Sunday, August 30, 2009
A Departure of Sorts
Let us depart from the tried and true (and often overworked) vision of VistA and take a new slant that will enhance our discussion of the software life cycle. Instead of looking at VistA as the EMR of a hospital, let us look at VistA as a potential candidate for a national Patient Health Record (PHR) which could be a building block of health care reform as it is currently being debated.
The difference between an EMR and a PHR is more political than technilogical. A patient health record is the property of the patient, not the property of the facility housing the record (for it is not housed in a facility), nor the property of the Federal Government (because it is not run as a government entity). A PHR must be started by a company, or companies, large enough to break off a small segment of their workforce and revenue to set up a totally different entity that could augment the standard EMR in any shape, form or fashion. For this job VistA is uniquely qualified, and run as open source on GT.M is uniquely capable.
Each patient who subscribes to the service (set up cost around $10 with a yearly maintenance fee of around $5) is provided with a subscription access code. This code can be printed on and imbedded in the magnetic strip of a credit card type prototype. Where the Federal Government would come in is that each facility that treats a patient would have to be required to supply the information for any subscribed patient to the facility. This can be done via HL7, or whatever the current method of communicating platform disparate information is at the time.
Each subscribed patient would have the ability to supply their access code to any physician they happen to visit, and the physician would then (via the access code and a web interface) have read-only access to the patient record. If a physician is given an access code, then he must supply his information to the system, with the access code being a part of the HL7 message to identify the patient. The interface for supplying information to the system would be supplied to each facility for free, as well as the web interface information.
Each physician would use their DEA number to access the medical information along with the patient access code. This would give the system knowledge of who accessed the system for which patient. Other things, such as IP address could also be captured to give an appoximate location.
Under this system, the patient information is immediately accessible to any provider in the US, or abroad should the decision be made to extend the system to those areas. Using GT.M with VistA would ensure scalability as well as performance and security by having multiple databases replicating nationally, or internationally as the case may necessitate.
Discussion?
The difference between an EMR and a PHR is more political than technilogical. A patient health record is the property of the patient, not the property of the facility housing the record (for it is not housed in a facility), nor the property of the Federal Government (because it is not run as a government entity). A PHR must be started by a company, or companies, large enough to break off a small segment of their workforce and revenue to set up a totally different entity that could augment the standard EMR in any shape, form or fashion. For this job VistA is uniquely qualified, and run as open source on GT.M is uniquely capable.
Each patient who subscribes to the service (set up cost around $10 with a yearly maintenance fee of around $5) is provided with a subscription access code. This code can be printed on and imbedded in the magnetic strip of a credit card type prototype. Where the Federal Government would come in is that each facility that treats a patient would have to be required to supply the information for any subscribed patient to the facility. This can be done via HL7, or whatever the current method of communicating platform disparate information is at the time.
Each subscribed patient would have the ability to supply their access code to any physician they happen to visit, and the physician would then (via the access code and a web interface) have read-only access to the patient record. If a physician is given an access code, then he must supply his information to the system, with the access code being a part of the HL7 message to identify the patient. The interface for supplying information to the system would be supplied to each facility for free, as well as the web interface information.
Each physician would use their DEA number to access the medical information along with the patient access code. This would give the system knowledge of who accessed the system for which patient. Other things, such as IP address could also be captured to give an appoximate location.
Under this system, the patient information is immediately accessible to any provider in the US, or abroad should the decision be made to extend the system to those areas. Using GT.M with VistA would ensure scalability as well as performance and security by having multiple databases replicating nationally, or internationally as the case may necessitate.
Discussion?
