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class="c32"><p class="c22"><span class="c15 c14 c25">Introducing the HIE of One</span></p><p class="c22"><span class="c15 c14 c25">Patient-Controlled Independent Health Record</span></p><p class="c36"><span class="c6 c13"><a class="c8" href="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DN_3DbDZUTIg&sa=D&ust=1511044300242000&usg=AFQjCNFLzwO7BmO4-kaiMRSGAF80v6vThQ">Highlights Video (2:25)</a></span></p><p class="c5"><span class="c3"></span></p><p class="c18"><span class="c7 c2">The Problem: A broken market</span></p><p class="c18"><span class="c3">By almost any definition, US healthcare is broken. Quality and cost are difficult to assess and even harder to control. Major decisions are politicized. People are frustrated. Cost is spiraling, leaving too many people without adequate care. </span></p><p class="c22"><span class="c13">The free flow of accurate information </span><span class="c13 c29">must</span><span class="c3"> be available to the key influencers and decision makers in order to deliver optimal care. These are the physicians that recommend and sign orders and the patients that choose a physician and accept treatment. </span></p><p class="c5"><span class="c3"></span></p><p class="c22"><span class="c3">In our current system neither physicians nor patients control the majority of healthcare information. It's controlled instead by institutions, such as hospitals, which employ physicians; by government; and by data brokers in the business of aggregating and selling patient information to manufacturers, insurers and other third parties. The result is fragmented information that compromises quality, cost, and provider and patient satisfaction. Consider:</span></p><ul class="c24 lst-kix_u3x884ymosly-0 start"><li class="c35 c31 c40"><span class="c13">3 of every 10 tests are reordered because the results cannot be found.</span><span class="c13 c39">1</span></li><li class="c28"><h3 style="display:inline"><span class="c13 c25">Patient charts cannot be found on 30% of visits.</span><span class="c13 c19">1</span></h3></li><li class="c28"><h3 style="display:inline"><span class="c13 c25">About 80% of all serious medical errors involve miscommunication during care transitions to different care setting.</span><span class="c19 c13">2</span></h3></li><li class="c28"><h3 style="display:inline"><span class="c13 c25">Approximately 25% of US patients reported that the results and records from one provider did not reach another provider in time for their appointment.</span><span class="c19 c13">3</span></h3></li><li class="c28"><h3 style="display:inline"><span class="c13 c25">20% of malpractice claims involve missed or delayed diagnoses due to deficits in handoffs between providers.</span><span class="c19 c13">4</span></h3></li><li class="c23"><h3 style="display:inline"><span class="c13 c25 c20">From 2014 to 2015, the number of individuals affected by protected health information breaches increased from ~1.8 million to ~110 million.</span><span class="c19 c13 c20">5</span></h3></li><li class="c28"><h3 style="display:inline"><span class="c13 c25 c20">Almost 70% of individuals report that they were not provided access to their clinical laboratory test results in 2012.</span><span class="c19 c13 c20">6</span><span class="c10"> </span></h3></li></ul><p class="c5"><span class="c3"></span></p><p class="c22"><span class="c9 c2">References: 1.</span><span class="c9"> Technology CEO Council. http://www.techceocouncil.org/clientuploads/reports/A_Healthy_System_Final.pdf. </span><span class="c9 c2">2.</span><span class="c9"> http://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_12.pdf. </span><span class="c9 c2">3.</span><span class="c9"> Mehrotra A et al. </span><span class="c9 c11">Milbank Q. </span><span class="c9">2011;89(1):39-68. </span><span class="c9 c2">4</span><span class="c9">. Gandhi TK et al. </span><span class="c9 c11">Ann Intern M</span><span class="c9">e</span><span class="c9 c11">d</span><span class="c9">. 2006;145(7):488-96. </span><span class="c2 c9">5.