Monthly Archives: December 2016

The Evolution of Patient Health Information (PHI) From a Sailors Point of View

stock-photo-healthcare

In my opinion patient health information should be first used to save and protect the health of patients. That’s not quite what it says in the Hippocratic Oath, I’m just paraphrasing. Secondly, it should be used to provide data analytics for trends good and bad within the healthcare system.

Similar to the late great, Aaron Schwartz, a member of the Internet Hall of Fame, we should legally hack healthcare data looking for good and bad data. After all, you can’t fix what you can’t measure. Unfortunately, modern healthcare is set up in silos.

In case you don’t know who Aaron Schwartz was, he was a computer genius that hacked the MIT Library, which is free information, of all the academic journals in medical research. He wanted to see if research journal papers matched up to their research results. He thought many journals were misleading so that the researchers could obtain more research funding.

I truly believe Patient Health Information (PHI) holds the key in helping the doctors service their patients more efficiently and effectively. For example, how many lives would have been saved when the allergy medication, Seldane, was on the market? They found out it was bad for the heart, but even worse if combined with a certain antibiotic. I took Seldane for a year before they took it off the market. Hundreds of people had to die before they noticed there was a trend.

Birthplace: U.S. Naval Air Station, Quonset Point, Rhode Island, 1965

According to my mother, I was born at Quonset Point, Rhode Island U.S. Naval Air Station in 1965. My mother carried me and my military medical record around, while my father was overseas protecting the National Science Foundation in Antarctica with Operation Deep Freeze. I know that sounds like a comic book title: Operation Deep Freeze, but it’s a thing, you can google it. Since I was born only 4 pounds I had to stay in the hospital for a while in an incubator. They let my Mom stay with me because my Dad was overseas.

Then I went to Newport Naval Hospital nearby to deal with more complications as a premature baby. Today it looks like I’ve more than made up for being premature at birth at just over 200 pounds. From the time I was born and until I was 20 years old, I had only visited Naval Hospitals and Naval Clinics. I remember my mother carting around a brown folder with all my information in it when I was only 6 or 7 while we lived on the island of Guam from 1971 to 1973. Then it turned to red folders when we moved to San Diego at age 8 to age 18. The benefits of a full-fledged Navy brat.

Childhood Hospital: Balboa Naval Hospital 1973-1984

Growing up in San Diego, I remember the folder turned red. And I remember all the clinics and hospitals. I remember one hospital in particular, which is Balboa Hospital, officially National Medical Center, San Diego. Apparently, I almost died at age 14 from an unusual infected cyst that was going to my brain, which prompted emergency surgery while I was in junior high. I had been lanced a couple times late at night with local anesthetics, until they decided to surgically remove them. At age 14, I was too old for pediatrics and too young for the adult ward. I was on an island by myself, afraid of needles, afraid of local surgery, and horrified by suture removals. The red folder followed me wherever I went in Naval Military hospital land. From ear infections, bronchitis, broken thumb playing Little League baseball, I had no idea what was in that folder. It could be Chinese for all I know.

I graduated from high school in 1984 and completely forget what happened to my little red folder. I had a scholarship in Theatre Arts, I was going to be famous, but only succeeded in being famous at frat parties and coed dorms.

Navy Recruit Training Command, Orlando, Florida 1988

After seeing the world in 1987 and 1988, which included Virginia Beach, San Diego, and Tijuana, I made the decision to join the Navy. Because that is the natural thing you do when you drop out of college in your third year.

In April 1988 I joined the Navy with a guaranteed crypto tech school because I scored high on the Military ASVAB test. Right away they issued me this blue military patient health record where they detailed all my vaccine inoculations and doctor visits. They detailed the removal of my wisdom teeth because no sailor can be at sea with the possibility of a wisdom tooth removal. We were ordered to carry that folder everywhere we went when we had check-ups and visits at the Navy clinic.

