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    •                              You  are  a  Stranger    in  a  Strange  Place    &  You’re  sick,  very  sick…       Link-­‐for-­‐Life —a  Global  Public  Health  Solutions   ™ for  we  the  people.      February,  11     1  
    •     An  Overview  of  Global  Public  Health         Issues  &  Solutions     Issues  Affronting  Global  Public  Health  “Healthonomics”  and  the  Tipping  Point  Global  health  care  is  expensive,  so  much  so,  we  see  prosperous  nations  on  the  cusp  of  healthcare  bankruptcy.    Today  of  the  195  official  independent  countries  of  the  world,  the  top  50  nations  are  spending  over  $5  trillion  on  their  public  health  and  human  services.    These  same  nations  are  also  declining  their  quality  of  health  in  all  the  metrics-­‐that-­‐matter  in  public  health  care  and  wellbeing.    Country  leaders  know  that  a  healthy  nation  is  a  prosperous  nation.    The  contrasting  is  readily  seen  within  impoverished  nations.    Wealth  is  the  blood  of  nations  but  health  pumps  the  blood.    The  dynamic  tension  between  the  health  of  people  and  the  prosperity  of  people  is  fueling  the  tipping  point.    We  call  this  the  Healthonomics  of  a  nation.    In  most  1st  world  nations,  public  health  is  a  central  topic  of  government’s  concerns,  actions  and  reactions.    This  becomes  very  apparent  at  the  mere  mention  of  a  spreading  pandemic.  Global  health  care  is  under  great  and  rapidly  escalating  stress  that  affects  everyone  both  directly  and  indirectly.    Today  we  see  disease  and  disorders  evolving  into  new  strains,  reactive  therapeutic  treatments  failing,  losing  effectiveness  or  simply  not  available  but  to  a  select  few.    We  have  learned  that  disease  and  disorders  have  no  boarders  and  can  spread  rapidly—worldwide.    Increasing  public  global  travel  of  course  compounds  this.  We  look  to  the  2,500-­‐year  history  of  health  care  practiced  as  an  art.    The  practitioners  of  the  art-­‐of-­‐medicine  are  losing  community  standing,  economic  incentives,  and  they  are  faced  with  growing  complexity  in  the  practice  of  their  art.    At  the  same  time  greater  and  greater  specialization  and  sub-­‐specialization  is  expected  of  the  profession.    This  has  intensified  with  the  arts-­‐of-­‐medicine  moving  to  the  sciences-­‐of-­‐health.  Also  fueling  the  tipping  point  is  the  seemly  slow  evolution  from  the  arts-­‐of-­‐medicine  moving  to  the  sciences-­‐of-­‐health.    Most  medical  scientists  and  academicians  agree  that  the  year  2000  was  the  apex  of  this  tipping  point.    Since  1985  we  have  seen  information  technologies  increasing  focus  on  the  cellular  and  molecular  understanding  of  life.    In  1986  we  saw  the  ebb  of  a  biological  scientific  research  initiative  motivated  by  a  new  strain  Ebola  appearing  in  quarantined  research  primates  in  Virginia1.    This  unique  event  oddly  motivated  the  United  States  and  Britain  to  sponsor  the  mapping  of  the  human  genome.    This  much-­‐publicized  multinational  scientific  project  quietly  spawned  many  other  IT  data  centric  analyses  of  aligned  research  and  computational  aided  interest  in  the  cellular,  molecular  biological  life  sciences.      Life  sciences  and  medical  research  scientists  began  computationally  doubling  data  every  six  months  on  a  global  computational  scale  by  the  year  2000.    This  rapid  growth  of  data  had  never  occurred  in  a  single  sector  prior  to  this  period.    The  world’s  supercomputer  centers  performed  more  and  more  computational  biological  and  biochemical  analysis  than  ever  before.    This  phenomenon  continues  today,  with  present  estimates  doubling  life  sciences  data  every  three  months.                                                                                                                              1  Why  Map  DNA  http://gallery.me.com/howardasher#100039    January  2011     Page  2  
    •     An  Overview  of  Global  Public  Health         Issues  &  Solutions    The  new  era  of  the  sciences-­‐of-­‐health  The  sciences  of  health  have  begun  teaching  us  the  disease  process  at  the  cellular  and  recently  at  the  molecular  levels.    We  are  beginning  to  learn  what  is  the  genetic  predisposition  of  disease  and  health  disorders.    We  are  learning  that  each  disease  expresses  a  unique  protein  signature.    These  protein  signatures  and  other  biomarkers  can  usually  be  expressed  in  our  biofluids;  saliva,  urine,  blood,  etc.,  eventually  negating  the  need  for  tissue  biopsy  or  other  invasive  methods.    We  are  beginning  to  see  disease  progress  or  regress  at  the  molecular  levels.    We  are  learning  that  people  with  specific  biomarkers  react  better  to  a  systemic  therapeutic  than  those  without  the  certain  biomarker.    