Embedded Health Data Chips for Interior Alaska

A Feasibility Study

Expert Panel

Graduate Advisory Committee

Dr. Robert Perkins, Advisor Dr. Ming Lee Dr. Leroy Hulsey

Embedded Health Data Chips for Interior Alaska

A Feasibility Study

Prepared for theEngineering and Science Management Program

Presented by UAF Masters Candidates Lien Huang

Steven RoscoviusFrank Toth

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

Is there a problem?

Feasibility Study

Is there a better way? We are challenged to explore new

technology But we are bound to do it ethically

and morally

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

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.

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.

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

What is the problem?

Identification of patients Unconscious Disabled No identification Very young Elderly

What are some options?

Do Nothing Radio Frequency Identification Chip Personal Data Assistant Devices ID Cards

Do Nothing

No apparent costs Are there hidden costs?

No change in current situation

RFID Chips

New technology Implantable Does not require batteries Type for consideration is ID number

only Can’t lose it

Personal Data Assistant Carry your entire medical history

X-rays Diagnostic scans Medical notes Lab tests

Compatibility Issues Exist Can be lost Rural use?

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

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%

Scoring

Options Rank Score Rank Score Rank Score Rank Score SCORE RANK

Do Nothing 4 0.60 1 0.10 1 0.40 3 1.05 2.15 3rd

RFID 2 0.30 2 0.20 4 1.60 4 1.40 3.50 1st

PDA 1 0.15 4 0.40 2 0.80 1 0.35 1.70 4th

ID Card 3 0.45 3 0.30 3 1.20 2 0.70 2.65 2nd

CAPITALCOSTS

STOREDINFO

CATEGORIES AND WEIGHTS

TOTAL

SPECIALNEEDS

35%

EMERGENCY

15% 10% 40%

VeriChip

Chip was originally developed to track livestock and wildlife

October of 2004, FDA approval for human implantation and use as a health device

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

VeriChip

No reported complications or side effects

At least 10 year lifespan Some have concerns with

magnetic resonance imaging (MRI) Reversible with minor surgery

VeriChip

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

VeriChip Case Studies

Alzheimer's Care in Palm Beach Infant Abduction Brittan Elementary School Mexican Attorney Generals Office Hackensack Emergency Program

NJ

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

Infant Protection 116 abductions from health-care facilities in

the last 22 years Infant mismatching Halo – infant protection systems

Chip is in bracelet

Brittan Elementary School

Sutter, California RFID tags embedded in student

badges tracked students throughout the

school Ended by parental pressure

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

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

Emergency Room Visits

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

Is it feasible?

Need to analyze Stakeholders Economic Legal and Ethical Social Program Schedule and Costs

Stakeholders

Economic

Trial period Capital Costs

Medical Scanners Training RFID Chips

Annual Costs Fee

Full Scale

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

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

Economic Costs of Trial

Present Worth (Discount Rate 6.5%)YEAR COST

0 $350,000

1 $100,000

2 $100,000

3 $100,000

4 $100,000

5 $100,000Net Present

Worth$765,000

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

Benefits

Cost Savings Less errors Improved efficiencies

Improved Health Services Intangibles

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

Benefits

Rand StudyNational Electronic Records

Potential Savings

HEALTH BUDGET

2 Trillion

INITIAL SAVINGS

88 Billion

4%

EVENTUAL SAVINGS

346 Billion

17%

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

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

Benefits

Improved Health Services Intangibles

Better patient service Fewer mistakes Speedy care Less exposure to lawsuits

Legal and Ethical

Identification and Tracking Social Environment

Privacy & Notice by Institutions Security Data Storage Options

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

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

Security

Encryption – Small Chips Lack Scanning Range (4”; 2-3 ft; 10 ft)

Tracking Possible Dutch e-Passports

2006 AK Community RHIO Regional Health Information Org

Improve health record exchange Lower costs Prevent medical mistakes

Health Information Security & Privacy Collaboration Issues of Exchange Health Information Health care providers; Insurers; Health care

agencies

Data Storage-Option #1

Option 1 Patient file at TCC. Information requests through VeriChip

to TCC TCC retains ownership No additional notification or release

forms

Patient Information

Health Care Provider

Request for Records

VeriChp Request for Records

TCCPatient File

Data Storage-Option #2

Option 2: Patient file is stored at VeriChip TCC updates the patients file but

VeriChip owns the data storage used Additional notification and release

forms requiredUpdates

Patient Information

Health Care Provider

Request for Records

VeriChipPatient File

TCC

Data Storage - Option #3

Option 3: Similar to option 2 Patient file is stored at VeriChip TCC leases data server No additional notification or releases

neededUpdates

Patient Information

Health Care Provider

Request for Records

VeriChipPatient File

TCC

Current Legal Status

Current Law Federal State

Federal

No current laws govern RFID technology

Current Bipartisan Caucus Industry, DOD, and Academics Pharmaceutical authentication,

drug/product recalls, food chain safety, homeland security, supply chain efficiency

State 2005 – 12 states have introduced RFID

legislation Wisconsin

Legislation to prevent implants w/o person’s permission

California Legislation security/guidelines protect

privacy rights of individuals – govnr vetoed Two other bills pending

Social Analysis

Are there social issues in rural Alaska that are different from Fairbanks?

What are some of the issues? Remote population Language Culture

Customs Tradition

Points of Caution Village’s point of view?

Lack of pressing need Oral Traditional Economic

Skepticism Overall Based on history

Stigmas Individuals Communities

TCC Board

Approval Small budget to continue

What do we do?

Evaluating Social Concerns

How do we evaluate these concerns?

We need a acceptance plan Hire a marketing firm? Local surveys? Meetings with TCC? Meetings with village elders?

Program Implementation Creating a implementation team

Team will be composed of primary stakeholders

Key task will be developing and implementing acceptance plan

Investigate funding Negotiate with vendor

Pilot project? Evaluate the process Review

Program Implementation

Go / No Go Deploy the hardware Monitor the outcomes Re-evaluate

Implementation Tasks

Implementation Schedule

Implementation Costs

1st year Capital Costs

Initial + Annual Fee $450,000

Implementation Costs $34,990

$484,990

Is It Feasible?

What are the needs? What are some likely solutions? We have discussed some of the pros

and cons in health and economics We have considered some legal /

ethical / moral issues? We have identified social issues

Recommendation

Further Investigations are Needed Economic and Health issues

It will work Legal issues are not defined

Risk involved Social issues might derail

completely

Special Thanks To

Robert Perkins Ming Lee Leroy Hulsey Jim Kohler Perry Ahsogeak Rebecca Madison

Questions

THANK YOU