A Fresh Approach to providing Universal Electronic Health Records

Collecting, securing, managing and making effective use of health information remains a problem globally. While this applies to every aspect of healthcare, including drug production, clinical research and trials, analysis of treatments, identification of health trends, etc., it is most visible for electronic health records (EHR). EHRs hold the promise of making it easier to capture, access and use health information. In practice, EHRs are failing to deliver this goal and face and present several challenges.

Some advanced nations such as the USA and UK have wide adoption of EHR systems but there are significant problems with EHR usability and interoperability and health data is highly fragmented and lacks correctness and consistency. Underprivileged and developing nations on the other hand simply cannot afford the cost of implementing prevalent EHR solutions.

EHR platforms have almost universally been developed as provider-centric enterprise systems for their organizations or medical departments. Numerous (as many as 1000+) different EHR software packages and different versions of the same software package are tailored to implement the specific requirements of independent enterprises. This has resulted in siloed systems that are hard to integrate due to differences in data structures, software, processes, and the complexity and sensitivity of the information that comprises EHRs.

This causes patient frustration and dis-engagement as they cannot access and manage their own health information, while the manual overhead of maintaining EHRs and coordinating them across disparate systems is contributing to an increased rate of physician frustration and overheads. Indeed, EHRs are cited as a major reason for causing physician burnout! A troubling trend given the lack of qualified physicians required to meet healthcare needs globally.

What chances of success would you give a plan that requires thousands of complex, independent enterprises to integrate with each other and then remain in sync as their businesses evolve and change over time? Yet, that is the situation in which the Healthcare industry finds itself with regard to achieving interoperability between the EHR systems of disparate hospitals and clinical practices.

This traditional approach to implement customized EHR packages for enterprises and then spending extensive amounts of time, effort and money in trying to integrate these siloed enterprise solutions is failing. The global expenditure for EHR will exceed $33.4 billion per year by 2025, and this is for an approach that does not empower patients, alienates and frustrates physicians, and is prohibitively expensive.

Underprivileged and developing nations simply cannot afford these prohibitively high costs. As an example, a study conducted in India in 2016 indicated that EHR software must be open source to reduce costs and enable its widespread adoption across the country.

The Universal Health Information Network (UNHIN) is taking a fresh look at a solution to this problem. It distinguishes the EHR information for patients from the enterprise information for hospitals and clinical practices. The enterprise information such as billing, claims, costs, salaries, etc. should remain solely with the enterprise, while the medical information for patients in EHRs is not enterprise information at all. It is the information of individual patients to whom the each record belongs.

The UNHIN will implement a decentralized, secure, patient-centric information network for healthcare. It will provide patients access to and control over their health information in their “health wallet”. Any provider that interacts with a patient can simply submit the patient’s information into the network, and UNHIN will take care of securing it, routing it to the appropriate patient’s wallet and storing it in such a way that only that patient can access the information and authorize others to access or use it. The health information for an individual is centered on that individual, and any healthcare provider requiring that information can simply access it from the UNHIN with due authorization from the individual, without having to integrate with any other healthcare organization.

The UNHIN achieves this by applying decentralized computing, including blockchain technology to establish an open, secure and universally available network for collecting, securing and managing health information. It overcomes and resolves the numerous challenges (including the high costs) related to managing health information and transform the way Electronic Health Records (EHR) are implemented.

The UNHIN is designed to solve this problem at a global scale that will make affordable EHR available to all geographical regions and economic levels across the world. The UNHIN will empower patients and physicians, reduce physician overheads, minimize costs and provide patient-centric managed access to health information in a way that does not exist today.

The UNHIN is completely open source and wholly community driven. It’s blockchain network implements its own token economy that allows it to be economically self-sustaining and free of any commercial enterprise, paid for by the global community, and owned and operated by the global community.

This means that the UNHIN will be free of the usual commercial pressures that currently drive the industry so that it is able to do the “right thing” from a patient and physician perspective and focus on the goal of enabling “healthcare as a universal human right.”

