May 06 2014

VA Prepares for an Influx of New Health Data

Patient-generated data will transform care, as long as health agencies can handle it.

The Veterans Health Administration has done a lot to exploit information technology for the benefit of military veterans. In the year since its founding, the VHA’s Connected Health program has seen its Home Telehealth, Mobile Health, My HealtheVet and other initiatives make significant strides in improving care through electronic health technologies.

But there’s one technology that could surpass them all, according to Kathleen Frisbee, co-director of Connected Health: patient-generated data.

“Patient-generated data is going to be the thing that really transforms healthcare,” Frisbee told attendees of the GITEC 2014 Summit in Baltimore. “We predict patient-generated data will be much larger in volume than electronic health records.”

That’s no small statement coming from an executive of the Veterans Affairs Department, which has been handling e-health records (EHRs) for 25 years.

“The key for us is to architect it right, make it secure and help people understand how it should be used,” Frisbee said.

Frisbee sees a time when patients wear patches that automatically — and constantly — send health information into a patient-generated database. Such data would then be combined into patients’ electronic health records to improve care.

“Everything we’re doing has to converge with the new EHR that the VA is building,” Frisbee said.

In February 2011, VA and the Defense Department launched a program to develop a single, common electronic health record system to replace their existing EHR systems. They have since decided to pursue separate EHR systems, with VA issuing a “sources sought” notice for its solution earlier this year.

“All this data is coming from those wearable devices, from home monitoring equipment and from mobile apps,” Frisbee said. “All of it’s going into this big NoSQL database. The problem is that we have to figure out a way to understand conceptually how that fits with the electronic health record. Remember, up until now the EHR was it. That was the world for clinicians.”

Avoiding Information Overload

Key challenges to introducing patient-generated data into an electronic health record include standardizing information (“You can’t get into that database unless you follow our standards,” Frisbee said), building the proper service-oriented architecture and establishing rules and governance.

“What are the rules for when a provider is required to look at [patient-generated data]?” Frisbee asked.

The VA has decided on a model that will not inundate healthcare providers with alerts to fresh information, which could be generated several times a day as more healthcare devices come online. When a patient enters data into the system, a provider can either subscribe to that data and receive updates (an opt-in model) or simply look at the data as needed, such as prior to patient visits.

Eventually, VA wants to make sense of all this patient-generated data. “We’ve focused a lot on looking at how you analyze this data,” Frisbee said. “Taking NoSQL data and trying to figure out a way [to present it] that’s meaningful for clinicians and patients, but not overwhelming.”


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