Patient centered focus will be the driving force to the Health Informatics future. A consumer centered approach has been missing in designing of the health IT system and hence the reason in delay of the advancement and adoption of technology in health industry. My focus area – A patient centered platform using PHR as the processing engine providing much needed access to patient and their family access to their medical record, in turn empowering patient to make more proactive decision regarding preventive care.

PHR offers an integrated and comprehensive view of your health information, including information you generate yourselves such as symptoms and medication use or information collected from your health device (BP monitor, Glucose monitor, Cardiac monitoring device, etc.), Information from doctors or your hospital/ Emergency/Lab/Pharmacy visits as well from your insurance. (Taken from book "Contemporary Health Informatics" by Mark L. Braunstein, MD)

PHR system – Informed decision making: Gives each person control of her or his personal health record, Allows individual to decide which data from their PHR should be viewed and accessed by whom, Contains information from patients lifetime medical history, Contains information from all of their healthcare providers, accessible from any place and any time, Is private and secure, Permits them to collaborate and coordinate their health with their providers, Help facilitate Patient social networking, Help manage alerts to the hospitals or police stations (Taken from book "Contemporary Health Informatics" by Mark L. Braunstein, MD)

Some of the case study from my focus area – Consumer or patient perspective initiative taken by some of the big players in the healthcare industry realizing the importance of patient centered approach to health care delivery:

Case Study 1: Aetna utilized Personal Health Record enhancements to further engage members in managing their health

• Enables members to make their PHRs (populated with health information and programs across the spectrum) available to health care providers online
• Enables individuals to better monitor their health status with the addition of Health Trackers
• Members can monitor data on individual health status as well as trends over time
• Enables patients to provide complete medical picture to their physicians
• Enables patients to engage in more meaningful interactions and address gaps in care

Issue and challenges: Due to the disruption brought in by changing IT landscape and plethora disruptive technologies (IOT, 3D Printer, BYOD, Big data, etc.) converging into the healthcare IT space will result in security issue, since most of these technologies are new and hence prone to security breaches. Privacy security and confidentiality is a major concern in adoption of the PHR system by consumers.

As per report published by Markle: Both patients and physicians cited privacy as a chief concern with PHRs. Of those surveyed, 87 to 92 percent of consumers said that privacy protection would factor into their decision to use an online PHR. Similarly, 70 percent of physicians agreed that PHRs may not have adequate privacy protections. Other concerns cited among physicians include the possibility that PHRs could contain inaccurate information (79 to 85 percent were concerned about this), create liability risks (76 percent), and that physicians would not be reimbursed for time spent reviewing PHRs (63 percent). (Markle, 2010)

Technologies in my focus area: A patient centered portal or app touches almost every aspect of technologies that is in play – Internet of things (Using health sensors to feed health data to the PHR app available on the mobile device), Cloud computing (A PHR system has to be in cloud to be provided as Software as a service), Big Data – Of course given the vastness of data in play it will require the mining and parsing of the data for a tailored approach, Latest and greatest Portal development software to build a user friendly and secure portal or app, AI – IBM Watson is an example that is widely being used in the health informatics space.

Legal or Ethical consideration: Legal issue pertains to the risk of PHI being available to “bad” guys and the system owner will be liable to penalty under HIPAA law. Personal health records and applications record sensitive personal information across a variety of devices, including mobile devices. Ensuring both robust security and ease of use is a challenge for the designers of personal health applications. Ethical dilemma would be around “Opt-in” provision tied to patient records being shared; physician not getting any incentives to push the adoption of PHR. Automated decision support raises issues around the use of authoritative statements, interaction between automated devices and physician oversight, and use of decision support with patients with mental limitations. Also, if an organization is public traded which is offering PHR then it adds on to the compliance towards various other acts – Like SOX, PCI, etc.

Future Vision: There is a need to build a one stop shop for patients/ consumers to view their health and medical history securely, privately and confidentially.  Not only that, Users will have visibility to their preventive action plan; pulled, compiled and mined data from their health tracking device (fitbit /apple watch, health monitor device, etc. ). This can provide a preventive care tool at the hands of consumers and will result in a 360 degree view of a patient in the form of customer relationship management process encapsulating healthcare industry.

The PHR enabled through Artificial intelligence and connected through the health sensors, IoT, where the PHR system can learn on its own; your behavior, lifestyle, your food intake, your health data from the sensors and in turn provide well researched suggestion and guidance through Evidence based practice look up can enhance the life expectancy. The PHR system can get connected to your local hospitals, PCP, police station when it identifies that a problem has incurred based on its AI capabilities.

Socio-Political-Economic Factor:

Demanding demographics

• Increasingly aging, changing ethnicity & socio-economically diverse segments
• Nearly half of Americans are expected to have chronic conditions by 2020
• Variation in consumer profile and lifestyle choices
• Capacity strain
• Staffing shortages in key clinical areas

Broadening Definitions of Health

• “Health” includes: food, pharma, beauty and consumer electronics
• Renewed focus on wellness, prevention, and self-care
• Increased demand for new health offerings due to healthier lifestyles and holistic approaches to aging, parenting, working, etc.

Rising Pressure in Policy & Politics

• Focus on the uninsured and expanding coverage
• New legislation requirements (e.g. NPI, ICD-10)
• Presidential Election
  • Governments require metrics that link spending to better health outcomes – increased focus on “value”

Increasing Transparencies

• Advances in science, communication, and information technologies
• Increasing awareness of variations in health system performance, quality, and cost
• Health risk assessments (genetic, environmental, behavioral) gaining traction

Converging Relationships

• Healthcare providers, payers, life sciences companies, policy makers, and consumers trend towards collaboration and formation of non-traditional alliances
• Changing and converging business models, and structured open-source innovations

Updated Concept Map:

Updated concept map includes the collaboration and security angle to the PHR system access and usage.

Top 3 biggest learning points:

1>     Systems - Broader understanding of the Health care Systems component - Tools, technology, standards, framework, architecture in place. Great insight in navigating through the EHR, EMR, Population health, PHR, HIE, CCD, etc.

2>     Data – The most important aspect of informatics and this class through the lectures, guest lectures, textbook – provided solid information around the categories, terminologies (ICD, CPT, SNOMED-CT, LOINC, etc.) what it means and how these can be used. Current challenges faced in using these and area of improvisation in this space. How to create phenotypes (guest lecture #9), how to utilize Natural processing language (NPL) to parse unstructured data. Data gathering through use of PICO (Problem/Intervention/Comparison/Outcome) model. SEIPS model to emphasize on the patient safety angle around the system design

3>     Overall Insight into the Health Informatics – Great insight through various guest lectures in the space of current research around BITS, Population health management, Phenotypes, NPL. Broader understanding of the US healthcare system – Challenges and opportunities in this space, where we are at? Reason for rising cost and what are the policies enforced by government to sustain the rising cost through pay for performance.

I have also provided a youtube video around healthcare industry outlook around consumer health and the future.

Works Cited

Markle. (2010). AMA & Markle Foundation Present PHR Survey Research at HIMSS. Markle, 4.