Stream: patient empowerment
Topic: Trust in healthcare
Brendan Keeler (Jun 21 2019 at 00:48):
I wrote a Medium piece about trust paradigms in healthcare. Given that the third and newest paradigm is patient authorization, I thought I'd like it here for commentary and discussion:
https://medium.com/@brendanjkeeler/trust-in-healthcare-integration-c236b9129c7b
Grahame Grieve (Jun 21 2019 at 00:59):
in terms of drawbacks of BAAs, you kind of hint at it, but you could be clearer: it's an ongoing money pit that you're going to bleed on
Grahame Grieve (Jun 21 2019 at 00:59):
(whatever kind of participant you are)
Grahame Grieve (Jun 21 2019 at 01:01):
with regard to Trusted networks, again, you hint at it but could be more direct: almost all trusted networks are document based, and don't have support for integrated automated workflows
Grahame Grieve (Jun 21 2019 at 01:08):
Beyond that, this author struggles to envision other trust paradigms,
in USA... yes. But in other countries it's obvious that the central government can and will provide 3 services that light the eco-system on fire:
- application & endpoint registration
- single patient/consumer sign-in
- single provider sign-in
I'd call this a central authority trust model but I have no thought that USA would ever go for this
Grahame Grieve (Jun 21 2019 at 01:11):
I'm interested in what the gap is between US CDI and what you can get in other paradigms (other than push notifications, which is architectural not informational). In your post you mentioned three things:
- images (there's a joint process Dicom (@Chris Carr) with regard to this
- Advanced vitals - I don't know what this means
- oncology staging - I think this is covered ok in the base spec, but not in USCDI / US Core
Is that it?
Brendan Keeler (Jun 21 2019 at 01:34):
Those are really good points, Grahame. The government (in many other countries) is uniquely situated to fulfill the centralized party role for the three services you mention. In my head, I imagined the EHR vendors or another private solution, but that's likely because I implicitly (like you explicitly) discounted the US government.
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Grahame Grieve (Jun 21 2019 at 01:46):
right. but more than a policy push, which is what you can aspire to in USA. Elsewhere, most governments will simply go ahead and implement
Brendan Keeler (Jun 21 2019 at 01:48):
As for what's not in the CCDS/USCDI...lots? Other specialty data (like obstetrics data), financial data, any vitals beyond the ones in the picture (inpatient vitals, for instance). Drinking status, drug status, SDOH, research study enrollment data, patient education all don't seem to be in there (at least now, when pulling it as a patient). I don't think I can see my referrals or scheduled appointments in there (or at least in the four or five PHRs I've tried).
From my prior Epic perspective, all the random flowsheets and SmartData elements that a HCO may have created and recorded information into.
Patient authorization still has a ways to go (in the wild, not in theory/at the standards level) to allow a PHR to become its full potential (a fully featured cross-organization patient portal). This is not an inditement of FHIR, but more a statement of where adoption seems to be and where policy ought to go.
Screen-Shot-2019-06-20-at-6.36.05-PM.png
Brendan Keeler (Jun 21 2019 at 01:49):
right. but more than a policy push, which is what you can aspire to in USA. Elsewhere, most governments will simply go ahead and implement
True. Sometimes well, sometimes poorly. But at least it's implemented :laughter_tears:
Grahame Grieve (Jun 21 2019 at 01:50):
my rule of thumb: you can trade between various forms of poorly ;-)
Last updated: Apr 12 2022 at 19:14 UTC
