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Embedded Health Data Chips for Interior Alaska
A Feasibility Study
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Expert Panel
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Graduate Advisory Committee Dr. Robert Perkins, Advisor Dr. Ming Lee Dr. Leroy Hulsey
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Embedded Health Data Chips for Interior Alaska
A Feasibility Study
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Prepared for theEngineering and Science Management Program
Presented by UAF Masters Candidates Lien Huang
Steven RoscoviusFrank Toth
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Overview Study Statement Introduction to Tanana Chiefs Conference Background and Options Criteria and Analysis
Stakeholders Economic Legal and Ethical Social Program Schedule and Costs
Conclusion
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Is there a problem?
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Feasibility Study Is there a better way? We are challenged to explore new
technology But we are bound to do it ethically
and morally
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Task Force We approached this as a task force Tanana Chiefs Conference (TCC)
Chosen for its unique health care situation
We were challenged in our study Discovered that numbers and dollars
may not always sum up the story
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Tanana Chiefs Conference Mission Statement
Tanana Chiefs Conference provides a unified voice advancing tribal governments, economic and social development, promoting physical and mental wellness, educational opportunities and protecting language, traditional and cultural values.
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Tanana Chiefs Conference The Department of Health
Services Mission Statement
TCC Health Services, In Partnership With Those We Serve, Promotes And Enhances Spiritual, Physical, Mental And Emotional Wellness Through Education, Prevention And The Delivery Of Quality Services.
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Chief Andrew Isaac Health CenterJim Kohler - Director 15,000 beneficiaries 43 villages $44 million health budget
1.5% for data management and communications $660,000 Electronic Health Record was implemented in February
2005 Health data management is vital and continually
challenging Quality of care and proper reimbursement Affects pharmacy, lab, radiology, continuity between
providers, scheduling, and billing Communication with 43 different villages
Challenges Flat budgets with double digit cost increases Staff shortages
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What is the problem? Identification of patients
Unconscious Disabled No identification Very young Elderly
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What are some options? Do Nothing Radio Frequency Identification Chip Personal Data Assistant Devices ID Cards
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Do Nothing No apparent costs
Are there hidden costs? No change in current situation
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RFID Chips New technology Implantable Does not require batteries Type for consideration is ID number
only Can’t lose it
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Personal Data Assistant Carry your entire medical history
X-rays Diagnostic scans Medical notes Lab tests
Compatibility Issues Exist Can be lost Rural use?
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ID Card A card embedded a unique ID number Quick check-in Cheap Easy to lose Do you want another ID card?
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The Best Option Ranked in 4 categories Categories scored by weighting
Initial capital costs for implementation 15%
Information stored on the device 10%
Availability of the device in an emergency 40%
Practicality of using the device for special needs individuals
35%
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Scoring
Options Rank Score Rank Score Rank Score Rank Score SCORE RANKDo Nothing 4 0.60 1 0.10 1 0.40 3 1.05 2.15 3rd
RFID 2 0.30 2 0.20 4 1.60 4 1.40 3.50 1stPDA 1 0.15 4 0.40 2 0.80 1 0.35 1.70 4th
ID Card 3 0.45 3 0.30 3 1.20 2 0.70 2.65 2nd
CAPITALCOSTS
STOREDINFO
CATEGORIES AND WEIGHTS
TOTAL
SPECIALNEEDS
35%
EMERGENCY
15% 10% 40%
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VeriChip Chip was originally developed to
track livestock and wildlife October of 2004, FDA approval for
human implantation and use as a health device
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VeriChip Approximately the size of a grain of
rice Implanted into subcutaneous fat
takes less than 20 minutes Performed by physician Contains 16-digit unique number Scanned using VeriChip device Information via the internet
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VeriChip No reported complications or side
effects At least 10 year lifespan Some have concerns with
magnetic resonance imaging (MRI) Reversible with minor surgery
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VeriChip Who would benefit the most?
Impaired speech Memory loss Loss of consciousness Chronic illnesses Common names Mistaken identities
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VeriChip Case Studies Alzheimer's Care in Palm Beach Infant Abduction Brittan Elementary School Mexican Attorney Generals Office Hackensack Emergency Program
NJ
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Alzheimer's Care 2-year project 280 patients Starts in May, 2007 Provides emergency department
staff easy access to those patients’ identification and medical information
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Infant Protection 116 abductions from health-care facilities in
the last 22 years Infant mismatching Halo – infant protection systems
Chip is in bracelet
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Brittan Elementary School Sutter, California RFID tags embedded in student
badges tracked students throughout the
school Ended by parental pressure
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Mexican Attorney Generals Office Originally reported by AP in 2004 18 members are tagged Controls access to secure areas
and to restricted data Combat corruption
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Hackensack Emergency Program Average increase of more than 1.5
million visits per year 2.7 million were made by persons
living in institutional settings such as nursing homes or prisons
At the same time the number of emergency departments have decreased by about 12.4 percent
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Emergency Room Visits
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Option for more detailed study Trial Period
5 Years 1500 people that would most benefit
from this technology Mental or physical handicaps, dementia,
elderly or very young Full Scale
After trial
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Is it feasible? Need to analyze
Stakeholders Economic Legal and Ethical Social Program Schedule and Costs
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Stakeholders
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Economic Trial period
Capital Costs Medical Scanners Training RFID Chips
Annual Costs Fee
Full Scale
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Economic Capital costs
Medical Scanners We estimated 43 scanners for the villages
plus 12 to cover the facilities in Fairbanks 55 scanners needed.