Unfortunately, the Navy billet for crypto tech at that time was full, so they made me choose another school. I had 24 hours to make a decision. Keep in mind I was already halfway through boot camp. I walked back to my barracks a little dejected and stressed. I thought about choosing the Seabees (Naval Construction Force) because my grandfather was a carpenter, and he thought I would be a great carpenter because I could draw a straight line without a ruler. Then I thought about Aviation Boatswains Mate, like my dad, but whenever I went on dependents cruises with my Dad on aircraft carriers and LHA’s, I got sea sick.

So I had an epiphany, and in milliseconds I asked my shipmates which schools had all the girls. At the age of 22, that seemed like a logical question to ask. Someone yelled out Hospital Corps School, and within 5 minutes I went from dejected to gung-ho motivated for Hospital Corps School. I forgot about almost dying. I forgot about the sharp needles. I forgot about all the blood. I was going to be a Navy Medic.

Naval Hospital Corps School, Great Lakes, Illinois 1988

My shipmates were right. Hospital Corps School was where all the girls were. Good times. Met my first fiancé there. My father was completely baffled as to how I became a Navy Hospital Corpsman because he remembers how terrified I was as a teenager of anything sharp or painful. I never thought of it that way, I just kept it moving. It’s a skill I picked up in boot camp. We learn to do things we thought we would never do. We adapt, and we overcome.

With my blue military health records in hand, I was shipped off to Great Lakes, IL Hospital Corps School, Recruit Training Command, (A) School. At Hospital Corps School we learned things equivalent to a legal practical nurse, emergency medical technician, and combat medic. So writing SOAP notes was a breeze. Patient assessments were a breeze. Basic medical treatment from a field perspective is what we gained. Stopping a sucking chest wound with a credit card was par for the course.

Graduation Photo, Hospital Corps School 1988

First Duty Station, Naval Air Station, Jacksonville, Florida 1988 – 1990

My first duty station was at Jacksonville Naval Air Station, Naval Hospital. The wards were completely over staffed, but they needed manpower in the Ophthalmology Clinic. I bypassed traditional nursing duty and went straight into a specialty. That meant more administrative work, and less hands on patient care. Don’t get me wrong, scrubbing for micro surgery around the eyes in the 80’s was cutting edge. I was there when radio keratotomy was first performed (the precursor for Laser eye surgery) and got to scrub for cataract surgery, glaucoma lens implants, and plastic surgery around the ocular region.

I still have my blue medical records, but now I am also writing inside military medical records as I check people into the clinic, civilian and military. My commanding officer at the time is responsible for the best and worse times I had in my Naval career. He didn’t like me, so he made my time at his command miserable, but he also introduced me to Information Technology in a very unorthodox way. He had me copying government floppy discs to his home computer. Yes, I was commanded to bootleg Microsoft product to his home computer. At the time, I didn’t know what I was doing, but I learned quickly once I left the Navy 3 years later. He also was responsible for showing me my first fax machine. I had to run to the second deck to retrieve his faxes for him on a regular basis.

During that time, I was one of the first Navy Corpsman trained on the Composite Health Care System (CHCS), which was created by Science Application International Corporation (SAIC). CHCS is still used all over the world at military hospitals and clinics. It is basically the Department of Defense’s glorified EMR system for healthcare. The workflow it provided helped us tremendously with efficiency because in the military we have a saying, “hurry up and wait”. Back then you carried your medical record around to the next cog in the wheel in the hospital. Then you had to wait your turn as they manually wrote in your order on a clipboard login sheet. CHCS sent those orders electronically, so your order was in process while you were on your way. At the time it was a very big deal because I was ordered to do all those things manually. That whole experience fueled my interest in computers.

One of my fondest memories was standing duty on nights in the maternity ward, where every newborn had to have a medical record put together as a new patient at the hospital, done by yours truly. The reason why it was fun is because my fellow corpsman was holding the newborns, and would tease the new babies with his fingers around their mouths. The babies trying to put the fingers in their mouths was instinctually funny and cruel.

Medical Laboratory School, Fort Sam Houston, San Antonio, Texas 1990

By the end of 1989, I was over my commander, and asked to go for an advanced school because I knew I was getting out that canoe club. So they shipped me out to Fort Sam Houston, San Antonio, TX to Medical Laboratory School. Yes, the Navy trained some of their medical lab techs on an Army base. My classroom consisted of Army, Navy and Coast Guard. That class was a little more difficult, but I passed.

