Intranets and Health Care

Intranets and extranets are specific variants of Internet technology. Examine intranets / extranets in HCOs, the benefit to health care delivery, implications to patient outcomes/safety, and any impact to health care costs.

“Information is a source of learning. But unless it is organized, processed, and available to the right people in a format for decision making, it is a burden, not a benefit.” (Pollard, W., n.d.)

Intranets and extranets are about getting information to the right people. In this writing I will explain what are intranets and extranets, how they are used and how they can benefit health care organizations (HCOs).

An intranet is a local network available to a certain set of people that have the rights to view it. These are usually within one organization. Bradley Mitchell states that these networks are used to facilitate communication between people or work groups and are accessed over technologies such as Ethernets or WiFi and use common protocols such as TCP/IP (Mitchell, B., n.d.). He goes on to explain that extranets are extensions of the intranet that allows “outsiders” access, through the use of special firewall rules (Mitchell, B., n.d.). Some people are not aware that they are using their company’s intranet as they are accessed through web browsers. SharePoint is one of Microsoft’s fastest growing intranet applications.

Just like in the business world the intranet is being used by HCOs to get the right information to the right people. It allows collaboration, fast and efficient communication and reliable availability. Ong, K. R., Polkowski, M., McLemore, G., Greaker, M. & Murray, M. (2001) did an case study on how an intranet was being used at Saint Vincent's Catholic Medical Centers (SVCMC). They found that SVCMC was using their intranet for “. medical knowledge resources, clinical practice guidelines, directions, patient education, online forms, phone directory, and discussion forums” (Ong, K. R. et al, 2001). As you can see this was a vital way to exchange pertinent information for their staff, administrators, executives and even patients. They also found out that the intranet was getting over 3,000 hits per day, with over 800 of those hits coming from unique visitors and 74% of those visitors visited more than once (Ong, K. R. et al, 2001). As you can see that once an intranet is up and running it becomes a vital part of a HCO.

One of the main benefits of an intranet/extranet is getting information to those who need it to make key decisions.This will definitely affect patient outcomes and safety, as information is readily available, easy to access and up-to-date. Another benefit is lowered costs. Harno, K., Paavola, T., Carlson, C. & Viikinkoski, P. (2000) did a study on the effectiveness of intranets in telemedicine. The found that by use of intranets, cost were lowered due to less spent on personnel costs, internal and external service charges, material expenses, travel costs and rentals (Harno, K., et al, 2000).

In conclusion we see that intranets/extranets get the information to the right people at the right time. This can improve patient outcomes, deliver information quickly and efficiently, and reduce certain costs.

References:
Harno, K., Paavola, T., Carlson, C. & Viikinkoski, P. (2000 Dec 1). Patient referral by telemedicine: effectiveness and cost analysis of an intranet system. Journal of Telemedicine and Telecare, 6(6), 320-329. DOI:10.1258/1357633001935996

Mitchell, B. (n.d.). intranet. Retrieved from http://compnetworking.about.com/cs/intranets/g/bldef_intranet.htm

Ong, K. R., Polkowski, M., McLemore, G., Greaker, M. & Murray, M. (2001 Jan-Mar). Building and growing a hospital intranet: a case study. Journal of Medical Internet Research, 3(1), E10. DOI: 10.2196/jmir.3.1.e10

ThinkExist.com. (n.d.). William Pollard Quotes. Retrieved from http://thinkexist.com/quotation/information_is_a_source_of_learning-but_unless_it/226524.html

Will PHRs survive?