Training Seamless Integration
RFID chips 1500 initial
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Economic Medical scanners
$600 to $3,000 Estimate $50,000
RFID chips $200 plus hospital costs,
estimated up to another $200 Estimate initial cost $300,000
Annual fee $20 to $80 Estimate $100,000 yearly fee
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Economic Costs of Trial Present Worth (Discount Rate
6.5%)YEAR COST0 $350,0001 $100,0002 $100,0003 $100,0004 $100,0005 $100,000
Net Present Worth
$765,000
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Upgrade to Full Scale Largest cost growth would be in
the RFID chips. 3 to 6 million dollars to acquire chips
VeriChip and TCC could find common ground far below.
No additional scanners Possible increase in yearly fee
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Benefits Cost Savings
Less errors Improved efficiencies
Improved Health Services Intangibles
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Benefits Cost Savings
Lack of long term studies Estimates of cost savings are difficult
Rand study on electronic medical records
Although not a true parallel it hints at the possible savings through increased efficiency and improved patient care
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Benefits Rand Study
National Electronic RecordsPotential Savings
HEALTH BUDGET
2 Trillion
INITIAL SAVINGS
88 Billion
4%
EVENTUAL SAVINGS
346 Billion
17%
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Benefits From Full Electronic Records Initial
If 90% adopt health information technology $77 billion from efficiencies
Shorter hospital stays prompted by better-coordinated care
Less nursing time on administrative tasks better use of medications better utilization resources
$4 billion from improved safety primarily by reducing prescription errors
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Benefits for TCC Expected Cost Savings?
With a annual health budget of $44 million, even 1% savings can be substantial
2% = $880,000 1% = $440,000 0.5% = $220,000
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Benefits Improved Health Services
Intangibles Better patient service Fewer mistakes Speedy care Less exposure to lawsuits
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Legal and Ethical Identification and Tracking Social
Environment Privacy & Notice by Institutions Security Data Storage Options
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Identification and Tracking Social Environment Passive – 16 digit Active – Up to 100 Pages of Text Tracking
Staff and Patients Substance Abuse Home Confinement for Inmates
Insurance Profiling
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Privacy & Notice by Institution Griswold v Connecticut (reviewed
privacy) 1st Amendment - Right of Association 3rd – Prohibition of Quartering of Soldiers 4th – Secure in houses; Search & Seizure 5th - Self Incrimination-zone of privacy 9th – Fundamental rights not specifically
mentioned Health Insurance Portability & Account Notice of Privacy Practice
Note use of RFIDs
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Security Encryption – Small Chips Lack Scanning Range (4”; 2-3 ft; 10 ft)
Tracking Possible Dutch e-Passports
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2006 AK Community RHIO Regional Health Information Org
Improve health record exchange Lower costs Prevent medical mistakes
Health Information Security & Privacy Collaboration Issues of Exchange Health Information Health care providers; Insurers; Health care
agencies
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Data Storage-Option #1 Option 1
Patient file at TCC. Information requests through VeriChip
to TCC TCC retains ownership No additional notification or release
forms
Patient Information
Health Care Provider
Request for Records
VeriChp Request for Records
TCCPatient File
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Data Storage-Option #2 Option 2:
Patient file is stored at VeriChip TCC updates the patients file but
VeriChip owns the data storage used Additional notification and release
forms requiredUpdates
Patient Information
Health Care Provider
Request for Records
VeriChipPatient File
TCC
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Data Storage - Option #3 Option 3:
Similar to option 2 Patient file is stored at VeriChip TCC leases data server No additional notification or releases
neededUpdates
Patient Information
Health Care Provider
Request for Records
VeriChipPatient File
TCC
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Current Legal Status Current Law
Federal State
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Federal No current laws govern RFID
technology Current Bipartisan Caucus
Industry, DOD, and Academics Pharmaceutical authentication,
drug/product recalls, food chain safety, homeland security, supply chain efficiency
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State 2005 – 12 states have introduced RFID
legislation Wisconsin
Legislation to prevent implants w/o person’s permission
California Legislation security/guidelines protect
privacy rights of individuals – govnr vetoed Two other bills pending
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Social Analysis Are there social issues in rural Alaska
that are different from Fairbanks? What are some of the issues?
Remote population Language Culture
Customs Tradition
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Points of Caution Village’s point of view?
Lack of pressing need Oral Traditional Economic
Skepticism Overall Based on history
Stigmas Individuals Communities
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TCC Board Approval Small budget to continue
What do we do?
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Evaluating Social Concerns How do we evaluate these
concerns? We need a acceptance plan
Hire a marketing firm? Local surveys? Meetings with TCC? Meetings with village elders?
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Program Implementation Creating a implementation team
Team will be composed of primary stakeholders
Key task will be developing and implementing acceptance plan
Investigate funding Negotiate with vendor
Pilot project? Evaluate the process Review
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Program Implementation Go / No Go Deploy the hardware Monitor the outcomes Re-evaluate
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Implementation Tasks
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Implementation Schedule
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Implementation Costs 1st year
Capital Costs Initial + Annual Fee
$450,000 Implementation Costs
$34,990 $484,990
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Is It Feasible? What are the needs? What are some likely solutions? We have discussed some of the pros
and cons in health and economics We have considered some legal /
ethical / moral issues? We have identified social issues
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Recommendation Further Investigations are Needed Economic and Health issues
It will work Legal issues are not defined
Risk involved Social issues might derail
completely
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Special Thanks To Robert Perkins Ming Lee Leroy Hulsey Jim Kohler Perry Ahsogeak Rebecca Madison
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Questions
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THANK YOU