April 2009 PHR Seminar - IL - 22.4.2009 1

All on one card The USB PHR – Patient Health RecordSupports efficiency and forces patients to take responsibility

27. 11. 2008 Präsentation at the German Bundestag Health Committee

April 2009 PHR Seminar - IL - 22.4.2009 2

The Challenge

The idea that Medical Records remain bound to institutions, networks, hospitals, HMOs or else are a non-starter:

A modern Patient wishes to have his data when HE / SHE needs it – which is expecially in Emergency Situations at point

of care

April 2009 PHR Seminar - IL - 22.4.2009 3

NotfallDienste

DigitalerDatensafe

BackupBonus

Zugriff zuEPABonus

SynchroneRisiko

AnalyseDMP

Digitale Abrechnung

von derKarte

Bonus

OTS undFreie med.Produkte

Sonder-Programme

Codierung beim

PatientBonus

Direktlinkzu ärztl..

Sonderl.

VersicherungsPortal

Der Patient - USER INTERFACE

3

VertragspartnerSpo

nsor

enVertragspartner

VertragspartnerSpo

nsor

en

April 2009 PHR Seminar - IL - 22.4.2009 4

The Claim: The MD demands to see data instantly – he/she have only 3 Minutes time

April 2009 PHR Seminar - IL - 22.4.2009 5

The Claim: The Patient wishes to view his data, explicitly his Medication and run a Medication risk analysis

April 2009 PHR Seminar - IL - 22.4.2009 6

• US HMOs: All data in the hands of the patient that presents them at point of care.

• German Hospitals: We wish that the Fallakte can be downloaded to the Patient Card and that the patient‘s doctors can view it and add their own data.

• German and US Doctors: We reject Patient Data on Giga Servers and demand that every patient holds a Patient Data Card that works also offline.

• Emergency Services: If we would have the patient data at point of accident, 40% of the patients that die (bleed to death) on the surgery table could be safed.

• Hospital care: Presently die about 58.000 patient in DE and over 100.000 in the US on wrong medication in hospitals. Data cards with integrated medication risk analysis could reduce this errors to a minimum.

April 2009 PHR Seminar - IL - 22.4.2009 7

How to bring all this demands under one roof – IT protection at hospitals, Data Privacy, unhindered patient access, and

instant high-volume data availablilty within seconds?

April 2009 PHR Seminar - IL - 22.4.2009 8

122

121

120

140

142

130

132

170 118

160

162

182

180

110

152

150125

USB

182

180

Several Service Providers feed ONE single PMP, butthousands of Service Providers from different network systems can access their Patients – AT NO CHARGE!

112

115

116

To Patients

>114

myXML™ Med-O-Card

Item FIG. 1100 USB Card - System

101 Network (Internet, VPN)

120 Lap top

121 PDA

122 Tablet PC

125 PC

150 Laboratories

152 Laboratories

110 Servers

112 Secure Patient Database

115 Pharmacological Data Base 1-2-3-…-x

114 (Internet) Pharmacies

116 Warehouse/shipping

180 Medical Expert Program 1

182 Medical Expert Program 2

162 Hospitals

160 Hospitals

118 Electronic prescription

170 Research organizations

132 MDs

130 MDs

142 Pharmacies

140 HMO – Health Funds

100

115115

April 2009 PHR Seminar - IL - 22.4.2009 9

122

121

120

140

142

130

132

170 118

160

162

182

180

110

152

150125

182

180

Several Service Providers feed ONE single PMP, butthousands of Service Providers from different network systems can access their Patients – AT NO CHARGE!

112

115

116

To Patients

>114

myXML™ PMP

Item FIG. 1100 USB Card System

101 Network (Internet, VPN)

120 Lap top

121 PDA

122 Tablet PC

125 PC

150 Laboratory a

152 Laboratory b

110 Servers

112 Secure Patient Database

115 Pharmacological Data Base 1-2-3-…-x

114 (Internet) Pharmacies

116 Warehouse/shipping

180 Medical Expert Program 1

182 Medical Expert Program 2

162 Hospitals

160 Hospitals

118 Electronic prescription

170 Research organizations

132 MDs

130 MDs

142 Pharmacies

140 Health Funds

101

100

122

121

120

140

142

130

132

170 118

160

162

182

180

110

152

150125

PMP

182

18

115115

April 2009 PHR Seminar - IL - 22.4.2009 10

How to solve ALL requiremtns?