</span><span class="c9"> https://dashboard.healthit.gov/quickstats/pages/breaches-protected-health-information.php. </span><span class="c9 c2">6. </span><span class="c15 c9 c25">https://dashboard.healthit.gov/quickstats/pages/FIG-Patient-Access-to-Results-of-Clinical-Lab-Tests.php. </span></p><p class="c5"><span class="c3"></span></p><p class="c5"><span class="c3"></span></p><p class="c18"><span class="c7 c2">The answer: Individual agency</span></p><p class="c18"><span class="c3">Control over our personal information is necessary--but not sufficient--because individuals must also be able to process their information on their own terms. Today processing is in the hands of Google, Facebook, and hospitals. That power is used strategically to their benefit, not the benefit of the physician or patient. Thus the broken healthcare market continues. </span></p><p class="c18"><span class="c3">To preserve our dignity and an open future, our "personal agents"-- that is, our digital financial and healthcare representatives--must be capable of computation, machine learning, and payment. As technology advances, our personal agents will become increasingly autonomous, capable of interacting with the agents of other individuals as well as with institutions, the way people always have.</span></p><p class="c22"><span class="c3">Licensed professionals, be they plumbers or doctors, are an important class of personal interaction because they serve both a regulatory and a decision support role. Their relationships have 3 principal components:</span></p><ul class="c24 lst-kix_4sxb79evgf48-0 start"><li class="c22 c35 c31"><span class="c3">Bilateral choice (both customers and professionals can define and choose their relationships)</span></li><li class="c22 c35 c31"><span class="c3">Payment for services</span></li><li class="c22 c31 c35"><span class="c3">Auditable regulatory responsibilities (individual license credentials are at risk)</span></li></ul><p class="c5"><span class="c3"></span></p><p class="c18"><span class="c7 c2">Blockchains and related technology are a breakthrough in individual agency</span><span class="c26 c7 c25"> </span></p><p class="c18"><span class="c3">Blockchains demonstrate scalability in all 3 of the essential components of patient-to-physician transactions: they are a bilateral choice, include payment, and leave an auditable trail. </span></p><p class="c18"><span class="c3">It’s important to note that physicians add value to blockchain-based contracts by serving as the link between the digital world of the blockchain and the material world of healthcare activity. With self-sovereign (self-ownership) technology and blockchain support, the physician can be independent of any particular vendor or institutional interest and can access patients and innovative services directly. Patients who control their own technology and health records can also access both physicians and artificial intelligence decision support without institutional interference. Self-sovereign technology enabled by blockchains can help fix the broken market in healthcare.</span></p><p class="c18"><span class="c2 c7">Delivering value in healthcare: more accurate and complete healthcare records for better healthcare decisions</span></p><p class="c18"><span class="c3">A patient-controlled independent health record shifts economic power to physicians who interact directly with the patient, even if a hospital or medical group employs them. An imaging center, lab, pharmaceutical company, or device vendor can communicate directly with the prescriber and the patient-owned health record. Patient-provider integration is no longer mediated by hospital EHRs, clearinghouses, or data brokers. </span></p><p class="c18"><span class="c3">This direct relationship provides more accurate and complete information to enable meaningful choices. This impacts payers, as well: as we struggle to apportion scarce resources, there is tension between the preference of the patient and the interests of commercial insurers and public payers such as Medicare, Medicaid, and the VA. Patient control of the health record is essential for more informed decisions and to mitigate the suspicion of rationing.</span></p><p class="c18"><span class="c26 c7 c2">Better healthcare decisions can lower costs and improve outcomes</span></p><p class="c18" id="h.gjdgxs"><span class="c3">The higher the personal healthcare stakes, the greater the incentive for a patient to pay to control an independent health record. Consider the actual experience of "Alice," a 39-year old mother of 2 diagnosed with ovarian cancer. At the time of her diagnosis, she was told she could expect to live no longer than 44 months.