Towards a Wearable Medical Record

1. Towards a Wearable Medical Record Social, Legal, and Technological Issues

2. The Question From LinkedIn’s Digital Health Group: Personal Medical Records and wearable device While cloud based computing could be a solution for future, what prevents designing a wearable computing device to carry personal medical records: is it the volume of data, methods of data transfer or legal bottleneck? With very high capacity solid state memory being available perhaps volume of data should not be a problem. Appreciate comments from group members.

3. Background • Issues with paper records • Hard to file and retrieve • Not portable • Results not always shared, or coordinated, across multiple healthcare providers • Appropriate care • Requires knowledge of existing conditions and medications • Can mean life or death in an emergency • Patient proactivity • Requires understanding one’s conditions and medications

4. State of the Art • Some personal medical identification includes USB storage (Pinterest) • Not universally carried or universally recognizable • Security issues prohibit USB-based uploads • PPACA (“Obamacare”) requires electronic storage of medical records • Adoption has been a slow and difficult process • Limited interoperability of EHR (Electronic Health Record) format and information between systems • No single, accessible-by-all-providers, database exists

5. Technical Issues • Volume of data • Inconsistent data formats • Inconsistent lab data • Device security • Bandwidth issues • Regulatory standards (or lack thereof)

6. Data Integrity Issues • Protection from accidental loss or change • Electromagnetic fields • Radiation • Temperature/ Water/ Humidity • Protection from deliberate loss or change • File modification or deletion to hide/disguise medical conditions or possible malpractice • Malware attacks

7. Data Security Issues • Patient privacy • Record ownership • Outside threats • Loss or theft of device

8. Personal Issues • Do I want to (have to) wear this identification? • Who will have access to my data, and what can they do with it? • Do I have any input into my medical record? • Can I access and analyze my own medical data? • Is my health data correct and secure?

9. Data Location Issues • Facility-based • Home-computer based • Device-based • Cloud based • Issues of availability, security, data integrity • Issues of signal, bandwidth

10. Record Maintenance Issues • Records need to be organized in a meaningful order to be useful • Different datasets and presentations are needed by different people at different times • Who is going to add the data? (Can it be uploaded directly from medical devices?) • Can the raw data be uploaded? • How should interpretations be uploaded (and attached to their images and clinicals)? • In what format(s) and structures should data be uploaded?

11. Solutions Discussed: Health Vault Microsoft Health Vault (http://healthvault.com) • Issues with getting images, labwork uploaded • Not all providers a part of the network • Patient-owned, and data upload/record change must be expressly permitted by the patient • Patient-level (i.e., nonsecure) image formats (i.e., does not support DICOM or PACS/RIS) • Device data must be manually uploaded • Part of the issue may be the lack of custom apps

12. Solutions Discussed: Smartphone Apps • Many people, worldwide, have access to smartphones and cellular data networks • The capabilities of the smartphone platform are still being discovered • New apps and devices use iPhonesas spectrum analyzers for urinalysis, local microbe detection • Existing apps and devices use iOS platform to manage blood glucose, weight, blood pressure • Issue: Access doesn’t mean ownership • Issue: Much cellular is still “feature phone” (voice and text only)

13. Solutions Discussed: Taltioni (Finland) Taltionihttp://www.taltioni.fi/en • Free (run by a non-profit cooperative) • Patient-based PHR • We are also working on context-sensitive decision support aids (http://www.ebmeds.org/web/guest/home?lang=en ) and, in similar lines to Taltioni, some of these are intended for citizens. If we are able to bring these two together and link them with the official health documents (http://www.kanta.fi/en/ ) we might have something new in our hands (unless our Data Protection Ombudsman gets involved...). • JanneLahtiranta

14. Solutions in Progress: HL7 In Brazil we are launching a solution for the area of ​​public health and private, we are providing a cloud system to record the information health of people safely and digitally certified. This system will work in offices and integrates with hospital management system and all service providers to support diagnosis and therapy protocols through HL7. In Brazil the bottleneck has been overcome and cool in the infrastructure does not exist problem. The solution of our company consists of applications including cloud CRM (Customer Relationship Management) for healthcare. AlexandreSchumacher

15. More About HL7 HL7: Health Level Seven • Name derives from the seventh (application) layer of the OSI model • A set of standards for health data exchange between disparate systems • Covers framework, protocol, syntax, document structure • Includes areas of medical conditions, clinical decision support, pharmacology, health records, finance/billing

16. Conclusions • A wearable patient health record that includes patient data locally is probably infeasible • Despite large storage capacity, security issues and file format incompatibilities may make the data inaccessible to healthcare providers • Current cloud-based systems have inclusion and compatibility issues to work out • Data and reports from incompatible EHRs • Inclusion of medical images, in their original formats • System, network, and data security

17. Where Do We Go From Here • Wearable authentication tokens • One-time code generators such as those provided by RSA SecurID • Patient token provides read access to all provider data about him, and write access for patient-generated data • Provider authentication tokens • Needed to access patient data • Two token access • Could be required to modify specific areas of the patient record

18. Resources • LinkedIn Discussion • DICOM • http://www.mccauslandcenter.sc.edu/mricro/dicom/ • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354356/ • PACS • http://en.wikibooks.org/wiki/Basic_Physics_of_Nuclear_Medicine/PACS_and_Advanced_Image_Processing • RIS • http://en.wikipedia.org/wiki/Radiology_Information_System • http://searchhealthit.techtarget.com/definition/Radiology-Information-System-RIS • HL7 • http://en.wikipedia.org/wiki/Health_Level_7 • http://www.interfaceware.com/hl7.html