One chronic disease targeted by the Clinic's data analytics engine is diabetes. The analytics engine searches EHRs for the results of A1C tests, which is a long-term measurement of glucose in red blood cells. Knowing a person's average, long-term glucose level can predict their likelihood of suffering other diseases such as kidney failure or stroke.
Cleveland Clinic knows the problem is multi-faceted. Patients must follow treatment regimes and choose healthy lifestyles, and physicians must have long-term data to tailor treatment. But, as Harris notes, if the patient doesn't know how they're doing at a macro level, it's more difficult for them to change their behavior.
"...That information is used to not only send alerts to the physician but also [to] the patient," Harris said. "They can become stewards of own healthcare at some level."
To more directly engage patients, Cleveland Clinic allows them to enter their own data via glucose readers, ether manually or having it automatically entered via a mobile device to a personal health record (PHR). Cleveland Clinic uses Microsoft's free HealthVault cloud service as its PHR. The HealthVault application can then transfer that data to the clinic's EHR for physician and data analytics use.
"The best way to correct glucose levels is to know what's happening with a patient when they're at home, not when they're in a doctor's office," Harris said.
Also being floated in the heathcare community are scalable, less expensive and more patient-centric community health record banks. Those banks are community organizations that put patients in charge of a comprehensive copy of all their personal, private health information, including both medical records and optional information added by the patient.
The patient explicitly controls who has access to which parts of the information in his or her individual account.
Voice recognition joins big data
But, before information can be shared, it needs to make it into EHRs. One way physicians and nurses can add their notes to EHRs is with voice recognition technology.
For example, the U.S. Army has an enterprise-wide license for Nuance's Dragon Medical 360 Network Edition voice recognition software for use with its AHLTA EHR and Essentris-Inpatient System. The U.S. Veteran's Administration also has 12,000 Nuance Dragon licenses integrated with VistA EHR system.
In many cases, a physician will use voice recognition to enter observations, prognosis and treatment into a patient's electronic record.
Dr. Walker, with the U.S. Army's Surgeon General's Office, uses voice recognition technology as he examines a patient to populate their record. A wide-screen monitor in his exam room allows the patient to view the data as it's being input so any errors can be corrected, he said.