The UNHIN implements a healthcare oriented decentralized storage network that cryptographically secures and shreds all information making it both unidentifiable and unintelligible. It adds to this a “proof of stake” based, multi-tier Blockchain that obfuscates all transactions while implementing a public network, thus preventing anyone from identifying any healthcare transactions.

The decentralized storage network and blockchain combine to implement a decentralized platform that meets or exceeds prevalent standards such as HIPAA. It implements a patient-centric model in which each patient owns and manages their health record. Healthcare organizations, physicians and other entities in the healthcare ecosystem interact with the UNHIN to access and update information as authorized by patients.

The UNHIN implements a native blockchain with its own network economy that incentivizes individuals and organizations to join the network. Network members interact more effectively with healthcare information and also earn tokens for providing various services to the network. For example, Blockchain nodes are rewarded with tokens for confirming transactions. Storage nodes earn tokens for providing secure storage to the healthcare network. Masternodes are rewarded with tokens for providing several healthcare-oriented services such as providing healthcare organizations and their practitioners with secure access to emergency records, requesting people for access to their information for medical studies, providing aggregated de-identified health information to support medical research, and more.

The UNHIN network will be ever present and free to use, while supporting its development and maintenance perpetually via its native network-economy. It will have several transformational impacts. For example, patients will own and manage their health records. Any time information is submitted to the UNHIN, it will be automatically secured and stored so that it can never be lost, and no one except its owner can access, manage and authorize it. Healthcare organization running masternodes will actually “earn tokens” to join the UNHIN, as opposed to having to pay money for implementing a traditional EHR system, and a lot more.

The UNHIN is implementing a truly suitable use case for blockchain. It is the kind of project required for blockchain to deliver on its promise and get wide ranging, global adoption, providing people a real reason to use its token for healthcare services. This will make the UNHIN token widely adopted and truly valuable the world over, and completely transform the healthcare ecosystem.

The UNHIN can solve the health information related issues we are facing globally and help improve and save thousands of lives on a day to day basis.

References

1. Global EHR Market to Hit $33B by 2025, Report Finds: https://www.healthcare-informatics.com/news-item/ehr/global-ehr-market-hit-33b-2025-report-finds

2. EHR interoperability, connectivity a big challenge around globe new study finds: https://www.healthcareitnews.com/news/ehr-interoperability-connectivity-big-challenge-around-globe-new-study-finds

3. Use of more than one electronic medical record system within a single health care organization: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613036/

4. EHRs get most blame for epidemic of physician burnout: https://www.healthdatamanagement.com/news/ehrs-get-most-blame-for-epidemic-of-physician-burnout

5. To Combat Physician Burnout and Improve Care, Fix the Electronic Health Record: https://hbr.org/2018/03/to-combat-physician-burnout-and-improve-care-fix-the-electronic-health-record

6. EHR use consuming physicians’ time for patients: https://www.healthdatamanagement.com/news/ehr-use-consuming-physicians-time-for-patients

7. Physicians leaving profession over EHRs: http://www.medicaleconomics.com/ehr/physicians-leaving-profession-over-ehrs

8. Research Shows Shortage of More than 100,000 Doctors by 2030 in the USA: https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/

9. Global health workforce shortage to reach 12.9 million in coming decades: https://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/

10. Top 10 Countries for EHR Adoption: https://www.beckershospitalreview.com/healthcare-information-technology/top-10-countries-for-ehr-adoption.html

11. Interoperability also posing big challenges in the UK: https://www.healthcareitnews.com/news/interoperability-also-posing-big-challenges-uk

12. Adoption of Electronic Health Records: A Roadmap for India: https://www.researchgate.net/publication/310576712_Adoption_of_Electronic_Health_Records_A_Roadmap_for_India

Published in Universal Health Information Network

Comments

  1. Rose Rosenfeld

    The best part from a patient stand point is their ability to control their records. These days patients need to go through a bureaucratic process to get them from the big health systems. UNHIN will allow patient to control it at their fingertips.

