Details of Good Idea: Computerized Medicine

Foreword

Index to Sections

• The Need for Computerized Medicine
• Requirements of Computerized Medicine
• Technical Approach to Deliver Comprehensive Computerized Medicine
• Business Aspects of the Venture
• Questions & Answers

The Need for Computerized Medicine

1. Patient medical records are not today well shared (if even at all) by medical professionals. For almost every new professional contacted by the professionals, patients are given medical history forms to fill out from memory (even through most of them could not spell their medical conditions correctly or even remember them all).
2. Test results have to be manually examined and added to the patient's records, possibly with special storage requirements (such as x-rays or EKG's).

3. Most records are chronological records that have to be examined in detail to find specific past conditions or tests. Indexing is very poor or non-existant.
4. Analysis accross patients of medical conditions and metabolisms are almost entire non-existant. So part of the medical process is trial and error trying to find solutions that will work, whereas is better analysis was available better solutions could be found sooner.
5. Medical professionals do not have immediate access to online medical libraries during patient consultations.
6. Lack of flexibility in the systems that do exist.

Requirements of Computerized Medicine

1. Easy access by medical professionals to all the patients medical information presented in usable formats.
2. Easy access by medical professionals to medical libraries to cross-reference symptoms and conditions with possible causes.
3. Uniform access by medical professionals to all test results of current and future medical tests and their related technologies.
4. Automated consultations with complete records made available to the medical consultant.
5. Patient medical information sharing between professionals.

6. Anytime anyplace access to patient's medical information by those authorization by the patient.
7. Automated analysis of tests provided to medical professionals including exception reporting.
8. Patient should be able to remotely access the system to report (with useful prompting) medical problems, symptoms, and concerns and to communicate with medical professionals.
9. Good cross-indexing and referencing accross the information is essential.

Technical Approach to Deliver Comprehensive Computerized Medicine

1. Develop Medical Enterprise Model - This model should represents how information can be related and referenced in a flexible, adaptable, and evolvable manner along with the main processes that interact with this information. This can be done through the establishment of an information technology team that works with medical professionals and develops an enterprise model for medical information (patients and their relatives), conditions/symptoms/diseases/remedies/etc, medical technologies (interfacing, tests, results, vendor info, equipment info), multiple medical providers (and their relationships), etc.) as well as the metadata necessary to permit flexibility in the system and the ability to adapt to future developments.
2. Assess Medical Technology (non-IT) - This can be done through the establishment of an medical technology team that would assess different medical technologies and the tests that they perform, how it works, how the resultant data is available and can be stored ahd shared in electronic form as well as what it means.
3. Assess Medical Information Technology - This can be done through the establishment of a technology assessment team that would examine existing medical databases, medical information systems, and medical office automation tools and determining their usefulness in this endeavor as potential joint venture partners, as sources of medical data, as potential partners to address the business side of medicine, and as potential systems to be interfaced to or converted from. The team should also assess medical data standards and the work of the OMG working group on Healthcare Technology.
4. Implement the Medical Database - This can be done through database development teams implementing parts of the enterprise model.
5. Implement the User and Technology Interfaces - This can be done through development teams focused on specific functions that would use the Medical Database and provide either for user-friendly interfacing to the systems capabilities for the users (doctors, nurses, staff, and patients) or data mapping and conversion for Medical Technologies. This could also be adapting existing information technology which provides these interfaces to use the comprehensive Medical Database.
6. Populate the Patient-Independent Medical Data - This can be done with medical analysis teams working with medical experts in populating the medical data, using existing databases as sources when they can be found. This information should be based off a universal database with automated updates to all medical offices as updates occur.

