The Mobility of Health Information (and Associated Comorbidities)

1. The Mobility of Health Information (and Associated Comorbidities) CORD Academic Assembly 2011 Tobi Tanzer, JD VP of Corporate Integrity, Corporate Compliance Officer and Privacy Officer HealthPartners, Inc.

2. I Am A Believer 3

3. I Am A Nervous Believer 4

4. 5

5. Imagine 6

6. Health History 7

7. In Triage or the Trauma Bay 8

8. At Your Fingertips 9

9. Public Health 10

10. Consults 11

11. Bureaucracy 11 12

12. Training 13

13. The ED of Tomorrow is the ED of Today 14

14. Health Info Expectations . . . 15

15. . . . Gone Bad . . .* • AccuracyData Errors *All scenarios described have been modified in details, but not substance. 16

16. . . . Gone Bad . . . • AccuracyData Errors • Ubiquity/Mobility  Carelessness 17

17. . . . Gone Bad . . . • AccuracyData Errors • Ubiquity/Mobility  Carelessness • Security  Naïveté 18

18. . . . Gone Bad . . . • AccuracyData Errors • Ubiquity/Mobility  Carelessness • Security  Naïveté • Coolness  Judgment Lapse, Lost Control 19

19. . . . Gone Bad . . . • AccuracyData Errors • Ubiquity/Mobility  Carelessness • Security  Naïveté • Coolness  Judgment Lapse, Lost Control • Convenience  Time (“Click”) Savers 20

20. . . . Gone Bad . . . • AccuracyData Errors • Ubiquity/Mobility  Carelessness • Security  Naïveté • Coolness  Judgment Lapse, Lost Control • Convenience  Time (“Click”) Savers • Sensitivity  Humanity’s Dark Side 21

21. . . . And Made Worse . . . • Immediacy of Access • Immediacy of Transmission • Access and Control (Rights? Privileges?) • Cost 22

22. Social Norms are Shifting Ron Barrett for the NY Times, 2/18/11 23

23. Health Info Expectations 24

24. Health Info Expectations 25

25. The Mobility of Health Information (and Associated Comorbidities) • Def. #1: A medical condition existing simultaneously but independently with another condition (commonly accepted) • Def. #2: A medical condition that causes, is caused by, or is otherwise related to another condition in the same patient (less well accepted) SeeValderasJM, et al. "Defining comorbidity: implications for understanding health and health services,” Annals of Family Medicine7 (4): 357–63(2009). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713155/?tool=pmcentrez 26

26. Why “Comorbidity”? “From a . . . policy perspective, coexisting diseases need consideration when deciding on the allocation of resources. Estimates of future costs will not be well represented as a sum of the costs of the separate illnesses. . . . Overall burden of disease and patient complexity provide a better conceptualization of the problem for this purpose.” Valderaset al. 27

27. EXPECTATIONS CONDITIONS 29

28. Unless . . . We cure – or at least treat – the comorbidities 30

29. Treatment Plan • Fear Training • Empathy Training • Boundary Training • Security Training • Bureaucracy Training • Risk Training • Enforcement 31

30. Fear Training 32

31. Empathy Training 33

32. Boundary Training 34

33. Security Training • 7% of large privacy breaches • caused by hacking • 66% caused by theft or loss of • portable devices 35

34. Bureaucracy Training 36

35. Risk Training 37

36. Enforce Expectations 38

37. Let’s Review Technology Expectations Sensitivity Mindfulness Lost Trust Lost Reputation Inaccuracies Poor Care Added Cost 39

38. Let’s Review Technology Expectations This is your job Sensitivity Mindfulness Greater Trust Greater Efficiency Better Cost Control Safer Care 40

39. Thank You! Contact Information Tobi Tanzer, JD HealthPartners/Regions Hospital tobi.x.tanzer@healthpartners.com 41