April 2009 PHR Seminar - IL - 22.4.2009 11

HH

HH

HH

HH

HH

HMOHMO

MDMDMDMD

MDMD

MDMD

HSHS

HSHS

HSHS

Deffinition: EMR - PHR

At MEDICA 2008 presented 150 med. Softwarefirms their own EMR.

None planed any ingteraction with

other systems;

None included the Patient

EMR

EMR

EMR

EMR

EMR

EMREMR

EMR

EMREMR

EMR

EMR

EMR

PHR

Does this make sense?

April 2009 PHR Seminar - IL - 22.4.2009 12

Requirements on the Patient Data Card:

1. Common Criteria Harware Security – a regular USB can‘t be used

2. Secure, verified software that guarantees that now Virus can enter the card – a preconditon for use at Hospitals or MD PCs.

3. ALL data and images must be on the card

4. ALL viewers must be on the card

5. Information must be coded (structured data ) – if non coded data is downloaded data must be coded on the fly. For that the card must have its own

• Pharmacological DB (coded ATC and/or Medication ID)

• ICD-9 or ICD-10 DB

• Radiology must be in diagnostic quality (DICOM) non-compressed

• Therefore card must have at least 4 GB

• All medical Data application must be installed on the card

• The card must have its independent OS and act as an indpendent PC

April 2009 PHR Seminar - IL - 22.4.2009 13

1. Med-O-Card can work as single USB or as combined USB/Smart Card.

2. Med-O-Card fulfills the requirement of the Law: All Data under authority of the patient.

3. Med-O-Card works both Online (Web, VPN, Mobile) or Offline.

4. Hospitals will issue the card on their own account to patients. Why?

5. HMOs learn the Marketing advantage of the combined secure Data / Lifestyle card.

6. Doctors have rejected the Smart-Card System and turned to Med-O-Card

7. Health Care Adminstration wishes to use the card for CODING

8. Health Funds get now the same data than the patient – consequences?

G E R M A N Y

April 2009 PHR Seminar - IL - 22.4.2009 14

1. Med-O-Card fulfills the requirement of the Obama Health Stimulus Plan and of the HR 676

2. US Hospials are the first to react positively. Like in Germany and in Israel they wish to issue the card directly to the patient

3. HMOs have demanded a Patient Data Repository in the hands of the Patient since 2006 – now they have the Tool without any need to enter IT systems that may, or maybe not secure.

4. The process of compliance with the US Health Administration demand for ‚EMR in every patient‘s hand‘ is now changed in Washington into the demand of ‚PHR in every patient‘s hand‘.

5. The US health IT structure is strong at Hospitals and very poor at MD level – the Med-O-Card solves that dilemma.

U S A

April 2009 PHR Seminar - IL - 22.4.2009 15

I S R A E L

1. 2 Hospitals are now discussing the technical requirements for issuing a Med-O-Card to all its patients.

2. The convincing arguments from Germany and the US all count for Israel as well.

3. The Ministry of Health has to license ONE SINGLE pharmacolgical DB such as is the rule in DE and US

4. The Israel Patients Rights Act 1996 protects the patient and forces MDs, Health Funds and Hospitals to hand over the data to the patient.

5. Knesset Members are now discussing whether the Med-O-Card plan shall be taken over by Pituach Leumi as a service for all Israel Citizen.

April 2009 PHR Seminar - IL - 22.4.2009 16

S u m m a r y

April 2009 PHR Seminar - IL - 22.4.2009 17

The Problems:

1. Health Network Structures, Giga-Servers and GOOGLE Health become more problematic the more patients sign on.

2. The NHS UK National Smart Card based Systems have lost over 600.000 patient data in 2007/8

3. The German planned Smart-Card System did not pass the tests

The Solutions:

1. US HMOs claim that they are not ready to wait another 30 years for working EMRs and entered into tests with Med-O-Card.