7. Gather Real World Feedback through Prototyping - This can be done through an on-site prototyping team that would work with real medical offices and facilities willing to serve as guinea pigs, would have the system installed and asked to provide feedback on what works well, what does not work for them, and how they would perfer it to work. The prototyping team would work with the development teams in making rapid changes to the loaded software to encorporate ideas and get rapid feedback.
8. Work with Medical Technology Vendors on Interfaces - This can be done with a medical technology team that works with medical vendors to standardize interfaces to their equipment.
9. Provide Technical Support - This can be done with a customer support team that works with medical professionals and eventually patients on issues with the system as well as the contained information.
10. Address Information Security and Universal Accessibility - Information security needs to be addressed, determining who has access to which information, who can make changes and additions, how authorizations. This can be done through an information security team that determines who has access to what information and how. In addition, a patient's information should be available to anyone whom the patient deems needing to know at time from anywhere.
11. Commercialization - At some point the product achieves commercial grade, requiring the full staffing to support commercialization of the product and the additional services that can be offered to support it.
12. Customer Installations - Implementation teams that would work with customers to convert their manual records to the systems would be essential, as are training teams to teach medical professionals on how to best utilize the system.
13. Patient Access - Develop the necessary tools to permit patient access to their information, the ability to report conditions, statuses, and concerns, as well as to communicate with medical professionals.
14. Automated Medical Analysis - With the data stored in a usable form, it is possible to develop applications to recognizing conditions from symptoms, predicting results of various treatments, flagging potential problems (for the particular patient), recommend particular tests, and other analytic tasks.
15. Medical Facility Layout Analysis - At some point, you may even want to experiment with how medical facilities are set up and test different arrangements of equipment.

Business Aspects of the Venture

Venture Options

1. Private Funding (requires the right contacts which I lack.)
2. Commerical Loans (tough to get right now even with a good business plan unless you have the right backers.)
3. New Venture of an established Medical Technology Provider (good option if you can find an right agreeable company.)
4. New Joint Venture of multiple Medical Technology Providers (spreads the initial costs among many players.)

Additional Business Aspects

Questions & Answers

• Q: Why did you provide more details of this idea?
  
  A: I had a Neuropsychiatrist express interest in this idea and ask for more details.
• Q: Did he have the will or means to implement your vision?
  
  A: He recognized that to do a comprehensive implementation would take a significant effort including a large upfront funding requirement. He was more interested in something that he could bring into medical offices today.
• Q: What is the state of technology of computer medicine?
  
  A: In the last ten years, a lot of different medical technologies have been introduced, some which are designed to share information with other computers. Medical administration has a lot of software available, but the clinical side has only limited computerization and automation of patient's medical records. The majority of the clinical automation consists of computerized note taking and limited interfaces to some medical technologies. A few go a bit further providing a more unified indexed patient records (to determine how flexible they are, I would need to examine the actual products and look at the metadata involved). Based on the research that I conducted, there is no true comprehensive approach towards computerized medicine going on today.
• Q: How are you qualified to speak about solutions for the medical field?
  
  A: While never working in the medical industry, I have a solid scientific foundation, am perceptive, understand technology in general and am capable of quality thinking on a multitude of topics. I have noticed a lot in the existing setup for the practice of medicine that does not well use computer technology to facilitate delivering excellent medical care.

• Q: Why will interfacing medical technologies into systems not deliver a well-integrated solution.
  
  A:The secret to good integration is a good understanding of the overall picture and how each part fits into the whole and incorporating the ability to adapt to the future. The majority of interfacing efforts attempts just to get the two systems to communicate and share data without addressing data normalization, data sharibility, future flexibility, and future requirements. Most integration efforts make future integration efforts more difficult, more time consuming, and more costly as they fail to address the future requirements.
• Q: What role can you play?
  
  A: I can head up the technology side serving as Chief Strategic Technologist of the entire effort, handling the techology side, working with the medical technology suppliers to interface to their products, and working with the medical community to understand the underlaying data structures to achieve the flexiblity that will be needed (including bringing in the experts in each area to properly address that area).
• Q: What is stopping you from implementing computerized medicine?
  
  A: I lack the funding and/or contacts to finance or establish the venture.