Interview: Dr. Tom Horan

by David Geer

July 3, 2007 —

David Geer recently spoke with Dr. Tom Horan, Director of the Kay Center for E-Health at Claremont Graduate University in Southern California about electronic health records for use in the healthcare system.

Listen to the original interview here, or visit our Podcast Center for more audio interviews.

Dr. Tom Horan, Director, Kay Center for E-Health at Claremont Graduate University

In high school, he was ... "an accomplished sailer and a slacker!"

Ask him to do anything but ... "organize an office!"

Favorite (non-work) pastime: "Live music, especially music festivals."

Something most people don't know about him: He entered college thinking he was going to be an architect.

Role models: John Seely Brown, Tracy Kidder

Philosophy: "Vision, think, feel, act, react."

Favorite technology: "Trusty razor."

What he's reading now: Dissertation drafts

David Geer: What are the shortcomings of the existing healthcare record systems?

Dr. Tom Horan: One of the major shortcomings of today's healthcare technology environment is that we can't get access to our own records. Imagine if you will, not being able to get access to your bank records online. Today we don't have access to our medical records and we think that that's a cause for a lot of inefficiencies in the system, not to mention dissatisfaction among consumers.

Geer: And how are you working on electronic health records in a way to improve that situation?

Dr. Horan: Our research is looking at how different segments of society can benefit from having personal health records and personal health systems. This includes those who find themselves in an emergency so that healthcare professionals, as well as loved ones, can have the information they need to make sure that the right treatment is provided during an emergency. It includes working with those who are underinsured or uninsured, who are frequent visitors to the emergency room, to make sure that all that can be known about that person's situation is known, and includes working with folks such as those who are disabled who have very complicated health needs, to see how the power of the Internet and technology can help manage their health affairs.

Geer: To get into the technology a little bit, how will future electronic health databases and related technologies help to facilitate this?

Dr. Horan: Well, one thing there won't be is a big, massive database with everybody's health information. That's a really scary concept and it's not going to happen. What there will be are highly secure distributed databases, whether it's in your healthcare provider's office or a lab's office, where you or someone who is authorized can reach out and grab that information as needed. Imagine if you will, being able to do a secure Google search that finds your records where they are and makes them available to you, as well as others who have been authorized in a very user-friendly format.

Geer: So we're talking almost about real-time availability of these records to the people who need it pretty much instantly?

Dr. Horan: Exactly. So that if something happens, if you have a second heart attack and you're in a remote region or a hospital or ambulance, the providers can get online and find out about your situation, about your heart condition, about what medications you were on, all that information isn't readily available right now, but could be.

Geer: So how would we make it possible to have these records instantly available to physicians and patients and anyone else who needs them immediately when they need them, while keeping them secure from those who shouldn't have a right of access to them?

Dr. Horan: The security of the health information is a cornerstone issue that needs to be dealt with. There are various pilots around the country that have research to demonstrate how information can be shared in a secure manner. Having said that, there is a continuing need to understand how to prevent breaches in those systems, as well as to ensure users of the systems, particularly consumers, that their information won't be used in ways that are not intended. The banking industry has done a very good job, to come back to that example again . They've done a very good job in proving the security and the sense of security in doing online banking and that kind of attention needs to be paid to health information.

Geer: So tell me about your research around streaming medical records to ambulances at the moment that they need this information.

Dr. Horan: A major focus of our research is understanding how technology can improve the quality, timeliness, and effectiveness of emergency response. And electronic health systems play a key role in that. Right now, if you're in a rural part of the country, it's going to take you twice as long to get to a healthcare treatment facility then if you're in an urban part of the country. And time matters when it comes to medical emergencies. So we've been looking at how can services and monitoring systems be set up so that service can start to be delivered in the ambulance, on the way to the hospital, rather than waiting for the patient, you or I, to actually arrive in the hospital. And so this requires new forms of wireless communication. It requires new agreements and protocols between the ambulance provider and the emergency room where the ambulance will be going.

Geer: One of the challenges that at least seems apparent to me is identifying the patient together with their particular records. I mean have the wireless and other communications and the access, but say you have a patient and they're unconscious and perhaps all they have on them for identification is their fingerprints or some other means of identification. How do you then join that person, say in that situation, with their actual health records and then permission to access those health records? Is that an obstacle that you're looking at?

Dr. Horan: That's a major item to resolve. Right now you have, in the old fashioned way, MedicAlert has those bands that people can have, that have an ID number. And as we move forward, I think there are new and inventive ways of doing that. Obviously, there's your health ID card that you might have in your wallet that could be accessed. There are some who have proposed and are looking at having very small implants in some part of your body. Sounds scary.

Geer: There would actually be a practical application of that commercial we saw a few years back where the guy walked through the grocery store, grabbed everything he needed and just walked out, but the chip in his body automatically charged it to his account and that didn't seem like a worthwhile reason to have somebody put a chip in my body. But to save my life is another story.

