Wednesday, October 17, 2007

Information in a Heartbeat

Back in April, I announced the formation of a new service at Beth Israel Deaconess Medical Center, the Cardiovascular Institute ("CVI") . This unique new patient care program encompasses all of BIDMC’s cardiology, cardiac surgery and vascular clinical services. Perhaps a bit boastfully, but I believe accurately, I stated that "The CVI will provide patients with the highest quality care – delivered by some of the best physicians in the world – in an integrated fashion unparalleled anywhere in the country."

I explained to our staff: "This group will build an integrated program from the bottom up. It will reflect advanced technology and clinical practice, the skills and drive of our clinicians, and the underlying needs of our patients and families. By aligning the goals and daily activities of physicians, nurses, allied health staff, administrators and the medical center, the CVI will create new opportunities to promote quality and safety, improve efficiencies, serve a larger number of patients, and put into action the best practices in cardiovascular medicine."

The CVI has already made great progress towards these goals, but that is not why I am writing this post. I am writing to tell you about a thoughtful -- and patient-centered -- idea that has been implemented by Dr. Ralph de la Torre, MD, the CVI's president and CEO. You see it pictured above.

If you are a patient in the CVI, you will receive the red heart shown above when you are discharged. When you open it, you will find a memory stick with your own patient record recorded for your personal use. Let's say you leave to spend time at your winter home in Florida or go on vacation to Arizona -- or England --- and you need to see a doctor there, either in an office or in an emergency room. Rather than engaging in a cumbersome exchange of medical records between incompatible information systems, you simply hand over your heart memory stick, and the local doctor or hospital can view the relevant information about your recent treatment at our hospital.

The memory stick will work on any computer with Microsoft software. There is no HIPAA issue. You own and control your medical record and only you can authorize someone to view it.

So, indeed, any doctor you trust can have your information in a heartbeat. A reassuring thing to have in your pocket after you have been treated for cardiovascular problems.


J. said...

That is absolutely brilliant! Not only is it a great thing for patient care and patients' rights, but it's also a great marketing tool. I could see it being helpful for any patient with a chronic condition, cancer, etc.

As a health care IT professional, I'd be curious what clinical IT systems you have in place that write out the record and what is contained in the record.

John Norris said...

That's pretty neat...what format is the record in?

mcCutcheon said...

That's a really great concept. Kudos!

Paul Levy said...

j & John,

I'm not sure, but I think we just extract relevant portions of the record and make pdf's of them. I don't think it is anything complicated, and I don't think it would matter much what EMR system you have in place. (You can always just hit "print screen", right?)

I agree that this idea could be very useful for lots of diagnoses and treatments.

Interestingly, this approach could bypass a lot of the debate on interoperability. Is this little memory stick a "disruptive technology"?

Rob said...

Simple, low-tech, obvious solutions are sometimes the hardest to see, but easiest to adopt. So often we technologists try too hard.

It's why I still use a whiteboard in meetings more than slides. Call me contrarian.

Nice work.

Michael D. Miller, MD said...

Sounds great, but does it have a password or similar security feature? And does the information include the names and contact information for the patient's BI (and perhaps other) clinicians, since this would be useful for other clinicians to contact them concerning acute or emergency care?

P. said...

I like the packaging; it's tough to lose or confuse. I hope Dr. de la Torre can publish some information about how CVI is generating these USB keys. I'd especially like to know how much labor was involved in setting up the system and how much staff time is required to produce each key. This kind of info would help other hospitals implement this idea. (Not all institutions are as pioneering as yours!)

Anonymous said...

Good Afternoon Mr. Levy,

There are issues in the IT world with external flash-memory plugging into your computers and your networks; viruses and mal-ware, and unauthorized data extraction being the major ones.

Is the flash-drive locked down after CVI loads it, or does it operate like a standard flash drive, where the user can continue to add and / or delete information from it? Just curious...



Michael D. Miller, MD said...

This does look good, and I hope there is a publication about it.

HMS student said...

This is a wonderful, innovative idea.

However, I would like to echo the privacy concerns of a few commenters since the memory stick given to the patient is small and probably easily misplaced. Also, there's no clear identification of it being a repository for patient information, so it could be easy for someone else to look at the patient file if the record isn't password protected. Still, it's a powerful symbolic gesture to give the patient an emblem of ownrership of his or her health.

A naive question: I assume it won't be possible to do this forever since memory sticks aren't *that* cheap. Can't you just give patients a nice paper folder with their medical record in it?

Paul Levy said...

First, I want to mention that we offer PatientSite, a password protected medical record that is available over the Internet. It is very secure, being designed with lots of protections, and it is kept up to date by the medical staff.

We are also happy to provide paper copies of the patient's record.

I view this heart stick as the electronic equivalent of photocopying the patient's information. Obviously, it can never be as thorough or up-to-date as the actual electronic record because it only shows what exists at the moment it is made. In that regard, it is like a paper copy of the record.

Whether it is more or less secure than a paper copy is an interesting question. I have seen paper records misplaced by patients next to ATMs, in coffee shops, and the like. But, you are right that this stick is also essentially unprotected, and patients should be told about that if they choose to take one.

Ileana said...

Very cute idea, but I don't think it's a solution... Patient Site is better. This is more like the little marketing thingies that you get at conferences - good for marketing and a great symbol, but they get outdated fast (well, depending on the patient's health history).

I can imagine the scenario: Mr. X Do you have your "heart USB" so we can update the information? Uhhh... ahhh... I forgot it at home. No problem, we'll just give you another one. Ok, now, which one is the latest?

Interoperability is needed... How would the patient's doctor know what their EKG looked like when they went to the ER in Florida or what prescriptions were given?

Paul Levy said...

Belated response to p, ileana,and others from Dr. de la Torre. I had it about right:

"We sign on to [our online medical record], right click on the EKG and CXR and actually save the picture to the memory stick as a jpeg ('send to'). The discharge summary and operative note is saved as a PDF file in the same fashion."

P. said...

Thank you for the update from Dr. de la Torre. Just responding to hms student's comment on cost, custom logo USB drives with 64MB of capacity (more than enough for a few JPGs and a PDF) can be had for about $6-$12 per unit in bulk. I think that's pretty reasonable.

Michael D. Miller, MD said...

Actually the price is cheaper than that. You can get 1G flash drives retail here in Cambridge, MA for $10, and I think 2G are $15-16... That's a lot of space for storing images and PDFs..

Anonymous said...


I love working at Beth Israel


HMS student said...

In response to replies above, yes, USB drives are cheap but paper is still 100-fold cheaper and I assume that the BI is dealing will deal with thousands of patients - that adds up to a huge cost, no?

And as a marketing/PR gesture, I love the cute little heart USB sticks. But the real purpose here is to give patients a physical symbol of their medical record so they can use it in the future. Couldn't it be posssible to implement that in a low-tech way? One could give the patient the physical equivalent of the medical record PDF in a shiny, cardiovascular health themed folder. Equally secure & insecure (as Dr. Levy pointed out above) and HIPAA kosher.

I would be impressed as a patient if, upon discharge, I was given without asking a handsome, authoritative physical document recording my care at the hospital and health information for future use.