Читать книгу Do No Harm - Matthew Webster - Страница 47

Almost ironically, the need to aggregate data is also a cause of some of the dispersion of data. Every company needs data in order to operate effectively. The more centralized that information, the better. Years ago, the information was by hand and needed to be pulled out manually—a time-consuming and painful process by today's standards. Assessments on that data were time-consuming and difficult. Now, with modern technology, they are much easier. But each system needs the data for different purposes. The insurance company needs to get all the requisition codes to analyze the data in a different way. A hospital needs to aggregate data from a host of different systems so that it has a more complete record. In the end, it is not about one aggregation, but many.

Many IoMT devices do not keep the data local to the hospital they are operating in. They send data to the cloud. This is not by accident. It has tremendous advantages for both the hospital and the device provider. Previously, a physical server needed to be installed and supported within the organization in order to maintain medical records. This created an extra burden for the IT staff and the hospital to support. Many things could go wrong—servers could go down, connectivity could be blocked, etc. There is also a maintenance overhead that comes with that extra device. The manufacturers of IoMT devices that depend on servers would need to support a patching process, provide tech support when the software components would go down, etc. This equals a lot of overhead that hospitals and manufacturers would like to avoid. Having a cloud service is a win-win for the providers because it reduces the technical overhead for IoMT and then provides an additional service that the manufacturer can charge for continually. Years ago, companies would sometimes forgo support to save time and money—a loss of revenue. It also helps the manufacturers because they can have more data to analyze and make their product better.

EHR systems are used to aggregate and access health records by hospitals, doctors, and other health providers. They are critical for the purpose of having centralized data. They also are moving to the cloud with many of the same advantages that are afforded to the IoMT cloud providers with similar benefits to the providers. The cloud, in short, helps to get companies out of the IT game (to an extent), allowing them to focus on what they do best—helping people.

Health insurance companies also need many of the same records that hospitals and doctor's offices require. They have to analyze the data and pay out claims, and they too are utilizing the cloud for many of the same reasons as other companies. Again, aggregation means diffusion of data.

With Health Information Exchanges (HIEs) we start to get into connections that not everyone is aware of. HIEs aggregate data within a Health Information Network. The goal of HIEs is to facilitate a faster, safer, and more efficient transfer of data than the previous way of having to walk or fax information over from one place to another. While typically they do not exchange information outside of their networks, they are known to connect to state or federal bodies to exchange information—yet another place where data interconnects.

There are additional grants built into the America Recovery and Reinvestment Act (ARRA) of 2009 for building Regional Health Information Organizations (RHIOs). The primary goal of RHIOs is to share health information within a region while following both state and local guidelines. Part of the overarching goal of RHIOs is to allow for the interconnection of medical information to a specific region. In some cases, they even share information with multiple regions.

The Center for Medicaid and Medicare Services (CMS) has the tremendous responsibility of overseeing patient data for several medically related federal programs. They do not necessarily collect the data themselves, though. Many of their programs are contracted out to third-party companies. When you connect into CMS web sites, these sites are often built on corporate networks.

All of these institutions that have medical information are the tip of the iceberg for where and how medical information is aggregated, stored, and exchanged. There are claims clearinghouses, labs, other types of information exchanges, data warehouses, other government entities, research institutions, service providers, biopharmaceutical agencies, aggregators, and so on. The potential location for data almost never stays within a single organization. It becomes part of an extremely rich interconnected ecosystem of partners.

So far, we have been exploring data strictly from a HIPAA perspective, but there is also data that looks like HIPAA data, but in reality, it is not.