Thinking about Flower [via Christopher Miles]

by drdaviss on 2.5.10

via w/permission

Thinking About Flower

I work for a company that generates most of it’s income from health care and I’ve been hearing more and more about the Flower, the electronic soon-to-be lingua-franca of health care organizations. As I do more research and gather more information on what Flower is and isn’t, I’ll write a series of blog posts that summarize what I’ve learned.
1.  What is Flower?
Right now Flower is in flux, it’s early days and people are only beginning to outline the goals for Flower. What has been decided is that…
  • Flower will provide the mechanism that health care organizations use to transmit medical data between each other.
  • Flower will provide an interface that people will use to ensure that they have control over who has access (or has accessed) their medical data.
  • Flower will provide an easy-to-use and intuitive mechanism that will enable health care professionals to ask a patient for access to some or all of their data as well as a mechanism for people grant or deny that access.
  • Flower isn’t trying to provide a personal health or electronic medical record. What they are trying to do is sketch out how an emergency room physician at your hospital might reach out to your primary care physician to find out more about you, and how this can be done in such a way that you feel in control and your privacy is protected while at the same time ensuring that you get the best care possible. It is no small feat! If you look around for other products that are working to meet this need, you won’t find much. Flower looks to be the trailblazer, in fact, they may be the only people trying to address this very real need.
2.  What Problems Will Flower Solve?
Right now there isn’t a formal process for getting your medical records from one organization to another. More likely is that everytime to work with another health care professional, they open their own file about you. For instance, your primary care physician may refer you to a specialist. That specialist won’t have any information about you at all and will start collecting by asking you about your history. Anything new that the specialist learns may not make it back to your primary care physician. That information is effectively locked up, it’s only available if you instruct other health care professionals to contact that specialist and collect that information.

When you get into a situation where you are seeing more than one or two specialists, the situation quickly becomes difficult to manage. If you were to get into an accident and were receiving care from an emergency room, collecting all this information quickly becomes impossible. If you are incapacitated and can’t speak, there’s little that can be done; the emergency room physicians will simply do the best with what little information they have on hand.

The situation with prescriptions is not much better. Because communication between health care professionals is loose and ad-hoc, it’s very difficult for them to keep in touch with each other. Surprisingly, the Internet hasn’t helped this situation much at all. While it’s true that they could send e-mail back and forth, e-mail itself is not a very secure method of communication. Even if it were, it’s difficult to sort the important information from advertisements and junk-mail. Take a look at your own inbox and I’m sure you’ll get an idea of what I mean.

This is the problem that Flower will solve: communication between health care professionals. Even better, it will also help them communicate with you!

3.  Patient Control of Patient Data
One of the interesting things about Flower is the role of the patient. In Flower’s view, the owner of the data should be the person making the decisions about where that data goes and who has access to that data. In almost all cases, according to Flower that person is you, the patient.

The vision is that when you visit a health care organization, the professional you are dealing with, let’s say Dr. Stanley, will let you know what kind of information about you they need. If you are participating in Flower, they will send a request (via Flower) to the health care organization that has that information, in this case your primary care physician Dr. Morris. The system that Dr. Morris works with will receive the Flower request that Dr. Stanley sent and will check to see if you have granted Dr. Stanley access to this data. Dr. Morris’ system will see that you have not and will hold the request, it will not send any data.

You will then log into your health care portal, which is also participating in Flower. The new request from Dr. Stanley will be visible and you will have the opportunity to approve the request. Once you do, the information that Dr. Morris has will be provided to Dr. Stanley’s system.

The architects of the Flower system are discussing the nitty-gritty details of how this access will be managed right now. Perhaps you will grant Dr. Stanley access to the information he needs for a specific window of time. There’s also talk of a mechanism that lets you revoke access, for instance if you end your relationship with Dr. Stanley.

The key difference between Flower and the competition is the role of the patient: it’s your data and you decide who gets access to your data.

4.  Health Care Professionals Get Only the Data They Need
Another way Flower is challenging our notions of how data is shared is the idea that not all data needs to be shared all of the time. When a health care professional begins a relationship with a person, they don’t necessarily want access to the entirety of their medical data since that person’s birth. That’s a lot of information and they often know exactly what information they need.

Every time a health care organization collects data about you, they become responsible for insuring the validity, integrity, and security of that data. The less data they need to store, the less data they need to worry about. Flower takes a good amount of this concern about privacy and security out of the hands of health care professionals. For the most part, if they have access to some of your medical data it’s because you granted them access to that data.

When you decide that a health care professional or organization shouldn’t have access to your data anymore, Flower will ensure that they know it.

5.  What’s Next?
While all this sounds great, how does this Flower system work? Where is the data stored and how does it get from one organization to another? There was talk about people managing their own medical data, how does that work?

I will explore these topics in the coming blog posts as more information comes to light. Even though is early days for Flower, there are still exciting things happening. Putting together the nuts and bolts of a decentralized medical data storage system is an exciting task!

{ 1 comment… read it below or add one }

Natalie Hodge MD FAAP 2.26.10 at 20:34

Very exciting #flower people. Looking forward to seeing where this heads. Let us know how we can help. Our physicians make house calls, blog, twitter, and speak #flower. There are a couple of folks you should talk with. Of course Epatient dave. And Ron Gutman from Wellsphere. He and I had a lovely conversation at the Mayo Clinic in September 09 about the need for this. You should definitely talk to him.

Natalie Hodge MD FAAP

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