If you would have stated those three terms (EHR, EMR or PHR) to me few weeks ago, I would have not even have begun to know the difference.  Actually, I just thought they were different names for the same thing. I know better now. I am also of the mind set that PHRs do not currently balance.  Brian Dolan (2011) wrote an article in which he listed 10 reasons why Google Health failed. They are:

1. Google Health was not fun or social
2. Google Health was not trustworthy
3. Google Health was too cumbersome
4. Google Health did not involve doctors
5. It was hard for Google to partner with insurance companies
6. It was too hard to overcome the current reimbursement barriers
7. Google Health was poorly marketed
8. Google Health received poor C-level support
9. Google Health had no advertising opportunity
10. Google Health was not useful to consumers (Dolan, B., 2011)

As you can see five out of 10 of these reasons was based on consumer use.  Even you stated in your previous post that you wished that a doctor could be involved, which coincides with number four.  I am not saying that all PHRs are like Google Health, but you can see how it is difficult to get these types of operations up and running.  EHRs and EMRs are all clinical based so they are faring well. As I stated in my original post, if PHRs could find some cohesiveness and then be integrated, there are a lot of opportunities. 

With the demise of Google Health, this does not mean the demise of PHRs.  I actually believe that this may be a key tool in the future.  The world is moving towards the mobile devices and so many transactions today are moving towards the on-line environment. It is only a matter of time, in my opinion, that "mobile health" will see a renewed emergence.  In 2008 a survey was dconducted on perceptions of HIEs and PHRs.  Patel, Dhopeshwarkar, Edwards, Barrón, Sparenborg & Kaushal  (2010), surveyed 117 respondents and a majority of them stated that they would use PHRs based on certain factors.

• 51% would use PHRs if being treated for a chronic illness
• 90% of the people would use PHRs from the group of respondents with some college education
• 84% of the respondents who had shared personal information over the Internet in the past would use PHRs (Patel, V. N. et al, 2010)

In conclusion, there were other factors, but this shows that as people are more educated, and as they use the Internet more for other daily transactions, this may increase the adoption of PHRs in the future.  Google Health may have failed, but maybe the timing for this was not right.  People are becoming more tech savvy and I am sure we will see a greater adoption of PHRs in the near future.

References:
Dolan, B.  (2011 June 27).  10 Reasons why Google Health failed.  Retrieved from http://mobihealthnews.com/11480/10-reasons-why-google-health-failed/

Patel, V. N., Dhopeshwarkar, R. V., Edwards, A., Barrón, Y., Sparenborg, J. & Kaudhal, R.  (2010 July 29).  Consumer Support for Health Information Exchange and Personal Health Records: A Regional Health Information Organization Survey.  Journal of Medical Systems, 36(3), 1043-1052.  DOI: 10.1007/s10916-010-9566-0

Introduction

So I guess this should have been my first post.  Well, too bad I guess.  Here is my introduction to my blog.  It will probably be boring to some and exciting to others.  Hopefully it can lead to some meaningful discussion and help my readers and myself learn something new.  A little about me:


My name is Quinton Butterfield. I am currently working as a Business Analyst for the Information Technology Office of the Government of Bermuda. I am currently living in Bermuda. In 2005 I graduated from the University of Alabama in Huntsville with a Bachelors degree in Business Administration and I majored in Management Information Systems. Since 2005 I have had a variety of IT roles and experiences, including data retrieval and business intelligence reporting, software quality assurance testing and now I am working as a liaison between business customers and IT engineers to ensure ITIL compliance and to make sure the IT needs of each government department under my watch are met.
The reason that I chose to pursue a MS in Health Informatics is rooted in childhood experience. My father, till this day, runs a medical laboratory and I grew up around a certain aspect of healthcare. However, I pursued a degree in MIS because I was always interested in technology. Those years watching my father in his profession have still lingered with me, and now that I can pursue a degree that captures my interests in both these fields, I am happily pursuing.
In my personal time I usually like to hang with friends, travel (I am going to Japan next year and hopefully London in 2014) and I try to be a good role model to my 13 year old godson. Then of course, living in Bermuda and when the weather is right, I love to hit the beach for some fun in the sun.

I hope that you get some meaningful use (sorry, bad HI joke I guess) out of my blog.

Cheers!!

