confirmation • Each provider must verify at each visit the validity of coverage. Smartcards can be programmed to search and record usage and coverage

37. Used as/for • Insurance cards • Storage of patient medical/medication data • Storage of links to other data sources • Patient or caregiver identification card

38. Problems • Breakdown of cards/ loss of cards: information always needs to be stored elsewhere • What is the advantage of the cards when the information is already available in another way? • Information can change and before this information is put on the smartcard (insurance status may change; change of insurance company) • Setting up infrastructure is very expensive