Embedded Health Data Chips for Interior Alaska

1. Embedded Health Data Chips for Interior Alaska A Feasibility Study

2. Expert Panel

3. Graduate Advisory Committee • Dr. Robert Perkins, Advisor • Dr. Ming Lee • Dr. Leroy Hulsey

4. Embedded Health Data Chips for Interior Alaska A Feasibility Study

5. Prepared for theEngineering and Science Management Program Presented by UAF Masters Candidates Lien HuangSteven Roscovius Frank Toth

6. Overview • Study Statement • Introduction to Tanana Chiefs Conference • Background and Options • Criteria and Analysis • Stakeholders • Economic • Legal and Ethical • Social • Program Schedule and Costs • Conclusion

7. Is there a problem?

8. Feasibility Study • Is there a better way? • We are challenged to explore new technology • But we are bound to do it ethically and morally

9. Task Force • We approached this as a task force • Tanana Chiefs Conference (TCC) • Chosen for its unique health care situation • We were challenged in our study • Discovered that numbers and dollars may not always sum up the story

10. Tanana Chiefs Conference • Mission Statement • Tanana Chiefs Conference provides a unified voice advancing tribal governments, economic and social development, promoting physical and mental wellness, educational opportunities and protecting language, traditional and cultural values.

11. Tanana Chiefs Conference • The Department of Health Services • Mission Statement • TCC Health Services, In Partnership With Those We Serve, Promotes And Enhances Spiritual, Physical, Mental And Emotional Wellness Through Education, Prevention And The Delivery Of Quality Services.

12. Chief Andrew Isaac Health CenterJim Kohler - Director • 15,000 beneficiaries • 43 villages • $44 million health budget • 1.5% for data management and communications $660,000 • Electronic Health Record was implemented in February 2005 • Health data management is vital and continually challenging • Quality of care and proper reimbursement • Affects pharmacy, lab, radiology, continuity between providers, scheduling, and billing • Communication with 43 different villages • Challenges • Flat budgets with double digit cost increases • Staff shortages

14. What is the problem? • Identification of patients • Unconscious • Disabled • No identification • Very young • Elderly

15. What are some options? • Do Nothing • Radio Frequency Identification Chip • Personal Data Assistant Devices • ID Cards

16. Do Nothing • No apparent costs • Are there hidden costs? • No change in current situation

17. RFID Chips • New technology • Implantable • Does not require batteries • Type for consideration is ID number only • Can’t lose it

18. Personal Data Assistant • Carry your entire medical history • X-rays • Diagnostic scans • Medical notes • Lab tests • Compatibility Issues Exist • Can be lost • Rural use?

19. ID Card • A card embedded a unique ID number • Quick check-in • Cheap • Easy to lose • Do you want another ID card?

20. The Best Option • Ranked in 4 categories • Categories scored by weighting • Initial capital costs for implementation • 15% • Information stored on the device • 10% • Availability of the device in an emergency • 40% • Practicality of using the device for special needs individuals • 35%

21. Scoring

23. VeriChip • Chip was originally developed to track livestock and wildlife • October of 2004, FDA approval for human implantation and use as a health device

24. VeriChip • Approximately the size of a grain of rice • Implanted into subcutaneous fat • takes less than 20 minutes • Performed by physician • Contains 16-digit unique number • Scanned using VeriChip device • Information via the internet

25. VeriChip • No reported complications or side effects • At least 10 year lifespan • Some have concerns with magnetic resonance imaging (MRI) • Reversible with minor surgery

26. VeriChip • Who would benefit the most? • Impaired speech • Memory loss • Loss of consciousness • Chronic illnesses • Common names • Mistaken identities

27. VeriChip Case Studies • Alzheimer's Care in Palm Beach • Infant Abduction • Brittan Elementary School • Mexican Attorney Generals Office • Hackensack Emergency Program NJ

28. Alzheimer's Care • 2-year project • 280 patients • Starts in May, 2007 • Provides emergency department staff easy access to those patients’ identification and medical information

