Mobile Health Information Commentary

(Unpublished draft, 2003)
There are advantages to being such an eclectic. When I figure out a complex topic like mobile health information, I want to share it with the very diverse audiences that need to know about it. Requirements analyses, lifecycle documentation, web-based training, and white papers rise out of the same inner drive: To communicate important information to a particular, clearly-identified audience, following a definite structure, in the way that audience can best integrate it.

Mobile health has caught my attention both for its great promise, and for its even greater complexity. The most successful mobile applications are demonstrating phenomenal ROIs. However, as with any dynamic technology, many more implementations are not successful.
To paraphrase a famous quote, the problem is not in our tools, but in ourselves.
Translation: More projects are defeated by poorly understood and articulated requirements and desired outcomes, than by leaning too far out over the leading edge.
These results are exaggerated in health care, especially when too much is riding on the outcome. I've also been investigating HIPAA, the 800 pound gorilla that's been snarling at health care information of late. I'm starting to think of a use for that Introduction to XML I had a few years ago.
There I go again--start out with a simple request, get off into an essay. Later for that.

Attn.: Steven Ortquist, Banner Health, re invitation to "Please send HCCA your HIPAA Privacy-related documents," based on my thoughts in response to this article:
Wireless health driven by HIPAA (Google search)... that lets anyone into the network." Most of the mobile ... We are integrating the handheld with our internal ... For now, Concentra's WLANs are HIPAA-compliant. ...
www.infoworld.com/articles/ct/xml/02/04/08/020408ctwireless1.xml

I'm an IT analyst studying aspects of HIPAA, toward extending my consulting practice. With HIPAA, a new word is about to enter the lexicon: Mobliability. That's Mobile Liability. "Authoritative" pronouncements about mobile health care are being made daily by writers who reveal their weak understanding of IT basics. Do health care information specialists notice the same weakness in health care knowledge among IT commentators?

My comments follow the relevant passages in italics:
Michael E. Stull, a principal at eHealthcare.net:
"Users will have to master authentication and, for example, turning on the ability of the system to use the access control lists of the MAC [media access control] address of the network card [used in] accessing the LAN."
Hey, who you callin' a user, pal? You're describing a job for a very experienced network engineer. Not what I'd consider a "user". And where'd you learn sentence structure?

Next: "Most of the mobile road map has been laid out for Concentra. The first leg of the journey was to eliminate an expensive medical transcription system that cost $3 million to $5 million."
Two misleading statements in a row. First, this is Why, not How. Second, it's a destination on the map, not the route to get there.

"Concentra's programmers spent about five months building ChartSource with ...(various Microsoft tools listed)... and XML and XSL style sheets."
It should be mentioned that without XML and XSL, not only would HIPAA be impossible, but DHHS wouldn't have had the nerve to even suggest it. A common format--or language, if you will--is the key element in portability. Reminds me of an old stand-up comic introducing a speaker with the line, "Our dear friend HIPAA, without whom none of this would have been necessary."

"The point-and-click application allows a physician to click on a patient's name to display his or her medical history. "
Point-and-click? If they mean "squint and poke", they should say so. Design for the handheld interface is a demanding, specialized discipline that few currently possess, and the screenshots shown look indecipherable.

"After an examination, the doctor feeds the diagnosis into ChartSource as well as 'the completed and signed medical note and puts it back into our Practice Management System [database],' Wilson explains."
"Feeds the diagnosis"- how? Freehand entry? selecting DRGs or codes from a list?

Also, since this article targets IT and not health care, it needs to state explicitly that only the handheld can automate the entire data path, from initial generation through all possible uses. And, once automated, it can be controlled and secured.

"The customized system includes a decision-tree application for consistency in patient reports."
How does a decision tree make patient reports more consistent? Is this a health care-specific reference?

Like many of the HIPAA regulations, this issue (where to put the firewalls) is not clear cut.
As general and vague as the HIPAA regulations seem, two things are certain. These are:
1. The regulations apply consistently to all. So, for so many organizations to be pursuing compliance in isolation is an immense waste. The health care consuming public would be better served by the industry seeking optimal collaboration and community-building toward common solutions. And if DHHS is not ideally situated to coordinate this massive effort across all 50 states, what the heck is it there for?
2. The drop-dead compliance dates are eerily similar to that much-vaunted and maligned trick of the calendar we saw a few years back, Y2K. It's big, it's comprehensive, and it's absolute. And as a fundamentally simple thing replayed billions of ways, there are just a few ways to do it right, and billions of ways to screw it up.

A final thought: When health care folks need new information to respond to a challenge, they circle the wagons and have a conference. My instructional strength is in e-Learning, so by contrast, my first impulses would be to:
1. create web-based courseware to increase the shared baseline of expertise across the varied disciplines;
2. host virtual events to build and strengthen the community of interest; and
3. invest heavily in Web-based portals to build the community of practice that will get actually the job done.

And, do you know what the outcome of all this working together will be? DUH-UH -- shared, portable health information! Remember, the P in HIPAA does NOT stand for Privacy, it stands for Portability. Isn't that what HIPAA was supposed to be about?