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Should health systems monetize patient data? - Christian Lindmark

-Christian Lindmark

Christian Lindmark - Thursday, October 3rd, 2024

Health systems have a large amount of patient data through EHRs and other digital platforms managing administrative tasks and clinical care. 

The de-identified patient data is useful for creating large language models, precision medicine, drug discovery and more. There are opportunities for hospitals and health systems to commercialize patient data and monetization could be valuable for hospitals with thin margins. But is it ethical?

Four healthcare leaders addressed the question during a panel at the Becker's Health IT + Digital Health + Revenue Cycle Conference Oct. 1-4 in Chicago. 

"Monetizing data comes up somewhere between every seven or nine seconds in healthcare, and it depends on what you mean by data," said Richard Zane, MD, chief innovation officer, UCHealth. "If we're going to see 500 patients who are a certain age with specific clinical genomic issues, and we're going to sell that data set, we can't do that, but can we optimize algorithms? Can we use clinical data in drug discovery? Those things are happening every single day."

Donna Roach, CIO of University of Utah Health in Salt Lake City, said her institution is conservative on commercializing patient data. She said much of the ethical discussions are focused around how datasets for particular patient populations are used and whether the patients consented.

"If you have a need and the consent isn't there, you may have to do the honors task of going back and getting consent, but once the consent is there, we can move forward," she said. "We sometimes jump to the conclusion that EHR data is so rich and why can't we generalize their consent to be in the EHR, but they've not consented for commercialization of their data. That's the balance and tug of war right now."

Academic medical centers in particular are poised to advance healthcare research, drug discovery and large language models. But organizations need to ensure they aren't exploiting patient data or unnecessarily risking HIPAA violations.

Christian Lindmark, vice president and chief technology officer at Stanford Health Care and School of Medicine, agreed most health systems and physician groups have taken a conservative approach to patient data commercialization, but cautioned non-traditional entrants without the same hesitation could reap the benefits. Startups offering a data-driven model for primary care are poised to collect and commercialize data quickly.

"They would probably be more on the forefront and I would assume we'd get some legal precedent around that if we went that route," Mr. Lindmark said. 

Sarah Poncelet, chair of strategy execution at Rochester, Minn.-based Mayo Clinic, said the health system isn't in the business of commercializing patient data, but instead aims to back or create solutions that would reduce time spent in the EHR. She also craves more longitudinal data.

"Over time, ideally it would be great if the patients owned their own data and we had ways for them to be able to consent and allow for us to have new findings," Ms. Poncelet said. "It's more around having the new findings so we can accelerate research through application and within our Mayo Clinic Platform, we have a lot of groups who are consenting to put their data into a shared cloud."

Researchers can access the patient data through a de-identified blockchain to accelerate findings of early hypothesis research and advance medicine.

"It's not about commercializing patients' data, it's about leveraging the information to accelerate findings."

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Christian Lindmark #christianlindmark

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Christian Lindmark. #christianlindmark

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Christian Lindmark #christianlindmark

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Christian Lindmark

Christian Lindmark. CTO of Stanford Health Care (Palo Alto, Calif.): The chief technology officer and their team play a key role in helping healthcare organizations achieve their overall strategic goals. Typically reporting to the CIO (as it is at Stanford Health Care), the primary role of a CTO is to ensure reliability, resiliency and security of all information systems, data and devices across the organization. There are hundreds, if not thousands, of applications in use across a health system, and the CTO is responsible for creating an infrastructure stack — both on-premise and in the cloud — that is quick to deploy, secure, fast to access and cost-effective for all these applications. The CTO needs to build strong and collaborative teams in infrastructure, engineering, networking, data center, identity/access management and end-user devices to accomplish this.

Secondly, CTOs are innovators, creating and implementing transformative technology offerings to improve the experience of our clinicians, staff and patients. Clinicians continue to rely more and more on technology in their clinical workflows, yet these technologies can often be cumbersome and frustrating if they're not easy to use and not always available. The CTO needs to innovate, simplify and secure the technology environment and user experience while working hard to ensure these systems never go offline.

