This document outlines risks and opportunities associated with the increasing complexity of health-related information sharing as records move to electronic formats. It notes that while electronic records provide opportunities to capture, store, share and use data in new ways, this also creates new risks from issues like data breaches and defining standards of care. However, the larger databases and connected networks also enable opportunities to more easily find needed information, conduct research across larger populations, and better inform patients and providers. The document acknowledges that while many have discussed these topics, taking a broader view of the many interconnected elements is novel and where risks and opportunities arise.

1. Risks and Opportunities Map Health Related Information Ancient map makers drew whatthey knew and then noted: Beyond here there be dragons! This map acknowledges that there are, to this day, dragons.

2. Agenda: A Large and Growing Market The Historic Simple Map The Near Term Complex Map Risks: Litigation Risks: Data Sharing Opportunities: Better Needles & Haystacks Opportunities: More & Better Data Opportunities: The Power of Large Numbers Medical information is rapidly moving from paper records to electronic formats and new sources of information are being added. The electronic formats provide opportunities to capture, store, share and use information in new ways. These new ways create risks and opportunities. Most of the elements identified and discussed here have been identified and discussed by others. What is new, is a broader view of more elements at the same time and their interdependencies. It is these interdependencies that pose risks and create opportunities.

3. Health Information: A large and evolving market Part of $19 billion for Medicare and Medicaid Health IT funded by the American Recovery and Reinvestment Act of 2009 Hundreds of independently developed electronic medical records systems being offered in the market place; scope ranges from single practitioner systems to systems for hospital groups One vendor claims 30,000 doctors; their system is free and revenue from the health information is part of their business model* There are evolving changes in provider/patient interfaces § and new, non-traditional formats for routine delivery of health care There are “captive” and independent information systems for participants: Google Health and Microsoft Health Vault dominate Telemedicine, a major source of data is now a $3.9 billion category

4. The Historic Simple Map

5. Structure: Near-Future Complex Map Dozens of providers share data (not files) about a participant. Participants have data too.

6. Major Elements: Near Future Model

7. HistoricSimple Near FutureComplex Beyond herethere be dragons

8. Increased Complexity = Increased Risk

10. Better standards for care – what is required?

11. Better records about what happened.

13. Increased Participation, Connectivity, & Database Size = Increased Opportunity

14. Increased Opportunity Better ways to findneedles of information …

15. Increased Opportunity … in more large haystacks of data because of large populations and centralized databases.

17. Telemedicine

18. Urgent care facilities

19. Intel’s studies on ageing

23. Increased Opportunity Increased sharing of Information among participants, e.g., PatientsLike Me: better informed andbroader choices

24. Increased Opportunity, Better data to set standardsof care for management, insurance and litigation

25. Increased Opportunity The power of large numbers: Search for 1 patient in 1,000 Database of 30,000 doctors 250 patients per doctor Find 7,500 candidates

26. Healthcare Information Increased Complexity Increased Risk Increased Opportunity … and dragons

27. Practice Fusion: Free EMRs http://practicefusion.com/ How Can Healthcare Software be Free? http://goo.gl/r9BP PatientsLikeMe : Patients Helping Patients Live Better Every Day – sharing personal health information: http://www.patientslikeme.com/ Patients Like Me Partners: With PatientsLikeMe, you get instant access to structured, real-world patient data — reported via clinically validated outcome management tools — as well as large, engaged patient communities. And you get it now, without the red tape. http://partners.patientslikeme.com/products/ Take health care off the mainframe A TEDMED presentation about Intel’s research using the way older people use their telephone to track changes in health. http://goo.gl/vALK Online Care: Internet links for doctors and patients http://americanwell.com/products.html References Contacts: LinkedIn EMRnet(blog: Exploring the value and complexity of networked electronic medical records) hal9007@gmail.com