Four Reasons Why Open Source and the Internet Must Play a Role in Medicine

CIO John Halamka explained lessons that hospitals and healthcare can learn from open source initiatives, including why online medical records can ensure a better healthcare community.

It would be nice if medical professionals never lost patient information. But unfortunately, doctors and other healthcare specialists are only human. And the running cliché that doctors' handwriting is hard to read is often repeated for a reason. During his presentation at the Red Hat Summit in Boston, Dr. John Halamka, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center, discussed four key reasons why medical records should be stored online. Storage, compliance, patient access and community are among the (supremely productive) Halamka's supporting reasons for his claim that online medical records will ensure a national standard of healthcare.

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Privacy issues are likely to arise, he admitted, but they can be worked out, and the benefit of better organization of our medical records would be phenomenal. "Open and transparent is good," Halamka explained to this open-source-centric audience. "Proprietary is bad."

Issues with Storage

Online medical records will help with storage issues concerning patient files. Today, most medical practices write patient information on paper and store each patient's files alphabetically. Records are faxed to new medical offices when patients move, and aren't even passed along that quickly if a patient enters a hospital emergency room. Equally of importance, pointed out Halamka, if a medical office doesn't survive a natural or accidental disaster, what happens to the records?

Furthermore, he said, medical records aren't stored forever. Although it's obviously important to keep a personal copy of medical records, if professionals could look up a patient's information online it would speed up the medical process. While having an RFID (radio frequency identification) chip installed in one's arm for instant identification might seem too Gattaca-like for some users, storing medical records online for instant access is more necessary than ever.

According to Halamka, an estimated 65 percent of U.S. citizens believe that doctors keep electronic records, while only about 15 percent of doctors really do . Why? For one thing, it's expensive; doctors have to subscribe to services that update medical transactions. One answer, Halamka suggested, is for hospitals to give the needed software to individual medical practices so these updates can take place. He suggested that the Internet could—for free—use SOAP and https standards to get the job done more efficiently and affordably.

Nor is the storage issue apt to let up anytime soon. The state of Massachusetts requires that hospitals save all patient data for 30 years. "We've just crossed the half petabyte line" at Beth Israel Deaconess Medical Center, Halamka explained. In addition to the hardware requirements, he said, the knowledge-base challenges mean "whole new areas" for service oriented architecture and software as a service.

Compliance Benefits

The relationship between doctors' offices, hospitals and pharmacies would be greatly strengthened by online medical records, Halamka believes. Right now, each entity generally acts alone (aside from the all too often occurrence of a medical practice prescribing a drug based on a relationship with a pharmaceutical company), Halamka pointed out.

However, storing medical records online will allow medical professionals from different offices to access patient records without needing to contact one another, speeding up the "paperwork." In turn, patients could know that any medical professional that they visit will begin with the same information.

Patient Access

By "eliminating the clipboard," as stated by Halamka, patients could easily access all of their personal medical history. They — and their doctors — will be able to see the dates of their last vaccinations, and even their genome information. Halamka showed his own personal data from Google Health, demonstrating the XML-based display of his lifetime medical record. It's a pure XML/XSL structure, he pointed out, which is vocabulary-controlled. Direct access to medical records will allow patients to know exactly what's going on, said Halamka. Instead of having to call a doctor and be put on hold while someone searches for their information, patients will be able to log into and update their medical information from home anytime they want.

A Better Sense of Community

Making better use of the Internet also includes improving hospital websites, Halamka explained. Websites should be formatted more like social networks, so a community feel can take shape between professionals and patients.

The United States needs to set the same health standards across the country and the Internet is one way to truly bring more organization to light. Right now, 500 organizations are collaborating to create standards, and as Halamka joked, it's harder than trying to get that many people to agree on lunch. Halamka is himself active in the American Health Information Community and leads the Health InfoTech standards panel. This isn't just about personal data, such as a patient's cholesterol tests or the drugs he's taking. The standards under review include standards for telemetry, vaccine transmission, and public health data.

"Healthcare interoperability requires open standards, developed in a transparent way, by a community. It requires reusable components and tools which accelerate technical connectivity and data sharing. The Open Source movement embraces all these principles," Halamka said, "so I welcome their contributions to the work connecting payers, providers and patients."

Senior Editor Esther Schindler contributed to this report.

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