Healthcare Innovations

Patient-Centered Medical Records

Being able to access our medical records is not the same as being able to use our medical records.

Linux Journal: The Patient as the Platform, 2008-Jun-24, by Doc Searls

I believe that having a data store for health records is a necessary but insufficient condition for the true independence and control required for each of us to be the point of integration for the health care we get, and the point of origination for controlling that care — for getting second and third opinions, for summoning data across bureaucratic boundaries, for actually relating to the systems that serve us, rather than serving as dependent variables within them.

For patients to become platforms, we need more tools and capabilities that are native to the patient. All of us need to be able to walk around the world with the ability to jack into any health care system and drive it. How? I don't know yet. I'm still new to this. But I do know that these are capabilities we need to add to ourselves, as independent drivers of health care services. And that these must be based on free and open standards and code.

The new health care infrastructure must be built on independent and autonomous patients, not on systems that surround and subordinate patients. Once it is, the systems will be vastly improved, and far more profitable for all.

We cannot fix health care only at the institutional level. No company and no government agency can fix health care, any more than any company or government could fix networking or computing. Those had to be fixed by hackers building solutions for everybody and not just themselves. (Even if they were just "scratching their own itch".) Today the Internet, Linux, and countless free and open source code bases are core infrastructural systems on which civilization itself relies. The amount of business this vast and growing infrastructure supports so far exceeds the amount it undermines and obsoletes that it's silly to even bother doing the math — if it could be done in any case. One might as well argue against the Big Bang.

Real Innovation: Pushing an Idea into Reality

I first heard about the Eden Alternative when Fast Company magazine did a profile of Bill Thomas. Too bad you can't see the fabulous photos online (Fast Company didn't purchase online rights to the photos). Those images of elderly people people living with their caregivers in a garden-like environment took hold in many people's minds. The original concept has taken a big journey and is now the basis for numerous experiments in healthcare.

WSJ.com: Rising Challenger Takes On Elder-Care System. 2008-Jun-24, by Lucette Lagnado

Robert Jenkens, who is spearheading the Green House project at NCB Capital for Robert Wood Johnson, says that some not-for-profits and at least one for-profit believe the model to be financially viable. St. John's Lutheran Ministries in Billings, Mont., operates both a nursing home and some Green Houses. In an internal review, officials found that it cost $192 a day to care for a resident in the traditional nursing home versus $150 a day in their Green Houses.

While building costs were high, Vice President David Trost says the Green House model also has cost savings. "We no longer have to take a resident 200 feet to the dining room -- we only have to take them 20 feet, and that is significant," he says.

Robert Wood Johnson executives say financial sustainability is a question they're scrutinizing intently. Based on this "first round" of Green Houses, they believe that it is financially doable, but they are rigorously testing the model and developing software that should help providers determine whether they can handle Green Houses financially.

How Health Care Ought to Change

Rather than parse the candidates boring, calculated to get funding and votes policies, the Institute for Alternative Futures is drafting its own idealistic policy. Four of the nine papers have already been published. Enjoy!

Institute for Alternative Futures.

IAF is looking forward to the 2008 U.S. Presidential Election with a forecasting project to guide those who will transform healthcare with clear and compelling descriptions of a system that works for all. Over the course of 2008, IAF will publish a series of papers addressing nine key transformations. Click on the papers outlined below to learn about key changes needed in our healthcare system to create a better healthcare system in 2019.