</span></p><p class="c18 c31"><span class="c3">Alice is a cancer scientist herself and decides to do what she can to beat the odds. Over the space of 3 years, Alice repeats a cycle of having the genome of her tumor sequenced after each cycle of therapy, sharing that and previous tumor genomes with a multiple oncologists as well as with all of the cancer research data scientists willing to process it. </span></p><p class="c18 c31"><span class="c3">After each treatment and tumor response cycle, high-stakes decisions around the next cycle must be made again. There are choices of immunotherapy vs. cytotoxic chemo, multiple drugs in each path, combinations of drugs, and the worry that a choice of cytotoxic chemo for one cycle will reduce the effectiveness of immunotherapy during the next cycle. In addition, new research, new protocols, and new therapeutic agents become available every few months. Each oncologist recommends different treatment options at each step. But the final decisions about her next treatment cycle are up to Alice, and time is not on her side. </span></p><p class="c18 c31"><span class="c3">Three years after her diagnosis, Alice looks good and her cancer appears to be under control. She is asked her advice for the next patient beginning her journey. Without hesitation, Alice says: “Each time you get a laboratory or tumor test, take all of the raw data away immediately on a flash drive, add it to your record, and share it with as many doctors, researchers, and drug companies as are willing to look at it.”</span></p><p class="c18"><span class="c3">Without ownership of her health record, a patient is at the mercy of various providers who often have incomplete or inaccurate information. Different providers may repeat tests or re-challenge her with treatments she may already have tried. Fragmented information makes second opinions less useful and ultimately narrows her options.</span></p><p class="c18"><span class="c3">When her health record travels with her, rather than with an institution, she or her physician can seek second opinions with confidence, knowing that every provider will have a complete and accurate history. This will open the door to a greater choice of treatments, and allow her to maintain closer control of out-of-pocket expenses. </span></p><p class="c18"><span class="c3">For the 5% of patients who account for over $100,000/year of healthcare costs, a patient-controlled independent health record has sufficient economic value that payers and physicians should recommend it and use it. Savings and outcomes will be transparent and readily quantifiable.</span></p><p class="c12"><span class="c3"></span></p><p class="c18"><span class="c26 c7 c2">Who will drive use?</span></p><p class="c18"><span class="c3">Patient controlled independent health records will be driven by physicians, device vendors like Apple, a growing list of labs and service providers, and patients who are invested in getting efficient, optimal care.</span></p><p class="c18"><span class="c26 c7 c2">The cost of Independence is small</span></p><p class="c18"><span class="c3">Patient controlled independent health records should be very inexpensive. Hosting, tech support, and the creation of the patient-controlled health record can be supported by a nominal fee paid by the patient or their insurer. The software itself is open source to ensure that the patient and provider are not locked-in by a vendor. A blockchain token linked to hosting, support, and investment can drive adoption of the patient-controlled independent health record.</span></p><p class="c18"><span class="c7 c2">Show me the money: using blockchain tokens to pay for patient </span><span class="c7 c2">services</span><span class="c7 c2 c26"> </span></p><p class="c18"><span class="c3">The patient buys fungible health tokens and distributes them to the hosting and support services for their health record. The separation of support from hosting contributes to independence as the support organization can facilitate switching from one host to another.</span></p><p class="c27"><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 576.00px; height: 432.00px;"><img alt="" src="images/image1.png" style="width: 576.00px; height: 432.