The Nexus of Forces in Action – Use-Case 13: E-Medical Data Access and Exchange
A person on vacation needs emergency medical care while in a foreign country. The medical care provider needs access to the medical history of the person needing medical care.
Primary Industry Sectors
Malpractice risk mitigation, QoS
Key Business Functions
Medical history discovery, medical history access, medical history interoperability, medical history update, medical claim to insurer
Medical provider in foreign country, primary care physician in home country
Patient's medical insurer
Messaging, integration, cloud (private, hybrid, public, community), medical data analytics, monitoring, mobile alerts, social networks (awareness)
Big data, mobility
A person on vacation suffers a stroke while in a foreign country. The stroke prevents the person from speaking. The medical provider in the foreign country needs access to the person's medical history to determine the proper treatment. Some medical history is maintained by the person's primary care physician in the person's home country. Some medical history is located in a variety of other systems. Once medical treatment is completed, the medical history data needs to be updated by the medical provider. The medical provider will need to submit a claim to the patient's medical insurer.
Some of the patient's medical history is available electronically using one standard, whereas the medical provider in the foreign country uses a different standard. Other medical history data is located in multiple medical provider locations.
Secure access to the medical history data and then data integration are the key challenges.
Patient record (controlled access)
Current Observations Data
Patient temperature, blood pressure, pulse rate, etc. (obtained from sensors, open access)
Information about patient history (controlled access)
Data sought by attending healthcare provider to make best decision regarding proper treatment (controlled access).
Action Taken Data
Information about treatment given to patient (controlled access once added to historical data).
Real Business Examples
US Department of Health and Human Services
The US Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC) is encouraging international health IT standards, and is engaged in a number of efforts to promote them. Some of those efforts include:
- Defining an international vocabulary for health terms and products
- Standardizing healthcare summary documents
- Increasing patient access to their health information internationally
- A consistent health IT standards framework to build upon
- An increasing demand for international health IT professionals
- Roadmap for international health IT collaboration
See Dr. Doug Fridsma’s article: International Health IT Standards: A Closer Look at ONC Efforts in HealthITBuzz.
European Health Insurance Card
The European Health Insurance Card (EHIC) lets people who are ordinarily resident in a European Economic Area (EEA) country get state healthcare at a reduced cost or sometimes for free in other EEA countries that they visit. It will cover a person for treatment that is needed to allow them to continue their stay until their planned return. It also covers them for treatment of pre-existing medical conditions and for routine maternity care, as long as they are not going abroad to give birth. (See the EHIC website.)
International Federation of Health Information Management
The International Federation of Health Information Management (IFHIMA) assists national associations and health record professionals to implement and improve health records and the systems that support them. IFHIMA was established in 1968 as a forum to bring together national organizations committed to improvement in the use of health records in their countries. The founding organizations recognized the need for an international organization to serve as a forum for the exchange of information relating to health records, health information management, and IT. (See the IFHIMA website.)
Existing Interoperability Standards
SNOMED, the World Health Organization International Classification of Diseases (ICD) current revision (ICD 10) and next revision (ICD 11), Health Level Seven International (HL7), US health IT initiatives like the Direct Project, Blue Button, Consolidated Clinical Document Architecture (CCDA), and many others.
Comments on Context
Inter-country agreements between patient care records and insurance coverage will need policy agreement and coordination.