HealthyIT

The challenge of adopting Health Information Exchange Systems in the US

Robert Dunlea — Mon, 24 Oct 2011 21:51:59 +0000

The adoption of Health information exchanges (HIE) is hobbled by the difficulty of creating a viable business model in the the fragmented landscape of health care in the United States. This fettering is apparent in the adoption of informatics technologies such as telelhealth. Adoption of telehealth results in a costs savings due to decreased transport, better patient follow up, and efficiently distributing specialty care (1,2). A recent study demonstrated that a nationwide adoption of telelhealth in emergency rooms, prisons, nursing home facilities and physician offices would save the health care system over 4.3 billion dollars(1). A similar 2005 study showed adoption of an standardize nationwide HIE would results in savings of 77.8 billion per year once fully implemented (3). Unfortunately in the fragmented landscape of US health care there is no single health care entity. Thus, the difficulty in adopting technologies such as telehealth or HIE lies in a health system with multiple actors each with different interests and agendas all trying to minimize costs and often times increase profitability so that the initial investment in such technologies by a single actor becomes a difficult pill to swallow (4).

Private sector telelhealth companies such as American Well have flourished because their business model relies on a partnership with private insurance companies (5). This allows for the adoption of telelhealth technologies without a cost burden to patients or physicians. Wright et. al. while discussing HIE adoption state that “finding a sustainable business model is a key challenge for existing and proposed HIOs some of which depend on subscription fees from physicians” (6) . This places the burden on a single actor in the system. In this study physicians became less enamored with the adoption of an HIE when a monthly cost of $150 was required for their participation. Following the example of companies like American Well, HIE adoption will move forward through partnerships: creating a business model where private companies, hospital systems, and insurance companies share the cost burden of implementing the system since they all will benefit.

References:

1. Cusack CM, Pan E, Hook JM, Vincent A, Kaelber DC, Middleton B. The value proposition in the widespread use of telehealth. J Telemed Telecare. 2008;14(4):167–8.

2. Demaerschalk BM, Miley ML, Kiernan T-EJ, Bobrow BJ, Corday DA, Wellik KE, et al. Stroke telemedicine. Mayo Clin. Proc. 2009;84(1):53–64.

3. Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005 Jun;Suppl Web Exclusives:W5–10-W5–18.

4. Kaplan R, Babad Y. Balancing influence between actors in healthcare decision making. BMC Health Services Research. 2011;11(1):85.

5. American Well – Partnering with Health Plans [Internet]. [cited 2011 Sep 9];Available from: http://www.americanwell.com/partnering_with_health_plans.html

6. Wright A, Soran C, Jenter CA, Volk LA, Bates DW, Simon SR. Physician attitudes toward health information exchange: results of a statewide survey. Journal of the American Medical Informatics Association. 2010 Jan 1;17:66–70.

HealthyIT revived

Robert Dunlea — Mon, 24 Oct 2011 18:37:32 +0000

I thought I would revive this old domain now that I am officially working in the informatics field (as opposed to being a medical student with an interest in informatics). As I progress through my new career I hope to put some helpful tidbits here for my reference and perhaps as a helpful reference to others. My research interests tend toward more applied health care informatics, but I am also a heavy technology user, so I will likely try to put some of my hacks here as well. Cheers!

Woof: a cool python script for quick file transfers

Robert Dunlea — Tue, 15 Feb 2011 21:20:45 +0000

I stumbled across a python script woof, or Web Offer One File, the other day in the typical serendipity of the web: looking for something completely unrelated. In short, running the script on a file will start a simple webserver and produce an address you can pass on to a friend in place of emailing it or dropboxing it. That friend on your local network can drop that address in a browser or use a command like wget and grab the file; the server shuts down and everyone is happy. It also will take a directory, zip it up and send that along too.

I use this with my wife sometimes when we are on our home network, working together and I’m to lazy to drop a file on our shared server. It’s a bit more handy when out and about at a coffee shop or library and we need to quickly share something larger than would be reasonable with bluetooth. It works well with all the unixes I tried it on, including my maemo device (n800). Since the Maemo 4 does telephony does not support file transfers I can just use woof to do a transfer while chatting locally with bonjour.

Obviously there are a million and one ways of moving files and directories about, but I like the bare simplicity and utilitiy of this on a local network.

Update 10/24/2010:

Yes I use dropbox and similar services to share stuff on my local network. Its even lazier than the woof script but really what was holding me back was my poor old n800 running maemo with no easy way to connect with these syncing services. If the files are sensitive and I really do not want them to go out to a third party without my own encryption on them – then I do one of two things:

use giver – works well if others are using linux and is an easy install via repositories.
Use lysncd to sync stuff to my home server. This location is auto shared with other family members on the home network. This works with my various linux devices as well (which do not have dropbox clients available).