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c27"><span class="c3">Public Blockchains Enable and Complement Private Health Records</span></p><p class="c21 c34"><span class="c3"></span></p><p class="c21 c33"><span class="c3"></span></p><p class="c18"><span class="c26 c7 c2">The Token Drives Consensus</span></p><p class="c18"><span class="c13">Ongoing </span><span class="c6 c13"><a class="c8" href="https://www.google.com/url?q=https://www.nytimes.com/2017/10/27/technology/what-is-an-initial-coin-offering.html&sa=D&ust=1511044300251000&usg=AFQjCNG3RFSQp9zvS0MG7ZoDsb3NcWqhkQ">token</a></span><span class="c3"> sales for an open source health record project are expected to attract developers as well as investors. Payment for hosting and support denominated in a health record token (rather than a general currency like Bitcoin) would look like an in-app purchase on today’s App Stores. A fraction of the token value would go to the operator of the token to support development and repay early investors. As with an app store, participation by developers is voluntary. </span></p><p class="c18"><span class="c3">A successful open source health record token will be expertly managed by doctors for doctors, and will appeal to a large number of patients. </span></p><p class="c18"><span class="c26 c7 c2">Where are we today: HIE of One status and next steps</span></p><p class="c18"><span class="c3">HIE of One is the industry’s most experienced patient-centered health records team. We also have the only standards-based open source health record and the only one integrated with the leading blockchain ID and credentialing app. HIE of One has secured a high-visibility pilot in Austin, TX that gives us access to more than 300 physicians and over one million patients. </span></p><p class="c18"><span class="c3">Investors in HIE of One are funding development in support of the pilot and marketing activities to develop other health information exchange installations, laboratory and direct medicine partnerships, and outreach to cancer and mental health patient groups, among others.</span></p><p class="c22"><span class="c3">Investors are also funding the introduction of a health record token in a coming version of the open source health record. </span></p><p class="c5"><span class="c3"></span></p><p class="c5"><span class="c3"></span></p><p class="c22"><span class="c13">Please see the </span><span class="c6 c13"><a class="c8" href="https://www.google.com/url?q=https://drive.google.com/file/d/0B_Rve6d1gHMWNmtueU5mTm9wVEk/view?usp%3Dsharing&sa=D&ust=1511044300252000&usg=AFQjCNEdgf46fVcru4xWc6YfIcZ2lzVs1A">White Paper</a></span><span class="c3"> for a technical description of the HIE of One patient owned health record, and feel free to provide your email address to receive updates.</span></p><p class="c27"><span class="c13 c37"><br></span><span class="c6 c2 c14"><a class="c8" href="https://www.google.com/url?q=https://docs.google.com/forms/d/1JVd62bl9IROmEszgJLRBX0CAxAniY0ESeBxGT5dW7T0&sa=D&ust=1511044300253000&usg=AFQjCNGFrblcBzGRn_bMelfW5vGqzUr34A">Keep in touch...</a></span></p><p class="c17 c21"><span class="c0"></span></p><p class="c17 c21"><span class="c0"></span></p><p class="c17"><span class="c0">Videos</span></p><ul class="c24 lst-kix_1scmx3xmkx9n-0 start"><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DN_3DbDZUTIg&sa=D&ust=1511044300253000&usg=AFQjCNEEENtabPDNGLhxrf1FUq9qMoriGA">October 2017 Highlights</a></span><span class="c1"> (2:25)</span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DP6FaUAcq6FI%26list%3DPLn9P7BiqUmmjk09q4I57cvPwysvsScm1p&sa=D&ust=1511044300254000&usg=AFQjCNFs_NIsoTP5Df5jPRhM6w1RSscF-w">October 2016 Playlist</a></span></li></ul><p class="c17 c21"><span class="c0"></span></p><p class="c17"><span class="c0">White Paper</span></p><ul class="c24 lst-kix_gpxxwqfclfl-0 start"><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://drive.google.com/file/d/0B_Rve6d1gHMWNmtueU5mTm9wVEk/view?usp%3Dsharing&sa=D&ust=1511044300254000&usg=AFQjCNGUvyXZhQcqAf_LJZCfn3DhEwU9vg">Rebooting Web of Trust V - October 2017</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=http://bit.ly/ELSI-LHS_Nov17&sa=D&ust=1511044300255000&usg=AFQjCNHhGrGYxLIVzA7Mq0B78YaXUCBafg">U Michigan Symposium Poster</a></span></li></ul><p class="c17 c21"><span class="c0"></span></p><p class="c17"><span class="c2">About</span></p><ul