After I graduated, I got married in between school and my next duty station, and I landed in Norfolk, VA. Guess what? Not only did I have my same old little blue folder, my new wife got one when we arrived at my new duty station the first time she got sick.

From behind this window, we processed over 8 million laboratory specimens in support of Operation Desert Storm / Desert Shield. Every physical for sailors leaving out of Norfolk prior to heading to Iraq was done right here.

Sewell’s Point Naval Branch Medical Clinic, Norfolk, VA 1990-1992

Sewell’s Point Branch Medical Clinic is where I realized all my hard work in Jacksonville paid off. I did half the work and got promoted faster. On graduation day Saddam Hussein invaded Kuwait, so 75% of my class shipped out to Fleet Hospital 5 in Saudi Arabia, while I remained States-side in support of all Naval and Marine physicals going in-country. After learning the ropes, I dealt with a much older EMR system there, and it didn’t take long for me to figure out short cut codes to speed up the process. I shared the codes with my shipmates and got noticed by the new department head, who decided to promote me to Petty Officer and recommend me for Blue Jacket of the Quarter in April of 1991.

In the military, when you achieve awards, they give you more responsibility, so I lead the HIV blood drawing team which consisted of me and a Navy truck driving to all the Navy bases in Norfolk, Virginia Beach, and Portsmouth drawing blood for the annual HIV test. Another responsibility was being a member of the Broken Arrow Response Team (BART), which allowed me to wear a yellow hazmat suit just in case the Navy dropped a warhead from Virginia to Maine during Operation Desert Storm / Desert Shield.

Not only was I carrying my blue folder everywhere, so was my wife. But at work I dealt with a whole different set of documents concerning laboratory results from lab tests we performed. Believe it or not, everything was handwritten, then manually typed into the system. There was a document for every type of test. It was way more complex, and you had to pay close attention to detail, because one decimal or digit out of place could kill a patient.

When it was all said and done, I had made petty officer third class, received 3 letters of commendation, a good conduct medal, and Blue Jacket of the Quarter for April 1991. I loved the work so much I continued being a medical laboratory technician for a couple of years after leaving the Navy in May of 1992.

Places I worked at included:

·        Sentara Health

·        GW Health Plan

·        George Washington University Hospital

Life as a Civilian 1992

There are two things I miss about the military, and you don’t realize it until you get out.

Standard Operating Procedures (SOP)

Every job in the military has complete instructions about how to do that job. It is in a manual form, and some of it is stenciled on the wall in front of you. Completely idiot proof. In the civilian world, you would be hard pressed to find such detail about a job. It does not exist.

Military Health Records

I don’t recall ever having a standard medical record when I got out of the Navy. Once I lost my military medical record, I never had one after that. I’m sure I could get the VA to send me a copy, but I wouldn’t count on it. Every health clinic or hospital I went to kept my records to themselves.

A Career in Information Technology

In 1994, I started my career in Information Technology starting in Canon Copier and Laser Fax sales in Washington DC. Then onto Computer City Business Sales in Tyson’s Corner, VA. Then I got my break at AmeriData Federal Systems, selling hardware and software to the federal government on GSA Schedule, and the rest is history. I have been selling information technology solutions since 1994 until today. Not much has changed, except in 1996 and 2009.

I went from selling hardware and software, to selling services in the form of Managed Services and Cloud Computing. Somewhere along the way, I lost track of my blue military medical records. Going to civilian hospitals and clinics was based on which insurance my company provided. Changing jobs meant changing HMOs, which meant changing doctors periodically. If you had a pre-existing condition sometimes it was hard to get the medical records from previous physicians.

Every clinic and hospital had their own system, which worked for them and not for the patient. Then the Internet changed everything. All of a sudden PHI was exposed in unfortunate way, and something had to be done.

In 1996, HIPAA, which stands for Health Insurance Portability and Accountability Act of 1996 and is United States legislation that provides data privacy and security provisions for safeguarding medical information, was created by lawmakers.

