HIPAA and the InternetEvan Crawford, Executive Director, e-Transformation/e-Medicine Center

The Children’s Hospital of Philadelphia crawford@email.chop.edu

Disclaimer

The thoughts, comments, concepts, conjectures and punctuation contained in this presentation are those of the speaker alone and should not be construed as having a relationship, formal or informal, to any organization, entity, employer, or to my mom.

Web people: Combining “Survivor” with “Who wants to be a Millionaire?”

% of non-Web CEO’s who would eat another person for $1,000,0009%% of Web-company CEO’s who would eat another person for $1,000,00031%*

*Internet World, 2001

Today’s topics, random thoughts, points of interest

The Web is where it’s atRegulation lags technologyConsumers follow the path that will get them what they want, regardless of regulationsA significant number of people now expect Web-based healthcare information, in real time, customized to themIf HIPAA or its consequences conflict with the desires of the public, HIPAA will take second place (with the public)Organizations who implement HIPAA in overly restrictive ways will lose in the marketplaceA HIPAA implementation informed by the needs of empowered healthcare consumers can benefit all partiesIt’s up to us

A quick definition

e-Medicine, or e-Health, is any content or functionality, usually Web-based, that compliments or replaces non Web-based care

Security and confidentiality are important to everyone. Just ask them.

To Grandmother’s house we go*>70% of grandparents don’t want to stay with their kids – or grandkids – when they visit6.3% of grandparents “would rather pitch a tent in a nearby park or have a root canal” before staying with their grandkids

The paradox of adult entertainmentHow do video stores stay in business?Can 100 million people make the same typo?

*Grandparent Getaway Survey, 2002

If you recognize this screen you’re a under arrestPlease leave your name at the door

Communities & Content

5 am

2,000,000+ users in this community

2.5 Pbyte (about 1 trillion floppy disks) of information available

File sharing on the Internet:

1. Not too legal

2. Not too secure

3. Kazaa alone is on 157 million computers with typical daily usage by 3 million users.* *Source: WSJ, 12/9/02

The empowered healthcare consumer & consequences

They will get what they want, and cut a few corners if they have to.

Information from the Internet influences consumer healthcare behavior*

In calendar year 2001, more than 125 million Americans used the Internet to look up medical informationMore than 70 million of them said it influenced the healthcare decisions they madeIn 2000, more than 16 million patients substituted a visit to the Internet for a visit to their physician

*Courtesy Consumer Health Sciences Research, 2002

A solid Web strategy can help meet the needs of the on-line consumer

Number of Links from External Sites to Medical Content of Selected Hospitals

19,412 17,90312,426

1,692 1,451 1,314 699 690

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More Web sites link to The Children’s Hospital of Philadelphia’s Web Site for Pediatric information than to the American Academy of Pediatrics

CHOP AAP

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A HIPAA implementation not informed by consumer desires will be a disadvantage in the marketplace

25% of e-Health consumers would be willing to pay for on-line access to their physicians*1/3 of Internet users indicate they would change their physician if he or she would not e-mail them** 35% of patients would be “more likely” to choose a physician who offered e-mail communication than one who does not***

Sources: *Deloitte Research, **Reuter’s Health, ***LaurusHealth.com survey

Test yourself: Which of these is least likely to be on your mind during a HIPAA implementation meeting?

A. How will we further restrict access to information stored on our network?

B. How can we tighten operational processes to further restrict access to patient information?

C. I wish I would have brought something to eat.D. I wonder which department that attractive

woman/man works in? Is she/he single?E. How can we implement all this and improve service

and access for our patients/customers?

A modest proposal: Post on the wall at every HIPAA meeting:

There is always a tradeoff between making a system more secure and making a system more accessibleAs security increases, accessibility decreasesBalancing these concerns will be one of the most challenging elements as we implement HIPAAConsumers (at least those who can afford it) will get what they want with or without usIf they judge our decisions too restrictive, they can opt out of the system (next slide)

Buying prescriptions on-line:

I hear New Zealand is lovely this time of the year.

And it’s where they filmed Lord of the Rings!

817,000 results (options?)

Xenical, from Roche, at less than ½ of the average cost in the U.S.

Shipping from New Zealand to arrive in 2-3 days.

Regulation/ enforcement lags behind technology.

Consumers follow technology (enabling what they want) rather than regulations.

“Virtual” doctors will diagnose you on-line, for $225, payable by credit

card. And you don’t even need to

leave the house!

