Semantics and Interoperability: The Foundation of the Personal Health Record

Much has been written already about the sustainability and practicality of PHRs. 

While a current generation of healthcare users frets about security and privacy, the next generation is much more concerned with availability.  

 Take Mint for example. Since its launch just a few years ago, this on-line banking service is incredibly popular.  In a time of well-publicized identity theft, it is interesting that a younger generation is all too eager to give out banking and credit passwords in exchange for the convenience of a single source of financial information. According to Mint, 65 million people in the U.S. use online banking today, and the average American has more than four bank relationships. Despite individual banks’ long-established on-line offerings, Mint’s success derives from its ability to provide an aggregated view from differing sources.  The analogy to health care is obvious, simple portals to payers or health systems are not sufficient, an interoperable view is an obvious necessity to today’s consumer.  But here’s the problem- unlike the US banking industry, our medical systems do not deal in a single domain (money), with a well-established standard (the dollar). 

What then is the role of semantics in this brave new world of the Personal Health Record?  Let me illustrate some common issues:

1.  Disparate medical records result in similar and/or duplicative data using different vocabulary standards. This ‘raw’ data, presented to the layperson in a PHR will result in misunderstanding.
2.  Lab data from differing facilities may have differing reference ranges. This will likely cause patients to question “normal” results, and limit their ability to accurately follow trends.
3. “Medical-ese” will need to be balanced by layman’s terminology.  A chest X-ray report with the phrase “pulmonary vasculature and cardiac silhouette appear unremarkable, however, one cannot rule-out neoplasm on this limited study” would probably better be listed in the PHR as “normal”.
4. Common laboratory panels with archaic or non-contributory values will need to be reassessed.  These are tests that should only be ordered in rare clinical instances, but for historic reasons are part of automated panels.  Clinicians have long ago learned to ignore such items in the complete blood count panel (eg. RDW, MCHC) or chemistry panel (eg. BUN/Cr ratio).  Patient’s frequently call me when they see their own reports—alarmed by “abnormal” results that have no significance.

I have previously opined that disease-specific clinical views of harmonized and appropriate information will be necessary for clinicians to interpret and utilize voluminous data in a meaningful work-flow. It is even more imperative that the layperson have analogous view in a PHR which will allow them to knowledgeably participate in their health care process.

Finally, we must remember that PHR data will undoubtedly flow both directions. EMRs must be capable of consuming home device or patient-entered data, in a presentation that does not confuse source to the caregiver.

Learn more about how the role semantics and interoperability play for PHR success by registering for this free webinar: Engaging Patients and Families with a Google Health PHR

Comments

[Penegra]

the presence of complete, accurate and rapidly accessible patient records should be a boon to both patients and practitioners. However, major providers of personal health records services are moving in this direction.

[hair loss treatment]

hm, interesting, i'd look into this as well...

[Lance Bollinger]

• Last week I commented on an article, here, http://histalk2.com/2011/09/14/readers-write-91411/,
which was about interoperability. I stumbled across it and I am NOT a
health IT expert, so please forgive me if I don’t know all of your
jargon.

I looked to see if I had a response to my questions, this was about
Epic systems, and I see no answer.

Forgetting about the particular
company, Epic, what really concerns me is that there doesn’t seem to be
any agreement in your field about whether interoperability is even
possible.

I researched Epic and there is some talk about the CEO of that firm
(forget name) being on a government board that is supposed to implement
interoperability, although some say this person’s company doesn’t
believe in it.

What I want to know is, will my doctor be able to share records with
my surgeon if the two don’t use the same system of platform from the
same provider?

Is Epic actually the norm, in other words, that none of
these systems can communicate with one another, and if so, then why is a
government board trying to make this happen?
I don’t care about all the politics, which the article I referenced
seems to be all about, but I DO care about whether or not my records
would be safe and whether or not they can be shared with the people I
WANT sharing them.

Can anyone help me?

Lance