·        Title 1 – Dealt with health insurance portability in the event you lost or changed jobs.

·        Title 2 – Was more about preventing fraud and abuse with PHI.

I’m guessing PHI was escaping the confines of the healthcare industry because the Internet was just in its infancy. Emails were a new thing. It would take much to get access to someone’s Patient Data and spread it all over. Personal Health Information (PHI) is not supposed to be accessible to the general public. Only the patient, their doctor, and auxiliary health care partners are eligible to access PHI in a secure manner.

Thirteen years later in 2009, there is an addendum to HIPAA with the HITECH Act, which addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

The Health Information Technology for Economic and Clinical Health (HITECHAct, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

Can your fax machine land you in jail?

In other words, too much information about patient data was being exposed via fax machines and emails. You must not allow PHI out in the open public. It must be secure behind encryption in storage and in transit, whether by email, fax machine, cloud fax, cloud storage, or just data residing on a computer unencrypted, or it could be deemed out of compliance with HIPAA.

 

 

After 22 years I’m back in Healthcare

In 2016, I was invited to be a guest correspondent for two magazines at SXSW. One of the start-up companies I was interviewing was called Simplicity Health Systems. You may have seen my blog about them earlier this year. That interview for an article turned out to be a job interview for me. Life is strange in a weird way because you never can say never. I had no intentions of returning to healthcare in any capacity, but yet here I am. Does this mean I’ll take up dancing again? Probably.

For some reason the planets aligned where I had the right information, the right connections, and the right conversations, at the right time. All this has led to a partnership with CenturyLink Cloud, the third largest telecommunications company with a thriving Cloud Marketplace. Last November, Simplicity Health Systems went live in the CenturyLink Cloud Marketplace.

My job is to help healthcare organizations communicate with their healthcare business partners in a HIPAA Compliant manner. Simplicity Health Systems builds adapters for email, fax, and data via EMRs. We connect everybody for less cost than the leading providers. We are not an EMR, but we make EMRs better. My job is to also keep healthcare workers out of jail for HIPAA Violations.

Looking to the future of PHI

When I was in the Navy we had a saying if things were fouled up or someone was doing something bad, we would say, “Not in my Navy!”. I believe when Healthcare professionals realize things are fouled up and people are doing bad things, they should say, “Not in my Healthcare!” Now that I am back in healthcare, I have started to remember what bothered me the most about leaving the military structure:

·        the lack of Standard Operating Procedures

·        the lack of Standard Medical Records

They don’t exist in the civilian world. With new technologies like encryption, smart cards, and mobile devices, this should have been resolved a long time ago on a national scale. Even some countries in Europe have their medical records on a smartcard. Working with Simplicity Health Systems has proven to me how important it is for the patient, and all health care organizations, to have effective, and streamlined communication of PHI.

There is an immediate need for effective communication, which involves direct patient care. If a patient can’t have access to historical data about their health and heredity, how effective will the present treatment be? There are population health needs to use data analytics on a large scale to detect trends good or bad for cities and rural areas. If you can’t measure it, you can’t fix it. With all this patient data tied up in silos whether political, geographic or economical, it is of no use trapped inside.

For the last 10 weeks that I have been working with Simplicity Health Systems, I have come to realize it is not enough to talk about the fear of a HIPAA Audit. I’ll save that for another blog. What is truly more important is that we are not providing the best possible healthcare with trapped PHI. Here at Simplicity we connect to everybody in a safe, secure manner at an affordable rate. We should be coining it, but the sad truth is healthcare needs to know that things can be better. Right now their job is so complex and busy, they do just enough to avoid fines.

In conclusion, I have lived on both sides of the fence of healthcare: civilian and military. The way we handle PHI will determine how well we treat our patients. In the computer business we say garbage in, garbage out. If you have incomplete PHI, your patient care will be incomplete. I envision a smarter more technically advanced method of delivering healthcare. The truth is we just need to adapt better technology that has been in existence for at least a decade.

Until such a conversion is complete, I will just shake my head while the nurse faxes my prescription over to the pharmacy. If you, or someone you know, wants better patient outcomes, feel free to contact me for a demonstration.

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