In the Clouds

One of the underlying assumptions in this blog, The Art of Medicine and Technology, is that we will continue to gather more data, hopefully learn from it, and use it to provide continually improved care. Most of this data will be gathered using electronic medical record systems and other information technology systems that are increasingly finding their way into physician practices and hospitals. In our day-to-day lives, we use all kinds of tools that store messages, documents, websites and photos on servers outside of our physical control. We’re growing increasingly dependent on services in the “cloud” of connectivity to store, maintain and move our information. In the field of medicine, the growth of EHRs, and their eventual connectivity as part of the Nationwide Healthcare Information Network (NHIN) will add new dimensions to this concept. What they are talking about moving around however, is data about patient care, quality reporting and payment for services. What about the “knowledge” we will gain from research done on data?

As we move from the third to fourth quadrants of the data lifecycle, where knowledge becomes part of decision support systems to be used at the point of care, the cloud concept raises interesting questions, not the least of which is: “Should decision support knowledge systems exist in the cloud?” Other issues to be addressed might include:

  • Who “owns” this knowledge?
  • Will there be “flavors” or “brands” of knowledge?
  • How can it be effectively updated?
  • How can it be secured?
  • How should access to the cloud of medical knowledge be managed?
  • How do we know we can trust it?

Again, I see this as a separate issue from the privacy and security questions related to the movement of protected health information. These questions are focused on the content and role of decision support systems in the future. Certainly these will continue to evolve over time. The first question that should be addressed is the one of knowledge ownership, which I’ve discussed in an earlier post. Once we have that solved, it will serve as a fundamental principle of our solution to each of the other questions. Public vs private ownership will lead to completely divergent paths. With public ownership, the trick will be to avoid creating an effective oversight model that isn’t overly-bureaucratic and costly; with private ownership, we must avoid models that exacerbate any inequality of care. Without a doubt, achieving this to the satisfaction of a significant majority will require solid leadership at the national level.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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