By Frank Din, DMD, MA, Medical Informatician for HIE
If you recall my post on the “Health Information Exchange Raison d’être: Part 2”, I stated that I would “look into the crystal ball and divine the future” after the details of a well-designed HIE are presented. It is time.
Let’s assume that the date is a few years in the future and there is a full functioning HIE doing what it is supposed to do, i.e., permitting the full secure exchange of health information. Everything is humming along as it should be. Capabilities that were once fairy tales are reality.
In today’s blog post, I look at one benefit: Equalizing quality of healthcare for rural areas.
In the pre-HIE world, there was a well-documented shortage of medical personnel in rural areas. But now, in our back-to-the-future scenario, the HIE solved the problem through a combination of:
- Semantic Electronic Medical Records data exchange
- Secure real-time video and multimedia service
- Access to distributed knowledge bases
- SOA-accessible applications
- Robust privacy and security
Rural populations now have access to the same knowledge and expertise that urban populations have always had. Even though rural areas still suffer from fewer doctors and specialists, the HIE allows the substitution of technology for physical presence.
Let’s, now, look at a 2 specific cases.
A difficult diagnosis:
The rural physician is confronted with a problem that is difficult to diagnose and treat. The doctor accesses a Clinical Decisions Support application that automatically processes the patient’s medical records, test data, clinical signs and symptoms, etc., cross-references this information against a knowledgebase of diseases, and provides the rural physician with a probability-weighted diagnosis and treatment list. The rural physician is now able to assess the weighted choices to determine the best course of action, using his/her best professional judgment.
The HIE, associated applications and data sources produced a real-time analysis. In the pre-HIE world, this might require weeks of manual research.
The rural physician arranges for a teleconference consultation that includes video, audio, real-time document sharing and whiteboarding with a specialist. This secure electronic collaboration is all conducted through the HIE with the remote specialist guiding the actions of the rural physician as the surrogate examiner. If the specialist wants to palpate for an enlarged spleen, the rural physician does the palpation and reports the findings to the specialist. The specialist can conduct a direct visual exam by viewing the high-definition video feed from the rural physician.
This full collaboration - a real-time diagnosis of the patient’s condition - brings expertise directly into the sickroom and avoids miscommunication.
In both cases, the power of the HIE removes one of the drawbacks to living in a rural area. This is the expected benefit. The beneficial, unintended consequence? Quality of life in the patient’s chosen life style without diminished health services. That is, rural living and all of its benefits (reduced cost of living, crowds, noise, etc.) are now more appealing to urbanites. Rural living no longer requires the sacrifice of the benefits of urban living. The demographic trend of dying rural areas may reverse with the new rural residents consisting of well-paid knowledge workers for whom employment is not dependent upon location, insofar as healthcare is concerned. Location becomes more a matter of choice, and quality of life decisions favor rural areas.
Thus the HIE provides both clinical AND social benefits. What might you see as the benefits (or drawbacks) of the HIE?
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