Lastly, but just as important as the other two, CTOs need to develop relationships with clinical leaders, hospital administration and other stakeholders throughout the organization. Having firsthand knowledge of the goals, challenges and vision of these individuals and departments is critical. The CTO role has typically been less clinically focused; however, partnerships with key clinical leaders across the organization are vital, especially as the CTO role in many organizations, such as Stanford Health Care, has expanded to include clinically facing systems such as biomedical engineering and clinical communication technologies.

The CTO role is different from the CIO or chief digital information officer role in that a significant focus for the CTO is on managing and driving technology in support of clinical operations, as opposed to technology that is directly clinical-facing or clinical by nature. The CIO role is the leader of the healthcare IT organization, responsible for ensuring all the IT teams are working closely together and aligned around the organization's strategic goals. They are not only responsible for the scope under the CTO, but also the clinical/business applications, analytics and security teams, and ensuring the relationships between these teams and key clinical and hospital stakeholders is collaborative and driving toward the organizational strategic goals.

The CIO role has a seat at the executive leadership table within the healthcare organization and directly provides input and feedback into the organization's strategic goals, while the CTO usually does not. The CIO provides the framework for success and removes obstacles to allow IT teams to succeed. There is no question that CIO and CTO have a mutually dependent relationship, as do the CIO and other IT leaders, but a great CIO makes all teams within IT successful, as well as ensures the organization sees IT not just as a cost center but as a partner in its success.

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Christian Lindmark

Christian Lindmark. Chief Technology Officer of Stanford Health Care (Palo Alto, Calif.): We see increased spending in our cloud environments annually and predict it will continue to accelerate in fiscal year 2023 and beyond, for both software as a service (SaaS) and public cloud. Stanford Health Care recently completed a data center consolidation project, moving from five data centers to two co-location facilities and increasing our footprint in the cloud. This is consistent with an overall trend in healthcare, with most organizations determining that owning and operating data centers is not cost-effective or efficient. Furthermore, many vendors in the healthcare space are providing SaaS solutions, eliminating the decision of on-prem versus the cloud.

Historically, when we have looked at our production environments migrating to the cloud, the total cost of ownership has overwhelmingly been more expensive on a five- to seven-year comparison — with capital costs for on-prem hardware and operating costs for management not being reduced enough to offset the increase in operating costs related to cloud spend. However, these comparisons are getting closer each year.

We have found the greatest value in native cloud deployments is with internal software development efforts and disaster recovery environments. The market is still in an early stage, and it will take a few years for some of the greatest benefits for healthcare to emerge, specifically around research data active learning/machine learning.

Additionally, sustainability is a major consideration for us at Stanford Health Care. We are committed to being leaders in improving our IT carbon footprint, and decisions we make related to our infrastructure investments and partners are key considerations moving forward, both in the cloud and on-prem.

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A link to Christian Lindmark.  See this link for more information about Christian Lindmark and healthcare IT.

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What Meaningful Use Means for Your Hospital's IT Infrastructure

What Meaningful Use means to your hospital’s IT infrastructure….

I.                     Intro

The electronic health record (EHR) is quickly becoming the focus of the healthcare system.  The goal of the EHR is to provide patient care more effectively, efficiently, and as a result, at a much lower cost than the current paper-based patient record system.  Because of the dependence healthcare organizations across the spectrum of care will have on the EHR, it is imperative that the EHR is always accessible, data is secure, and the system is reliable.  Unfortunately, many existing hospitals do not have the necessary IT infrastructure in place to properly support an EHR.  More worrisome is that many of these hospitals aren’t even aware of the existing IT issues they are up against.  It is crucial that these IT infrastructure issues that have been overlooked, ignored and swept under the rug year after year are now fixed.

This paper will not address architectural space design issues to accommodate new workflows that result from EHR implementation, nor will it discuss EHR systems and their functionality, return on investment, or other criteria.  There are many implications that will arise in the planning, selection and implementation of an EHR, including cultural changes necessary to achieve “Meaningful Use”.  Rather, the purpose of this abstract is to discuss the IT infrastructure upgrades, often behind the scenes and inadvertently overlooked, that need to be considered as part of the EHR implementation process.  A failure to identify these requirements can prohibit, if not completely derail a successful and organization-wide acceptance and use of the EHR system and core modules.

