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The Medical Banking Project agrees on the "cloudy" future of healthcare but argues banks (or their 3rd party suppliers) are the vendors with the greater exposure to security concerns, have the greatest history with online data delivery, etc.
Hopefully on this one occasion these resource pointers will not be considered "too spammy" for this listserv:
MBlog – Medical Banking Blogging – http://mblog.mbproject.org
International Journal of Medical Banking – http://www.mbproject.org/journal
Medical banking Project site – http://www.mbproject.org
LinkedIn Group – http://www.linkedin.com/e/gis/74285/183D9F20CD6D
7th National Medical Banking Institute ADVANCING HEALTH CARE REFORM BY CREATING A FEDERAL HEALTH BOARD – http://www.mbproject.org/stream.php
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With the due date for Electronic Medical Records provision of HIPAA coming in 2014 – The Healthcare Industry needs more innovative solutions around the implementation that is easier for those less technical to use. It will be very tempting for all of us technologist to jump on the opportunity – but we need to proceed with caution.
One of the biggest burdens faced by medical care professionals are the very systems we put in place to help make their jobs easier. The number one complaint I have heard when talking to the users in the medical industry is the amount of time needed for the electronic charting, syncing, loss of data etc taking away from continuity of care for their patients.
Centralizing this data is a HUGE savings for physicians. Universal Client computing came from understanding the impact of not applying the right technology for the right use case but also understanding the need that there has to offline capabilities as well as online to avoid negative outcomes. Tying together offline and online with solutions like application virtualization that can leverage local compute power by do bidirectional updates of data to the cloud over HTTP/HTTPs – or other hybrid based uses cases will go much farther then just espousing one technology over another.
We need to think both In and Out of the Cloud to have solutions that will work in the real world…..
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There are many uses in the healthcare industry where the Cloud can help but when implementing for those systems a bit of care needs to be taken. From the major hospitals I have worked with in the US and discussions in EMEA the following uses cases fair very well in the cloud:
1) Medical Billing – particularly when billing is done either in a foreign country or by a third party. Privacy laws in Europe around health information require the data to be kept in the country of origin. I have seen medical billing done successfully with VDI implementations for larger institutions but believe a CLoud implementation with EC2 (following proper SAS70 guidelines) would also be a viable solution.
2) Transcription services make sense as well – similar to medical billing.
Edge Cases Not Recommended 3) I am a large proponent of the Cloud and Virtual Desktops but there are edge cases that should wait until the technology is more mature like Critical applications required for 3D or 4D imaging used in diagnosis, in Emergency Medical areas like ER, Nurses Stations, ICU, etc that require access to vitals and charts, Pill dispensing stations that are locked. As someone that has provided technology for infrastructure for over a decade – I know too well how lives can be lost due to accidental patch or reboot on an individual basis now multiply that by 40 or a 100. The technology is not ready yet.
For the Optic Digital imaging diagnosis below – can you tell us where the graphics processing was done? Also did anyone chart the malpractice or misdiagnosis ratio of those films over traditional methods? At first blush the costs savings look great – but we are talking about eyesight and lives when we are talking about medical.
I have heard of issues with hospitals trying to implement Cloud based solutions in Emergency rooms. In one case the wireless network connection failed while a physician was trying to review films to remove a bullet from a patient. Although IT tried they could not fix it in enough time to save the patient.
The next example is a personal one – My family was impacted by a significant misdiagnosis of EchoCardiogram films for my husband's heart. The EchoCardiograms were misread by a Physician in India collaborating with the Physician in Phoenix. We were told that my husband's condition was graver then it was, asked if we wanted to participate in an experimental study for the greater good of man kind because his condition was not reparable (Supra Cristal VSD, Pulmonary Stenosis and a Patent Ductus Arterosis). At the time our childre were 6 and 11. We spent two days of hell planning for the worse. The second physician we spoke to the following week had a different opinion and referred us to Stanford. Stanford concurred with the second physician. He did have the VSD but did not have the other issues. Apparently the resolution on the remote display protocol was not clear enough for the Physician in India that read the Physician in Phoenix's file to get an accurate discern that what she was seeing was not a PDA but additional movement on the echo from the higher pressure shunting of the blood when the valves opened and closed. We never sued the doctors because it was a technology issue.
Had we have listened to the first doctor mentioned – chances are my husband would be dead given the morbidity rates of the experimental surgery or at best would have another 2 or so years left. Instead – he has a good prognosis.
Now I ask you – if that is your spouse, parent, child or YOU would you want the films processed at the server and streamed? I for one am glad we sought a second and third opinion from someone that used a local PC with high end video graphics cards.
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Khazret Sapenov :
I also know, that doctors use Amazon Mechanical Turk to process transcripts, thus reducing their HR burden.
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Yes – in fact you can use the cloud for making the supply and demand equalise. We did this for a diabetic retinopathy project where we connect doctors within certain regions to do diagnosis of eye images of patients who have been to clinics in different city or country. Thereby reducing the waiting time and giving dr's additional revenue streams.
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Medical expenses are increasing everyday although the same medical processes have been around for a while with cloud computing do your think there is an opportunity to overhaul and simplfy high cost medical processes leverging infrastruture-as-a-service?
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In healthcare its important to learn first and foremost the HIPAA regulations. Some of the clauses from what I understand require in simplified terms that the patient sensitive data be separated and/or encrypted from others and the machines be in a “cage”.
Having said that once you have the patient identifiable data separated from the actual data, you could use the cloud. I can see specially in claim processing, image processing or data mining that the cloud could be very useful.
Also since the “cloud” sits on the internet a
nd a down internet can bring in a lot of liability to the end provider – I feel EMR would be a long shot.