2. Coding of Data on Med-O-Card becomes one of the major benefit for patients, doctors, hospitals and administrations alike.

3. The Geman Health Administration wish to run the Hybrid card where the Health Funds still control the workflow but where the patients and their doctors will hold the clinical data.

April 2009 PHR Seminar - IL - 22.4.2009 18

Thank You !

>>> Annexes

April 2009 PHR Seminar - IL - 22.4.2009 19

Eine typische Integration beider Systeme (VPN – SSL) erlaubt z.B. die sofortige Anbindung der PATIENTEN KARTE und der damit verbundenen PROFESSIONAL HEALTH CARD mit dem

Patienten basiertem PATIENTEN / ARZT PORTAL

Die Patientenkarte verwendet ihre bereits installierte Patienten-ID zugleich als Access-Authorisierung für das Patienten Portal und erlaubt erstmals dem ARZT

(mit Willen und Genehmigung des Patienten ) auf ALLE gespeicherten Patienteninformationen zuzugreifen.

VPN

SSL-Internet

Zentraler Patienten Daten ServerArzt + lokale PVS

Arzt-Zugriff auf eigene und (mit Patienten-

Genehmigung) Daten anderer Ärzte und DMPs

April 2009 PHR Seminar - IL - 22.4.2009 20

Alles was nun zu tun verbleibt ist den USB MC beim Arzt in den PC zu stecken und das Passwort einzutippen (dies fällt bei der späteren

Sicherheits-Applikation weg, da der Arzt PC als ‚Authorisiert‘ auf der USB MC registriert sein wird.

April 2009 PHR Seminar - IL - 22.4.2009 21

WHO-ATCMedication

Codes

MD Data

&Reports

WHOICD-10

DiagnosticCodes

RadiologyImages

USVideos

CodedLab-Results

AllergiesVaccinations

 

HospitalData

ReportsCodes

MonitoringBP, Puls,Glucose,WeightEKG

CONTENT Modul

Emergency

Service

SKYPE

Mother&

Child

FitnessPerformance

Slimming

SportsAnti-Doping

HMOControlled

DMPs

MEDIGAMES  

HANDYMonitoringEmergencyE-Pharmacy

MonitoringBP

PulseEKG

E-Pharmacy

MARKETING (Lifestyle) Modul

IT+W

IT

Die modular aufgebaute XML-Datenstruktur erlaubt selektives

e-Lifestyle & Health Management & DMP Management via

Patienten Portal - USB MEDOCARD - Memory Card des Handys

April 2009 PHR Seminar - IL - 22.4.2009 22

Selbstbewusstsein: NHS in UK, Telekom in DE...

“NHS 'can be trusted' over records” (UK Health Commissioner on Health IT Berlin, Feb. 2008)– after they have lost over 600.000 patient files in 2007.

See how it goes from there on…

300.000 patient files have gone missing

June 19th, 2008 Lame NHS loses 31,000 patient records

January 18, 2008NHS Patient Medical records lost in

Stockport, England UK

£12bn NHS computer system crashes at the first attempt

It is the latest blow for the £12billion national programme, designed to give doctors access to patients' records wherever they are in the

country.

Oct. 30th, 2008

December 24th, 2007

April 2009 PHR Seminar - IL - 22.4.2009 23

Promotional / Marketing Advantages for the MD:

1. Each MD, Clinic, MD-Network, Hospital will issue its own, customized USB- MEDOCARD to their own patients

2. Hospitals, Clinics or MD-Nets can operate their own patient servers and market their services locally.

3. DOCTORS get their own operator code and operate from their own WEB-Site

April 2009 PHR Seminar - IL - 22.4.2009 24

Google service's inaccuracies may hold wide lesson

WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention.""I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua.DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment."The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at Cisco Systems.

http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/