  2. Teresa Fuchs

    Your are so right about how difficult it is for patients to get a hold of their own records. Under the current systems now operating, although HIPAA states that a patient owns their health information, I have often seen resistance from physicians to allow patients to see their test results until they have had a chance to review them and present them personally to the patient (which may take some time). They claim they want to avoid patient’s misunderstanding results or to prevent them from unnecessary worry or even panic. I have also personally been told more than once by a lab or radiology office that they are not allowed to give me my results. They can only send them to the physician.
    After reading about this system it would seem that a patient would be able to view their test results as soon as they are complete. Have any physicians voiced an objection to this?

  3. Shubh Singh Post author

    Thanks for your comments. I’m glad you brought this up as it is a very important point to discuss. It is not necessary that a patient will be able to immediately view their test results. This will be configurable, and may change for different legal jurisdictions and also for different physicians who can setup their preferences. For example, a physician would be able to set a preference that test reports that they order should not be released to the patient until after they have reviewed and approved them, in which case the patient wouldn’t see the test reports in their account until the physician has given a go ahead.

    We want due process to be followed, but we want patients to have easy access to their test reports once the process has been completed, and also that the test reports shouldn’t get lost.

    In my personal experience in the New York City area, I haven’t had to visit any large health system because I haven’t had any health issue requiring that so far, so I have visited small practices over the years. What I can tell you is that I don’t have a single one of my test reports with me over the years. This is because I had to explicitly make phone calls and ask for the test reports which I never got around to doing, or I was given a paper copy which I simply lost after sometime. I have 2 children, and it would be good to have my wife’s reports, who has interacted with a large health system for childbirth, but again its the same thing, we don’t have a single report on hand, and its also pretty much the same for our two children. It would have been great if we had a secure, electronic health account where our reports would get accumulated without us having to think about it. The physician would have discussed these reports with us, and they would automatically make it to our health account and get archived for posterity, so that if we need to find them we could.

    Regarding objections from physicians, we have been taking a global perspective on this, and we find that this varies from country to country, and perhaps even state to state. Several states in USA consider health records to belong to physicians (I will look up a reference for this and post it shortly), so physicians are entitled to hold them back, though in the prevalent information age there is a lot of stress on data and how people should own their data, so it doesn’t feel logical or intuitive. Several physicians we have talked with in USA do say that they feel that patients should own their information and this will aid in patient-centric care. That of course doesn’t mean that reports and other information should get directly released to patients, these should be duly reviewed by physicians. I still remember when we were having our first child, a heart specialist we went to see took me for a walk to explain to me how they have found a serious condition with my wife, and that I should not panic and try to be as supportive as possible, when the lab technician or a nurse informed him that they had sent him the wrong report! So it turns out everything was normal, I’m really glad that the report wasn’t delivered directly to me and multiple people checked it!

    Looking across the globe at some of the other places where we are working, in Trinidad and Tobago, the State (i.e. the Government) owns health records, so patients need to ask for their information under the freedom of information act. Even if physicians agree that information should be provided to patients, the system will need to be structured so that due approvals and obtained before providing their records to them. In India, most hospitals actually hand over all health record information to patients, including physician notes, test reports, etc. in a paper health record file that the patient needs to keep. So physicians in these hospitals have no problem with giving patients their electronic health records. That’s what they do right now in paper form! Modern hospitals in large cities in India a changing that with their enterprise based health record systems. So if you talk to physicians from these hospitals, they do raise similar concerns, but we have found them to be a minority in our research so far.

    In any case, as I explained above, the idea is that the UNHIN will be flexible and configurable by jurisdiction and physician so that due process can be followed. The main intent is that after following due process patients should get their test results and other information promptly, without having to make phone calls, exchanging emails or faxes, or standing in queues asking for permission. This health information should automatically be updated in their accounts and should never get lost so that they can look it up as and when required, and so can physicians whom they visit in the future (with due consent and authorization from the patients of course).

  4. Teresa Fuchs

    Thank you for that wealth of information! Although I personally find it frustrating at times, it makes a lot of sense that the physician can control the release of information, but eventually all your records will be in one easily accessible place. That is certainly a great benefit. Having all you health care providers being able to get the “whole picture” will allow for a more comprehensive, patient centered care, instead of each specialty working without your complete health information.