Know Healthcare 5 - HL7

HL7 – Health Level Seven is a standard for exchanging information between medical/healthcare applications. This standard defines a format for the transmission of health-related information. Examples being patient records, billing information lab records etc

Translators – Though multiple healthcare applications communicate using HL7, they might not use the same language internally. So we need translators to translate the incoming HL7 into a language that the application understands internally and vice versa. Example: You application might use ‘M’ to identify a male, but in HL7 terms a male could be represented as ‘XY’.

HL7 RIM – HL7 Reference Implementation Model (My Personal favorite) - An object model created as part of the HL7 Version 3.It is a big domain model diagram linking all the entities of HL7.If you create your DB and application models referring to it  , you are already on the right track to create a health care application.

Will write more on HL7 RIM in future posts.

Know Healthcare 4 - Terminology

 

 EMR – Electronic Medical Record – The computerized version of the medical records of a patient. These records are local and stay within the physician’s office or within the four walls of the hospitals. These data are not networked or shared with multiple organizations. It is just a electronic version of the data that can be stored, retrieved and modified.

EHR – Electronic Health Record – It is the system of storing and sharing health information of patients electronically between hospitals, physicians and other organizations. The standards and implementation ideas of this are still evolving. The key difference between EMR and EHR is the mobility of the data.

HIE – Health Information Exchange –Is the process of moving EHR between places, HIE systems facilitate such electronic sharing of data.

PHR- Personal Health Record – Health data recorded and provided by patient themselves. Like you recording your weight, height and heart rate daily.

Ambulatory Care - Any medical care delivered on an outpatient basis .It is the procedure or care provided to a patient who walks in and walks out the same day.ex Dental care, blood test, X-ray etc

Know Healthcare 3 - Secondary Usage of Data

Secondary Usage of Data – In simple English it means using data for a purpose other than the purpose it was collected for. In healthcare it mostly refers to secondary use of EHR – Electronic health record.

Let’s say you visit a doctor for  general health check up, he collects you BP, Weight, heart rate etc. You get an analysis of the data say a week later giving you details of your health condition. This is the primary use of the data collected from you.

If the physician shares your data (with your consent) with an NGO which is looking for health related data from your county to know the effects of having 8 fast food restaurants around, it is the secondary usage of data.

In a more serious note  collecting and working on the secondary usage of data really helps hospitals, physicians, insurance companies, pharmaceuticals to be proactive rather than reactive to situations.

 More specifically it helps pharmaceuticals to know a lot about disease, symptoms and side effects ,which assists them to speed up the research and reduce the time spent on clinical trials.

Know Healthcare 2 - Clinical Trials

Clinical Trials: Steps followed in drug development before releasing the drug to market and making it generally available.

This is the main reason behind why your medicines cost a lot and I am sure you will agree with pharmaceuticals about their costing after you know what it takes to get a medicine out to market.

1) In US a patent you file for a new kind of medicine will expire in 20 years, which means after 20 years any one can reverse engineer the technology and produce it without patent restrictions

2) Any drug company when they roughly know, they have a workable concept for a medicine, will patent it first.

3) After patenting they will usually begin with say 1000 potential compounds (chemistry of the medicine) for the medicine

4) Out of which after a detailed study they will come down to say 500 compounds based on initial safety, storage, mass production capabilities etc. By mass production capabilities I mean, say you find one medicine that can cure a disease but if it takes 20 yrs to make one because of the rare nature of the compound used, what is the use?  So, the compounds they choose should be very widely available and should support mass production (say million tables in a day).

5) Out of the 500 they do trails on guinea pigs, monkeys and other animals first to see how it affects them. After this they will end up with say a 100

6) Next is testing on a very small group of people, say 10 at a time. They will be observed for any side effects and how the disease reacts to the medication.

7) Now they will have 10 compounds and will test that on a bit larger group of people- volunteers 

8) In all the above said steps there are lot of government restrictions and regulations that they have to satisfy, which I safely skipped mentioning .After all these they will have one compound they can take to market  if they are lucky enough

The interesting thing here is the points from 3 to 8 takes a good FIFTEEN YEARS off the total 20 year patent period and in addition to this they spend hundreds of millions of money during this term.

Guess what?

They have to see revenue in the remaining 5 years before others start reverse engineering it. That’s the story behind the costing.

Secondary usage of health records is a key answer to reduce the years of clinical trial, we will see what Secondary usage means, soon...

Know Healthcare 1 - Wellness Programs

Wellness Program: One of the prime ways to keep the healthcare cost low is by helping people stay healthy so that they never visit hospitals. This idea is in line with “Prevention is better than cure”. In US especially, to reduce the health care costs, government is encouraging corporate and other work places to provide an environment where employees can takecare of their health. This includes providing access to simple gym equipments,making “calories aware” food available in cafeteria and vending machines ,encouraging walking programs - like displaying ‘Park in distance, walk tooffice’.’Use Stairs’ sign etc etc. Government rewards such workplaces encouraging such practices and these are called Wellness Programs.