eHealth vanguard

July 3, 2008 at 2:56 pm 2 comments

Being focused on personal genomics and its developements through the past few month, it is more than ever good to keep an eye on health data management. Indeed, personal genomics will generate huge amounts of data. It may be useful to realize that, in the same time, some try to build medical data sharing systems. In this article (maybe a bit longer than previous posts), three systems will be compared:

  • US health data management
  • Google Health
  • Belgian electronic health platform: BeHealth

Of those three systems, the belgian one seems the most vanguardist for several reasons that will be covered in the next lines.

1. US health data management

The United States is the only wealthy, industrialized nation that does not ensure universal health care coverage [1]. The US system causes problems to many patients and their providers. They experience problems with care coordination. In fact there is almost no coordination at all. For example, a Harris Interactive survey of California physicians found that:

  • Four of every ten physicians report that their patients have had problems with coordination of their care in the last 12 months.
  • More than 60 percent of doctors report that their patients “sometimes” or “often” experience long wait times for diagnostic tests.
  • Some 20 percent of doctors report having their patients repeat tests because of an inability to locate the results during a scheduled visit.

On another hand, SERMO, an American medical social network, offers its customer (65,000 physicians) to share clinical insights, observations, and review cases. Members must be authenticated as US licensed physicians, based on Social Security Number. Although this system is a good opportunity to share knowledge and even launch clinical trials, this is not really a universal health data management system. Patients have no access to it. Strictly speaking, there is even no “patient record”.

There is thus no integrated, global solution in the USA for health data management.

2. Google Health

Google Health is yet another Google app intended to provide PHR (Patient Health Record). At the opposite of SERMO, it is patient-centered. Even more: the patient is in charge of everything, so that in fact there is no real control on what is true, false, relevant, etc. in the record. The patient is thus responsible of the information his record contains. What interactions are possible with that PHR? Google Health offers to:

  • Search for a medical care provider
  • Import medical records and notices (only from some affiliated US services)
  • Send your information to some affiliated US services

Google Health is not intended to facilitate communication between several specialists or between your physician and some specialist, etc. You have to give the information to the right person(s). A major drawback of Google Health is that the user may feel lost with medical terms. Dealing with medical conditions, lots of names are rather technical. For example, it may be difficult not to get lost in the middle of the 17 types of Anemia listed. The same problem occurs with medications, immunizations, etc. Finally, there is no sign of a potential genomic data integration.

The PHR offered by Google Health is thus a good information management tool (after all, that’s their job) but the user may have a bad experience and feel uneasy with it, being no medical professional. No control about veracity of the information is performed. The integration with other services is really poor. Above all, it is questionable if it is a good thing to send all your medical information to the online advertisement company…

3. Belgian electronic health platform: BeHealth

Belgium has a centralized, universal coverage health care system. Its social security system is one of the most advanced in the world [2]. Every belgian citizen has a social security number and most of the health cares are free of charge.

Family practitioners, hospitals, specialists, social security, all maintain records about parts of the medical history of the patients. Those records are managed by professionals which offers a good quality and relevance of the information. Records are thus not under the patients responsibility but, as a trade-off,  are also fragmented. There is no or few centralization of the patients data. This guarantees privacy but is also an obstacle to more efficient medicine.

A new eHealth project of the Belgian federal government, called BeHealth, is currently being developed. The aims of this platform are:

  • Quality and coordination of health care optimization
  • Patients security optimization
  • Administrative procedure simplification for all actors in the medical field
  • Optimally support health care policy

How will it work? Not by centralizing all the information: this is far too dangerous for privacy. BeHealth will be based on the principle of data exchange between all the medical field actors while guaranteeing the highest standards in terms of security and privacy.

What BeHealth won’t do:

  • Bring modifications to concrete organization of medical cares.
  • Record personal data in a centralized way (what google health does).
  • Monopolize medical electronic services.
  • Realize itself studies and lead experiments on patients data (what sermo does).
  • Take part to political choices or influences.
  • Be technology-driven (what google health is).

This project will allow the routing of appropriate information to medical providers, communicate anonymized data to some (approved) research projects, control the legitimity of access to patients information. More information (in french) here. Since it is based on a collaborative framework, it makes room for every type of medical data, including genomic data. An actor such as GeneTonix (which is a european company with nearly the same objectives as 23AndMe, Navigenics or deCODEme) could fully integrate personal genomic data into BeHealth services.

The Belgian system seems more advanced than the American one. The Belgian project BeHealth is not yet fully implemented. On June 12, Laurette Onkelinks, belgian public health federal minister anounced that a special series of laws to fully integrate BeHealth are going to be discussed. We will follow BeHealth development in the next months with interest.

This article is not exhaustive and it is probable that comparable system already exist in other countries. What about Canada, Australia, …?


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