Tuesday, June 28, 2011

Personal Health Information Security

We’ve been having an interesting technical discussion at LinkedIn (at this link) about health information security when trying to share patient data among multiple data silos. We’re examining issues concerning the security of cloud computing, e-mail, and information stored in local computers and mobile devices. We’re discussing the strengths and weakness of encryption, exploring reports of data breaches, and identifying the incremental risks of different security prevention approaches.

We’re also presenting and evaluating innovative security solutions, such as: (a) allocating a specific IPv6 block just to healthcare; (b) using a novel method that is impossible hack (even with brute force) by “scrambling and padding” patient data using multiple keys; (c) separating patient identifiers from the person’s clinical data; and (d) using globally unique IDs (GUIDs) to name patient data files and mapping the GUIDs to the actual patient identifiers.
These kinds of creative discussions and brainstorming are essential when seeking solutions to the daunting challenges facing healthcare reform. The important thing, imo, is to be open to all ideas and critically examine them in terms of strengths, weakness, problems and risks.

Related posts:

• Should Personal Health Information Reside in Silos?
• Who should Own a Patient’s Health Data, Where should they be Stored, and How should they be Exchanged (Part 2 of 2)
Personal Health Information Privacy

Monday, June 27, 2011

Healthcare Reform "Value Promotion & Reward" Strategy

I've been writing about the need for high value healthcare for over four years. In the past year or so, more and more people have begun discussing the notion of value with regards to healthcare reform.

I've recently participated in one such discussion at KevinMD in a post about the tension between physicians and health policy experts (at this link) and another about how physician consolidation places health reformers in an ironic dilemma (at this link).

My comments focused on making the case that success healthcare reform models must be built on strategies focusing on (a) delivering high value care to every patient (client/consumer) by (b) enabling and rewarding the efficient delivery of high quality (safe & effective) “sick-care” (treating illness and dysfunction) and “well-care” (prevention and self-maintenance) within (c) a trust-worthy learning environment that promotes continuous, demonstrable improvement in care value.

Such strategies measure value as quality divided by cost, which is a measure of cost-effectiveness.
Key tactics of this value promotion & reward strategy are:
  • “Value-pricing,” which means paying more for healthcare services and products proven to be more cost-effective (and vice versa)
  • Patient-centered cognitive support, which consists of advanced health IT systems that help practitioners/clinicians/providers avoid information overload as they: (a) gain deep knowledge patients’ problems and risks, along with sharp awareness of the most cost-effective diagnostic, treatment and prevention options and (b) use that knowledge and awareness to make valid decisions, take competent actions and achieve good outcomes 
  • Shared decision-making, during which health practitioners educate patients about their treatment options in understandable language that takes into account patients’ individualized needs, circumstances and preferences
  • Practice-research collaboration (knowledge networks) that generate and disseminate ever-evolving evidence-based preferred practice guidelines and self-help recommendations
  • Healthcare delivery models assuring access and availability of high-value care to everyone.
Related posts:

The Need for a Value-Pricing Model in Healthcare
Enabling EHRs to Improve Care
Healthcare Reform Models Focusing on Value to Consumers - Part 1
Healthcare Reform Models Focusing on Value to Consumers – Part 2
Healthcare Reform Models Focusing on Value to Consumers – Part 3
Four Interlocking Issues about Fixing American Healthcare
Patient-Centered Life-Cycle (PCLC) Value Chain--Process Reform: Pay for Value