II.                  Environmental and Space

Implementing an EHR system in a building over 15 years old faces many challenges.  Chances are Technology Distribution Rooms (aka Telecom Rooms, TR’s, IDF) don’t exist that are equipped to properly handle the fault-tolerant requirements expected from the EHR.  Unfortunately, there are even facilities built within the past 5 years where this holds true.  Older Telecom Rooms (Closets are probably a better word to describe them) are very small and probably jammed full of equipment, typically with inadequate space, power and cooling, to support the existing systems, let alone new equipment.  Often these spaces have water within the room (i.e. janitorial/housekeeping sink) or water pipes (sewer, storm drain, etc) running overhead above the equipment.  All of these concerns must be considered and dealt with during an EHR implementation. 

At a minimum, Technology Distribution Rooms (TDR’s) should be used only for technology systems (single-purpose) and not shared with other spaces, such as electrical, mechanical, housekeeping, etc.  These rooms should have card access to monitor which individuals access the critical equipment within these rooms.  Ideally, TDR’s should be stacked from floor to floor, but retrofitting an existing patient care area most likely will not accommodate this.  All new construction should have stacked TDR’s.  TDR’s should be sized appropriately based on the square footage they serve and the number of technology systems they support.  The new AIA 2010 guidelines recommend 12’ x 14’ as a minimum.  Each TDR can serve roughly 25,000 square feet, if centrally located within that space to accommodate cable distance limitations.  Each TDR should have a dedicated panelboard, fed from a centralized UPS, serving the room, preferably 100 Amp minimum.  120V and 208V circuits can be run from this panel to the appropriate equipment in the room.  These rooms need to maintain a temperature range of 65 – 74 degree Fahrenheit and it is not uncommon for the equipment in each of these rooms to require up to 2 tons of cooling.

  III.                Cabling

The Structured Cabling System provides the information technology foundation for the transport of information (voice, data, and video) between end-user devices and network equipment.  The structured cabling system supports voice, data, wireless, PACS, cable TV, security cameras, and other technology systems that utilize non-proprietary cabling systems.  It not only includes the horizontal cabling from the Technology Distribution Room to the individual devices, but also includes the high-bandwidth single and multi-mode fiber optic backbone cabling as well. Patch panels, wire management, equipment racks, cable support pathways, and other accessories complete the Structured Cabling System. 

The two types of cabling that needs to be addressed with an EHR roll-out are the horizontal cabling and the backbone cabling.  The horizontal cabling supports the end-user devices and it routed from the TDR to each end-user device.  If the facility was built within the past 10 years, chances are Category 5, Category 5E, Category 6 or Category 6A cable was installed, all of which provided acceptable bandwidth for data transmission at the time it was installed.  All cabling rated Category 5 and below needs to be replaced to properly support the data transmission speeds ideal for an EHR.  If cable replacement is required for the EHR implementation, it is recommended to install the best cabling available, currently Category 6A. 

The backbone cabling for your data network consists of the fiber optic cabling that connects the network electronics in each TDR to the network electronics in the data center. The network electronics in the data center in turn connect to each of the technology system servers.  It is recommended that both single-mode and multimode fiber optic cable be installed to each TDR.  Multi-mode fiber should be 50 micron, specified to support 10Gbps.  A 50% growth capacity, at a minimum, should be added to the number of fiber strands initially used to determine how many should be installed.

IV.                Network Electronics

The network electronics make up what is most often referred to as the Local Area Network (LAN).  The LAN is the life-blood of an organization, keeping information flowing from point-to-point.  The LAN includes the network electronics that allow for the transmittal of data (saving and retrieving emails, documents, images, and information from servers, access to the internet, Voice over IP (VoIP), etc.) within a facility as well as externally.  The continuously increasing bandwidth demands keep these electronics changing rapidly.  Unfortunately, newer equipment also means expensive cost, which in many cases, facilities have put off for many years.  A local area network and the associated electronics should be reviewed and analyzed every three years at a minimum, to determine if the existing design still meets the organization’s requirements for speed, security, and functionality. 

