Disaster Preparedness |
DELIVERING EMERGENCY MEDICAL CARE
Lingering problems and recent events have prompted this white paper on delays in the first line
medical response to manmade and natural disasters.
Paper records have obvious and well known limitations, and for that reason there has been a
major push to move to electronic medical records. But as paper records become more and more
scarce, what happens to medical care if the computers go down? IBM, HP, Oracle, USi and
others all provide NON-STOP servers and systems with 99.999% reliability within a delivery
system- i.e. a hospital, office or clinic setting, BUT only if the power stays ON.
Lingering problems
Even in the best of circumstances medical records are not commonly available at the point of care in most US cities. When the Medics get a 911 call and enter a house in the richest or poorest
neighborhood, that patient’s medical history is not available until they reach a hospital, clinic or
doctor’s office and even then the information will only be available if that center is their usual
source of care. Clinical Information Systems (CIS) don’t automatically exchange information
and it takes minutes, hours or even days to get the information to make the necessary care
decisions. Privacy laws to protect the patient often inadvertently delay their care and threaten
their life. It takes time to get “consent for release of medical information”, transfer the request
there and then receive the correct data back. Faxing is illegal in over 40 states but it is commonly
done to speed the information transfer. Otherwise, it takes days by registered mail. When patients arrive at the hospital, it takes about 15-20 minutes to register them and get their identification, contact and payment information. In an emergency situation that might be the difference between life and death. Because patients are so mobile, their records are scattered among various delivery systems. This fragmentation of institutional records creates the opportunity for medical record errors that kill 98,000 Americans each year. Another 100,000 die each year because of adverse drug reactions and interactions and the ONLY way to prevent adverse drug interactions is to have everyone on the same system and have that system work in real time. The present emergency response and delivery of care is not optimal, even in the best of conditions.
Global Portable Medical Records
For the last nine years, we at Chi-square (X2) have been advocating a Global Portable Medical
Record System (GPMR) that would solve most of these problems. The patented Chi-square
Triad™ consists of:
A smart card portable medical record (a micro-chip card - like a credit card) that contains over
80 pages of core information that you can carry in your wallet. It securely contains your contact
information, next of kin, your doctor’s contact information, insurance coverage, living will, code
status, allergies, blood type, HIPAA preferences & releases, social history, family history,
implantable devices, problem list, list of medications (updateable in real time), vaccinations (also
in real time), legal documents, birth certificate, etc. Cash can be carried on the card for copayments
& deductibles and it can be linked to your VISA card for other expenses. The card acts
like a mini-computer. It can store data, make calculations and exchange data though a URL on
the card directing it to:
A Private Network (PN) where the patient’s entire record resides on a guarded X2 server. The
PN is secured & managed by the telecommunication companies and the PN can only be accessed
with a smart card issued by X2 and authenticated by your delivery system. This eliminates
hacking from the Internet.
Application software to connect 1&2.
Think of this system as an ATM banking system for medical record exchange. Providers have
smart cards issued by a certificate of authority (usually the board of licensing in their state of
residence) that allow them to access the X2 Private Network, which connects all participating
hospitals or clinics on the network. These institutions have installed smart card readers (think
ATM Machine) and subscribe to an ISP that connects everyone together. With agreement among
delivery systems (legal contracts) and with the permission of the patient (entering their
password); an outside doctor can access that patient’s medical record in Cerner, IDX, EPIC, or
HBOC in Chicago, Baton Rouge or London.
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