Dr. Horan: Right, right. And I think for many of these things, they're first going to be used where the situation most calls for it. So if I have some very chronic health condition that's complicated, I may choose to wear a band that, for example, is now available that has a USB drive in it. That when somebody plugs it in it will connect to a site that then connects over to my health record, or a card that I can show, or in the futuristic way, something that's a small chip that's implanted that can be scanned.

Geer: And pardon the pun, but it looks like survival of the fittest would apply as far as the technologies that would actually last, whatever works best, whether it's the USB device or an implanted in-body chip, whatever becomes popular and common because of its effectiveness and people's acceptance of it is probably going to determine what's going to be the advance in that particular type of solution.

Dr. Horan: Right. I think what will happen is we will start to realize that having access to our health information is a really critical thing and so we will have choices about how we want to make that access available to our loved ones or healthcare providers. And people, given their preferences, will choose to keep it in their wallet or make it available electronically or have some other device that provides ready access. But something will be out there.

Geer: And like many things, it may be generational adaptation. What the current generation doesn't easily adapt to the next one will and so on.

Dr. Horan: Right. Yeah, we may elect to carry cards. If you look at today's generation, for example, sales of watches have gone down dramatically. Why? Because kids now get their time from their cell phone. And I think the same kind of thing is going to happen with some artifacts that we carry with us, like cards, and the next generation, they think cards are kind of cute.

Geer: So another application question. How would developing devices, in conjunction with cell phones, in order to store health records be of help?

Dr. Horan: The cell phone is the electronic device that we carry with us more than anything else. And so it makes sense that as we think about communicating information about our health that the cell phone can play a role. And so there are tests underway by which you could have a cell phone number that could be called and then with the appropriate passwords and such, get access to your health information. If you think about it, the cell phone right now is the device that you call for an emergency. So it's really just the next natural step that the cell phone would be of service in helping to access your health record as well.

Geer: And one of the primary points I know for you is how these technologies will save money, which I assume again also points to how it will be helpful to people who are most in need.

Dr. Horan: One of the case studies that we're looking at right now is in collaboration with the Mayo Clinic in Rochester, Minnesota, and in this study we're looking at how having better information early on in the emergency process, result in improved health outcomes. And one health outcome is less time in the hospital, and so if more treatment can be delivered when enroute to the hospital, what we want to know is, will that result in less time staying in the hospital, which is a very expensive experience. So that would be a tremendous money saver if what we think is happening is borne out by our research and our data.

Geer: And obviously the patients are going to benefit from this. Healthcare providers will be able to offer services more cheaply and maybe be able to redirect some of their funding towards other types of technologies and services. Who else will benefit from this type of technology and how?

Dr. Horan: Well, just to agree with you, the consumer is a big beneficiary because it gives them greater control over their own healthcare. As that happens, the quality of care can go up because knowledge is power. The consumer is offering more knowledge about the healthcare. That should benefit the interactions with the healthcare provider because there's less unnecessary kind of information exchange going on, it can be more targeted. And one should hope it should reduce -- if there are changes in health, make a contribution to reducing healthcare costs, or least slowing the growth of healthcare costs.

Geer: Finally, what challenges remain to stepping this technology along to where we would like to see it?

Dr. Horan: Well, there are no real financial incentives for the healthcare industry to move aggressively to provide consumers with personal health records, and so that's a big challenge. There's a financial incentive to provide healthcare, because they get reimbursed and paid, but right now there isn't enough financial incentive to really advance personal health records to the consumer. So that's why bills like one being offered by Congressman Kennedy this session in Congress, which would provide reimbursements for developing personal health records, that's why those kinds of initiatives are an important part of the equation.

Geer: Is there anything I've missed here that you really wish we had gotten in?

Dr. Horan: Well, if you step back, you will see that consumers are getting on the Internet to look for health information in droves. Some 60 to 70% of people who use the Internet have looked for health information. Public opinion surveys show that people want to have access to their health records. Yet there is this gap between that interest and the delivery of those records by the healthcare industry. And closing that gap is a critical item if we're going to have improved healthcare. And that's where we're trying to make our dent.

Geer: And any ideas on how you might first be making that dent, so to speak?

Dr. Horan: One way to start to make that dent is through simple steps. For example, everybody hates filling out that clipboard at the doctor's office. If the doctors would send that to you electronically so that you could fill it out before you go to the doctor's office, then you would like it better, I would like it better - because you don't waste time - and secondly, it would be a step to the steppingstone of developing that personal health record.

Geer: And that would definitely be a practical taste of an application that would wet people's appetite for more of the same.

Dr. Horan: Exactly.

Geer: Thank you for speaking with us today, Dr. Horan. If you would like to learn more about Dr. Horan's work, surf to www.cgu.edu.

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