Assignment from Health Care Data class

Compare and contrast an EMR, EHR and PHR.  Characterize the similarities/differences of data between these systems. Your response should examine the opportunities and issues of data interacting between these systems as well as interactions between other system components / applications.

Several years ago Google ventured upon starting a repository for electronic personal health records.  At that time I stumbled upon this, and though I never signed up for it, I was intrigued by this concept.  This was a way to keep all of your health information in one place that could be accessed by yourself or anyone that you gave permission to access.  Fast forward several years, and Google is dumping this project.  I bring this up because I started a discussion on Linkedin.com about Google Health and called the records stored there electronic medical records.  Needless to say, someone on the discussion corrected me and said that they were personal health records.  This was the first time that I came to the understanding that there is a difference between personal health records (PHR), electronic health records (EHR) and electronic medical records (EMR).

The similarity between all three of these is that they all hold information on an individual’s health, treatment and/or recovery.  However, there could be quite a difference in the data in these records.

PHRs are usually accessible via portals over the Internet and are used by the patient to record their own health information.  The patient uses some type of security to access the information.  They can then give access to this information to whoever needs it.  Since the patient is the one maintaining it, this could lead to inaccurate data or missing data.  This could be by human error, or if the patient does not keep the record up-to-date.  As for the information contained in these records, Huba & Zhang (2012) stated that some information found in these types of records could include “lab test results, medication records, lists of past and future appointments…and the outcomes of those appointments” (Huba & Zhang, 2012).  The article also states that certain demographics like age, name, etc (Huba & Zhang, 2012).  The individual, not a health care professional, manually adds these to the record.

Similarity EMRs would contain the same information as the PHRs.  They would include the same demographics, the same lab results and the same medication records.  However, these records would be more comprehensive then PHRs.  This is because they are created by clinical professionals and would be less prone to error and would include details from each and every patient encounter.  They would also include progress notes, and other nuances that a patient would not be able to include, due to their layman status.

Further still, in terms of elevated comprehension, would be the EHR, which would include information from certain heath care events, such as surgeries or emergency care incidents.  These records would include information from various sections of a healthcare organization or even over a larger geographic area.  They would also include discharge notes, pathology reports and other pieces of information that would not be generated though a primary care visit.

One would think that interoperability of these systems would be advantageous.  However there are some hurdles that need to be overcome before such a noble task is brought to fruition.  First the adoption of PHRs has various barriers that could affect data reliability.  Through a qualitative research project by Matthew Witry et al (2010), it was found that “the likelihood that an individual would consider PHRs as a method to manage personal health information appears low’ due to “computer and health literacy affecting PHR usability, especially in older adults” and concerns “with the privacy of their personal health data (Witry, M, et al, 2010).  Because of the low usage of PHRs there are many accuracy concerns, and less accurate data could present a problem with interoperability.  If these barriers can be overcome the benefits and opportunities for interoperability would be immense.  This is especially true for “truckers, snowbirds (retirees who travel south for the winter months), or anyone else who spends a significant amount of time away from home” (Witry, M, et al, 2010). 

In conclusion, PHRs, EMRs and EHRs are similar in some aspects as they hold some identical information, while EMRs and EHRs can be more comprehensive and accurate.  Also, the integration of these can pose a problem due to accuracy issues and slow adoption of the general public of PHRs.  Once these barriers are breached, and adoption speeds up there are many opportunities to be had.

References

Huba, N & Zhang, Y.  (2012 May 30).  Designing Patient-Centered Personal Health Records (PHRs): Health Care Professionals' Perspective on Patient-Generated Data.  Journal of Medical Systems, 36(6), pp. 3893 – 3905.  DOI: 10.1007/s10916-012-9861-z

Witry, M., et al.  (2010 Jan 01).  Family physician perceptions of personal health records.  Perspectives in Health Information Management, 7, pg. 1d.  PMID: 20697465