29. Infant Protection • 116 abductions from health-care facilities in the last 22 years • Infant mismatching • Halo – infant protection systems • Chip is in bracelet

30. Brittan Elementary School • Sutter, California • RFID tags embedded in student badges • tracked students throughout the school • Ended by parental pressure

31. Mexican Attorney Generals Office • Originally reported by AP in 2004 • 18 members are tagged • Controls access to secure areas and to restricted data • Combat corruption

32. Hackensack Emergency Program • Average increase of more than 1.5 million visits per year • 2.7 million were made by persons living in institutional settings such as nursing homes or prisons • At the same time the number of emergency departments have decreased by about 12.4 percent

33. Emergency Room Visits

34. Option for more detailed study • Trial Period • 5 Years • 1500 people that would most benefit from this technology • Mental or physical handicaps, dementia, elderly or very young • Full Scale • After trial

35. Is it feasible? • Need to analyze • Stakeholders • Economic • Legal and Ethical • Social • Program Schedule and Costs

36. Program Local Physicians Communication Companies Primary Airlines TCC VeriChip Fed Gov Elders State Gov Law Enforcement Health Care Providers Members Privacy Advocates i.e. ACLU Secondary Stakeholders Travel Industry Schools Health care providers Taxis

37. Economic • Trial period • Capital Costs • Medical Scanners • Training • RFID Chips • Annual Costs • Fee • Full Scale

38. Economic • Capital costs • Medical Scanners • We estimated 43 scanners for the villages plus 12 to cover the facilities in Fairbanks • 55 scanners needed. • Training • Seamless Integration • RFID chips • 1500 initial

39. Economic • Medical scanners • $600 to $3,000 • Estimate $50,000 • RFID chips • $200 plus hospital costs, estimated up to another $200 • Estimate initial cost $300,000 • Annual fee • $20 to $80 • Estimate $100,000 yearly fee

40. Economic Costs of Trial • Present Worth (Discount Rate 6.5%)

41. Upgrade to Full Scale • Largest cost growth would be in the RFID chips. • 3 to 6 million dollars to acquire chips • VeriChip and TCC could find common ground far below. • No additional scanners • Possible increase in yearly fee

42. Benefits • Cost Savings • Less errors • Improved efficiencies • Improved Health Services • Intangibles

43. Benefits • Cost Savings • Lack of long term studies • Estimates of cost savings are difficult • Rand study on electronic medical records • Although not a true parallel it hints at the possible savings through increased efficiency and improved patient care

44. Benefits • Rand Study

45. Benefits From Full Electronic Records • Initial • If 90% adopt health information technology • $77 billion from efficiencies • Shorter hospital stays prompted by better-coordinated care • Less nursing time on administrative tasks • better use of medications • better utilization resources • $4 billion from improved safety • primarily by reducing prescription errors

46. Benefits for TCC • Expected Cost Savings? • With a annual health budget of $44 million, even 1% savings can be substantial • 2% = $880,000 • 1% = $440,000 • 0.5% = $220,000

47. Benefits • Improved Health Services • Intangibles • Better patient service • Fewer mistakes • Speedy care • Less exposure to lawsuits

48. Legal and Ethical • Identification and Tracking Social Environment • Privacy & Notice by Institutions • Security • Data Storage Options

49. Identification and Tracking Social Environment • Passive – 16 digit • Active – Up to 100 Pages of Text • Tracking • Staff and Patients • Substance Abuse • Home Confinement for Inmates • Insurance Profiling

50. Privacy & Notice by Institution • Griswold v Connecticut (reviewed privacy) • 1st Amendment - Right of Association • 3rd – Prohibition of Quartering of Soldiers • 4th – Secure in houses; Search & Seizure • 5th - Self Incrimination-zone of privacy • 9th – Fundamental rights not specifically mentioned • Health Insurance Portability & Account • Notice of Privacy Practice • Note use of RFIDs