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ATMs for healthcare

DCLnews talks to IT expert Landen Bain, who is using XML and other standards to digitize clinic notes and clinical research documents.

Landen Bain is a prime mover in the development of IT infrastructure in healthcare. A former chief information officer at Duke University Health System, North Carolina, and at Ohio State University Hospitals in Columbus, Bain has a big vision to transform the delivery of healthcare. He wants to digitize the country's health records and make them easily accessible to doctors and medics across the nation.

That way, if you are taken ill in Michigan, but live in LA, paramedics will be able to get your personal health details up on screen in a flash and give you the appropriate treatment faster and more safely.

This, however, is not as straightforward as you might think - even in these days of Internet banking and other information exchange systems. Security and privacy issues add a great deal of complexity. In the past, the big problem was the lack of information availability, along with the difficulty in deciphering the multiple data formats being used. If medical information becomes more easily transportable and standardized it becomes critical to set up suitable protection of private medical data.

To find out more, DCLnews caught up with Bain during a hiatus in his busy schedule and asked him about the main issues involved in implementing health e-records.

Landen Bain: People are always saying, "Look at how automated banking is, what with ATMs and internet banking - why can't you do the same with healthcare?" And it's true, you can access your records from a hamlet in the Himalayas, if that's where you happen to be. But for a doctor to access your medical records from another state in America you need phone calls, faxes, transcriptions, and often a good deal more. So it's understandable that people want to know why healthcare isn't automated like banking.

All I can say is, it certainly could be if all you had to deal with had two digits to the right of the decimal place and was a number. But that's not the case. Medicine is language-based; and the sharing of data in medicine is not the exception, it's the rule. In banking information is only occasionally transferred from bank to bank by users. In healthcare it's a constant occurrence. Added to that, medical and healthcare information covers a myriad of different types of information, in many different formats, across a wide geography, and spanning many years worth of information. People who say healthcare is behind in its technology are only looking at the surface.

DCLnews: What are you currently working on to implement health e-records?

Landen Bain:  Our project is called Single Source. What we mean by that is a single data capture that creates a single source document. This in turn populates the electronic health record on the patient care side, and also populates the clinical trial manager system, which constitutes the other aspect of our work.

DCLnews:  So you're focusing on two avenues - patient care and clinical research?

Landen Bain:  That's right. We're trying to come up with a way to gather data simultaneously, which meets the needs of these two realms.

DCLnews:  Is XML involved?

Landen Bain:  XML is certainly part of it. There are two standards and they're both XML-based. The key one is CDA, or Clinical Document Architecture. This is under the HL7 family of standards. We believe it can be the schema for the single source document. This in turn can produce XML that complies with the CDISC (Clinical Data Interchange Consortium) standard, which is called ODM or Operational Data Model.

DCLnews:  What are you doing in practice to make this a reality?

Landen Bain: We're about to conduct a single clinical trial at Duke University in North Carolina, and we'll use that as a proof of concept to show the feasibility of jointly capturing data for clinical trials and health records. Two types of document are being captured: Case Report Forms (CRF) for clinical trials, and Clinic Notes for health records. Case Report Forms are highly structured; every data element is defined precisely. Whereas Clinic Notes are very loose in structure; they might include off-the-cuff observations or recommendations from doctors, for example. You have to be able to accommodate both.

DCLnews:  When will this be rolled out?

Landen Bain:  We have the technical architecture in place. We have the tools selected. We've begun the process of designing the forms capture for both the Case Report Form and the Clinic Note. So we expect to implement the proof of concept within two or three months.

DCLnews:  Where do you see it going after that?

Landen Bain:  Following the proof of concept at Duke, we will look at testing the system in a number of physicians' offices. This could be put into action in a year.

DCLnews:   How do you see all this benefiting the world?

Landen Bain: The main benefit will be it will help pharmaceutical companies get new drugs tested and to market sooner. Currently there are a lot of hold ups. Not in the bench research, but in the clinical trials. Getting enough patients enrolled to complete these trials is what's holding things up. Our system will help get data through faster and break the bottleneck. It will also save money - especially when you consider the drug company cliché that for every day a trial is delayed it costs a million dollars.

DCLnews editorial
April 15th, 2004