There are even sites for

consults with emergency physicians.

“The online auction allows buyers to bid for five different procedures . . . The site had received a lot of positive feedback from visitors and bidders who said the auction made plastic surgery more accessible and affordable.”

On-line disease management

(DiabetesWell.com)

The reason people turn to the Web is that our service makes it an attractive alternative

Typical healthcare provider performance levels:*

Average witness under oath

Average person’s tax

return

Saddam Hussein’s weapons reports

*Data made up by presenter

Level of patient care

Customer service

Information availability

Where does this leave us?

Can a healthcare system execute a successful Web strategy,

implement HIPAA, and improve their marketplace position?

Of course!

By asking patients, clinicians, referring physicians, educators, and others what information they need, you can anticipate and provide the services they want so they will not “virtually abandon” your organization.If you know what your population wants, and understand your current Information Systems (and Internet technologies), you can provide information access with better security and meet and exceed HIPAA requirements.The Web infrastructure you build can be leveraged in many other ways by your organization and your patients. A few examples . . .

On example: The e-Transformation project is an ongoing project,

with multiple, simultaneous workstreams:

e-Trans Project:

Work-streams

Consumer streams

Clinician streams

B2B streams

Intranet streams

Marketing & Technology streams

Reimbursement streams

Legal and security streams

New Venture streams

BroadVision Content Management System: Our Core Technology

Add-in Components: Purchase when business justification is present

Distributed content

management

Personalization/ customization: “mychop.edu’

eCRM/Consumer Profiling and

Service Centralization

Specialized sites for various

transactions; i.e., Telemedicine

Wireless Information Presentation

This architecture provides a competitive advantage when combined with your current Information

Systems (see next slide)

A substantial Web infrastructure enables you to increase services and security.

Providing increased access and security

Information flow between multiple clinical areas, patients and referring physicians is often a problemSecurity and access can be control by Content Management System, and route only appropriate role-based information to those who need itDynamic content management necessitates information definition at data element level, and complete audit trailNB: None of the following information displays have actual patient data

This same technology and infrastructure can form the basis for the Personal Health Record

Other ways of meeting various needs follow

Using the same Internet architecture will make HIPAA Web-based education easy. We also do Mandatory (JCAHO) education on the Web ($42,000 savings in first year; JCAHO Score: 97)

Student’s account

page

A good Web infrastructure allows multimedia education as well.

We started with our consumers, and it seems fitting to conclude with them.

What did we do for our consumers (with an eye

toward HIPAA compliance) and can we retain them?

As you remember, empowered consumers are looking for information that’s relevant to them

Ability to find a physician on-lineOn-line appointment requestsOn-line Q&A with expertsAbility to ask billing questionsMore than 12,000 page-equivalents of clinical information, reviewed by Board-certified physiciansDynamic content feed helps patients & caregivers find what they need with a minimum of effortMultimedia Q&A

On-line appointment requests, with a 24-hour response time.

Interactive billing

questions automatically

route question to appropriate

practice.

Source: Children’s Hospital Web Prototype Survey results.

All Web functionality is validated with the target audience to insure it meets their needs.

Value of Web site to you and your experience (Families)

Find medical information (Families)

Communication around patient with specialist (Referring MD)

Find information about Hospital and services (Referring MD)

RATE THE FOLLOWING ON SCALE OF 1 TO 5 (AUDIENCE)

3.2

2.3

2.8

3.9

4.5

4.4

4.5

4.8

41%

91%

61%

23%

CURRENT FUTURE % CHANGE

FAMILIES

REFERRING PHYSICIANS

Target audience same rankings pre- and post-experience with prototypes:

e-Transformation@CHOPComments from Patients & Families

“I have recently become a school nurse and today I had questions regarding my own child’s and a student’s health. I accessed your Website and was easily able to find the answers I needed. I will be telling everyone about this Website. Thank you!”“I am happy to see we can reach you by e-mail. It saves me a lot of $$$.” “What a wonderful Website. Thank you.” “I just wanted to tell you that I am a blind PC user and found your site to be screen access friendly. I appreciate the fact that someone took the time to make the site easy to navigate for those of us who have to use screen access software.”

What’s next?

•As consumer awareness of HIPAA increases, use our compliance to reassure patients & families and differentiate ourselves in the marketplace.

•Keep ahead of technology, regulations, and consumer demands.

•Remember the old Danish proverb:

“Prediction is difficult, especially of the

future.”

Thanks so much!