Prior to implementing and/or upgrading your EHR, it is important to talk with a local LAN vendor or consultant to review the existing network design and configuration.  It is imperative that the LAN is designed to accommodate both the current and future bandwidth demands of working with large files/images as well as designed with redundancy and proper configurations to reduce the chance of catastrophic network failure.  Proper firewalls need to be implemented to protect patient data as well.

V.                  Wireless

Nearly all healthcare facilities have some type of 802.11 “Wi-Fi” coverage in their facilities. In fact, many facilities have what they consider 100% coverage, be it 802.11 a/b/g or the new 802.11n protocol.  Facilities use the wireless network for guest laptop access, mobile computing by physicians, and even the deployment of wireless phones.  Some are even putting master clocks, tracking systems, temperature monitoring, telemetry, and other medical communication systems on the Wireless LAN (WLAN).  While it is encouraging that more and more healthcare facilities are realizing the benefits wireless, there is a misconception that 100% coverage will adequately support the wireless demands placed on the network.  Each wireless access point can support a specific amount of bandwidth, which must be shared among users connected to that specific access point.  So while a healthcare organization may have Wi-Fi coverage throughout their facility, the density of access point deployment greatly affects the user’s experience in terms of data transmission speed, dropped connections, dropped calls, and potentially even the ability to connect to the wireless network at all.

Ubiquitous wireless coverage is definitely required to support the implementation of an EHR.  In addition to just being ubiquitous, however, the wireless system must be designed to handle projected wireless bandwidth by analyzing projected individual connections, bandwidth usage, and applications.  Multiple laptop connections surfing the internet have a certain demand, while a single video-streaming application has a much greater impact.  Additionally, using the WLAN for tracking equipment, staff, and patients requires a dense access point deployment to generate the granularity typically expected of a tracking system.  A properly implemented wireless network is critical to the successful implementation of an EHR.  It will improve care-giver mobility, provide immediate and universal access to patient data, enhance asset tracking capabilities, provide patient and patient’s family’s access to the internet and even support real-time video-streaming.

VI.                Data Center

The data center (often called server room in smaller healthcare facilities) is the brain of any healthcare organization.  In addition, it is also the most expensive piece of real estate, per square foot, that an organization owns and maintains.  This is not referring to its construction or maintenance costs, which are quite significant, but rather to the lost revenue and increased costs associated with an unplanned data center outage of any significance.  The data center is the central repository for all information that resides within an organization.  In the digital age of information, with patient’s electronic records and their lives riding on the ability of intricate systems to send, receive, store, and analyze data, the data center cannot fail   It must be designed with redundancy, not only from a cabling and electronics standpoint, but also from an electrical and mechanical cooling perspective.  There must also be a well-planned and tested disaster recovery plan in place just in case there is a massive failure.

  Unfortunately, many healthcare organization’s data centers and server rooms are located in places that were not purpose built to be a data center.  Many of these locations have inadequate power and cooling, are too close to water sources, and/or are located in areas that are not best situated to house the critical and life-safety data that resides within the data center.  Some healthcare facilities have begun to address this issue in the last 3 – 5 years by building new purposed built data centers, however, a greater number of facilities have continued to ignore the need for a reliable data center.    

  Most data centers in large healthcare environments have hundreds of different servers and applications, Storage Area Networks (SANs) with petabytes of information, and new systems being added monthly, if not weekly.  Newer technologies, such as blade servers and virtualization, continually evolve and change, making the planning of a data center very difficult.  Despite this dynamic environment, a healthcare data center should be built somewhere between a Tier II and Tier III data center, as defined by the Uptime Institute’s Tier levels.  All equipment within the data center should be on UPS power that is connected to the facilities generator power system.  The data center should have a redundant UPS infrastructure to handle the data center load in case of primary UPS failure.   Likewise, HVAC systems should be designed to an N+1standard at a minimum.  In smaller healthcare organizations, the same data center principals apply to server rooms. It is all about scale. 

Christian Lindmark.  #christianlindmark