Information Technology Reference
In-Depth Information
Chapter 7
Increasing Knowledge
Going all the way back to Larry Weed it has been a goal of health informatics that
clinical data from electronic records could be aggregated, analyzed and visualized
in ways that would contribute to our understanding of the natural course of disease,
the clinical effectiveness and safety of the treatments we employ once they are out
in the community, more effective understanding and control of public health and
other purposes such as finding patients who qualify for clinical trials.
This is much simpler in a centralized model of health information exchange,
such as they have in Indiana. Key clinical data is abstracted from all the connected
systems and is curated into a more standardized and structured form that is ideal for
all the purposes just listed. However, the US is moving strongly away from this
model in favor of a federated approach for both economic and political reasons. In
such a model each provider's data is stored only in their EHR. There are also hun-
dreds of EHR products that providers can implement to qualify for Meaningful Use
and they don't represent data in a consistent way.
Despite the increased difficulty of aggregating data, good arguments can be made
in favor of the federated approach:
Each health organization maintains their own HIPAA-mandated contractual control of
their PHI.
Local content experts have the strongest relationship with and best understanding of
their own data.
It is easier to manage consent locally where direct contact with the patient is easiest and
trust is greatest.
Federation reduces the scale of data breaches and concerns about exposing data to
competitors.
In addition to the federation of the data here in the US we will have hundreds of
regional and statewide health information exchanges operated by health systems
that may have competitive reasons for being reluctant to share their data.