class="c24 lst-kix_s57xws4li10p-0 start"><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/adrian-gropper-6916651/&sa=D&ust=1511044300256000&usg=AFQjCNEpVPl1d0F_tk1zRkYOb5VENdE8rQ">Adrian Gropper, MD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/michael-chen-a274a656/&sa=D&ust=1511044300256000&usg=AFQjCNE5aCIYqn6fsEyQHaxtiW9pN9SvSQ">Michael Chen, MD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/edie-pargh-0431785/&sa=D&ust=1511044300257000&usg=AFQjCNEhlgZY0_7B0ygecFmjQFtdkjC04Q">Edie Pargh</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/randybak/&sa=D&ust=1511044300257000&usg=AFQjCNEW0k9ssLCXvBQyugtAfC_2o6uhkg">Randy Bak, MD, JD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/thomas-welch-650362a/&sa=D&ust=1511044300258000&usg=AFQjCNHpm9yBwsyqeQbuMnM6kpS3H9FPUQ">Thomas Welch, JD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/zak-fallows-0641228/&sa=D&ust=1511044300258000&usg=AFQjCNE0MI3tDhxnBJqfiDEGqiSY423M-Q">Zak Fallows</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/deborahcpeelmd/&sa=D&ust=1511044300259000&usg=AFQjCNHtbrTYwt5sL5R4Muu1xSXHQd1VKQ">Deborah C. Peel, MD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/marlene-smitherman-055637a/&sa=D&ust=1511044300259000&usg=AFQjCNEnEqL77UjgfUzfcP52CZiU3oXPbA">Marlene Smitherman</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/david-dinhofer-md-msmi-facr-81158915/&sa=D&ust=1511044300259000&usg=AFQjCNG3j0MNc8zEawcGhRmy6SdM_K4IUw">David Dinhofer, MD</a></span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.linkedin.com/in/robert-goldstein-502a3520/&sa=D&ust=1511044300260000&usg=AFQjCNGu8OU7_JxKL21THQa5mhXYBWN-lQ">Robert Goldstein</a></span></li></ul><p class="c17 c21"><span class="c1"></span></p><p class="c17"><span class="c0">Links</span></p><ul class="c24 lst-kix_8173bidf9a6r-0 start"><li class="c16"><span>Source Code </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://github.com/shihjay2/&sa=D&ust=1511044300260000&usg=AFQjCNEJ1reBu1so09bEw-AzxnNp96DD-w">https://github.com/shihjay2/</a></span><span class="c1"> </span></li><li class="c16"><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://medium.com/@sheldrake/defining-sovereign-technology-so-we-can-build-it-and-so-we-know-it-when-we-see-it-98ad77914025&sa=D&ust=1511044300261000&usg=AFQjCNERSiheakCToC8lyaY-zwQz_5vh3Q">Defining Sovereign Technology</a></span><span class="c1"> </span></li></ul><p class="c17 c21"><span class="c1"></span></p><p class="c17"><span class="c0">Affiliates</span></p><ul class="c24 lst-kix_6bkzxv203aas-0 start"><li class="c16"><span>Digital Life Collective</span><span class="c2"> </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://diglife.com/&sa=D&ust=1511044300262000&usg=AFQjCNEb3bs_UwLkF_sFoMC8ExTqf54fgw">https://diglife.com/</a></span><span class="c1"> </span></li><li class="c16"><span>W3C Verifiable Claims </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://www.w3.org/2017/vc/WG/&sa=D&ust=1511044300262000&usg=AFQjCNGJUOHU9Ky4FWNpQiNaz93fbNyAlA">https://www.w3.org/2017/vc/WG/</a></span><span class="c1"> </span></li><li class="c16"><span>Rebooting Web of Trust </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=http://www.weboftrust.info/&sa=D&ust=1511044300262000&usg=AFQjCNErnH1idk-BgKVRaB2t5iynF_jXLA">http://www.weboftrust.info/</a></span><span class="c1"> </span></li><li class="c16"><span>Patient Privacy Rights Foundation </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://patientprivacyrights.org/&sa=D&ust=1511044300263000&usg=AFQjCNFS88BAl_VnTwvqA6N0XPivqxeEvw">https://patientprivacyrights.org/</a></span><span class="c1"> </span></li><li class="c16"><span>HEART </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=http://openid.net/wg/heart/&sa=D&ust=1511044300263000&usg=AFQjCNEtvQE1CK7PRWjwyQi04M9MvOOqEQ">http://openid.net/wg/heart/</a></span><span class="c1"> </span></li><li class="c16"><span>UMA </span><span class="c6"><a class="c8" href="https://www.google.com/url?q=https://kantarainitiative.org/confluence/display/uma/Home&sa=D&ust=1511044300264000&usg=AFQjCNFSSBMQvbb62Jup4S8cYfc1kto59g">https://kantarainitiative.org/confluence/display/uma/Home</a></span><span class="c1"> </span></li></ul><p class="c17 c21"><span class="c1"></span></p><div><p class="c21 c30"><span class="c1"></span></p><p class="c21 c38"><span class="c1"></span></p></div></body></html>