We  above  all  are  beginning  to  re-­‐learn  that  no  two  people  are  alike  and  that  one  pill  does  not  suit  all.      Most  importantly,  we  are  beginning  to  learn  medicine  and  health  is  very  personal  and  personalized  medicine  will  make  an  enormous  difference  in  human  health  and  wellbeing.     Solutions  Affording  Global  Public  Health  Let’s  get  Personal  In  order  for  we  the  people  to  enjoy  the  arriving  benefits  of  personalized  medicine  we  absolutely  need  to  have  full  ownership  and  possession  of  our  personal  health  records,  history  and  eventually  our  very  personal  and  private  genotype,  phenotype  and  genetic  predisposition.    We  need  this  complete  information  24/7  anywhere  and  anytime  we  need  health  care.    We  need  this  personal  health  record  (PHR)  to  always  be  up-­‐to-­‐date,  accurate,  and  complete.    We  need  our  PHR!    We  also  need  our  PHR  to  belong  to  us  we  the  people,  and  not  owned  by  any  institution  or  health  network.    We  need  to  be  free  to  move  from  one  health  care  system  to  another  without  ever  being  concerned  we  could  lose  access  to  our  health  information,  history  or  any  part  of  our  health  record.  We  need  to  know  our  PHR  will  be  non-­‐disruptive  to  any  health  care  institution  or  health  network.    Just  like  we  can  do  with  our  bank  ATM  debit  card,  use  it  anywhere  in  the  world  and  know  we  will  not  be  disruptive  to  any  institution.    We  also  need  to  trust  our  PHR  information  will  only  be  available  on  a  need-­‐to-­‐know  basis.    Again  just  like  our  bank  ATM  transaction.    We  know  our  financial  information  is  safe.    We  trust  that  the  grocery  clerk  only  gets  approval  when  we  ask  for  $20.00  cash  back  from  our  ATM  debit  card  transaction.    We  know  the  grocery  clerk  has  no  knowledge  or  access  privilege  to  our  entire  bank  record.    The  point  here:  this  is  not  a  new  concept.    If  the  global  banking  system  can  do  this  successfully  for  the  last  20+  years,  so  should  our  global  health  system.  January  2011     Page  3  
    •     An  Overview  of  Global  Public  Health         Issues  &  Solutions    Above  all,  we  need  to  have  one  private  and  personal  trusted  place  to  know  we  will  always  have  our  lifelong  health  information,  records,  images,  prescriptions,  lab  results,  and  any  and  all  of  our  health  record  available  to  us.    We  need  to  know  we  can  log  into  a  health  care  facility  and  our  entire  health  record  is  accurately  available  on  a  need-­‐to-­‐know  basis,  to  any  caregiver,  throughout  the  point-­‐of-­‐care  (PoC).    We  need  to  know  that  any  health  care  we  receive  throughout  any  PoC  will  be  automatically  placed  into  our  PHR  and  always  be  up-­‐to-­‐date,  complete  and  accurate.    We  indeed  need  to  know  that  we  no  longer  need  to  fill  out  a  form  to  be  seen  by  a  caregiver.    We  know  we  may  not  remember  all  the  important  allergies,  medical,  surgical,  immunization  and  pharmaceutical  details  the  caregiver  needs  to  know  to  perform  fully  informed  care.    Moreover,  in  many  emergency  or  disaster  situations,  we  the  patient  may  not  physically  be  capable  of  communicating  our  medical  histories  to  caregivers.    We  need  our  caregivers  to  be  fully  informed  about  us,  at  PoC,  after  all  our  health  histories  are  unique  to  us  and  yes  it  is  very  personal  and  private.  The  EMR  and  the  Missing  Link  Many  countries  have  spent  much  effort,  money,  time  and  political  capital  to  motivate  health  care  institutions  to  install  and  deploy  electronic  medical  record  (EMR)  system  to  a  meaningful  use.    EMRs  after  all  would  reform  healthcare!    Well  no  they  will  not.    At  least  not  all  by  themselves—for  that  is  exactly  what  EMRs  are  and  should  be—all  by  themselves  and  institutionally  centric.    They  must  be  institutionally  centric  to  help  the  exact  institution  perform  clinical  practices,  specific  to  the  institution’s  clinical  workflows,  clinical  resources,  schedules,  and  best  practices.    Asking  an  institutional  EMR  to  be  “Patient-­‐Centric”  is,  well—silly.    EMR’s  are  prospectively  designed  to  be  institutionally  centric  and  must  be  to  be  successful  for  the  unique  needs  of  the  clinical  or  healthcare  or  hospital  or  any  specific  health  care  institution.       Institutional  EMRs  must  manage  many  different   patients  most  requiring  specific  care  in   alignment  with  their  specific  clinical  condition.    A   hospital  EMR  is  taxed  with  many  different   patients,  each  requiring  a  wide  and  variable   clinical  workflow,  different  schedules,  various   medical  resources,  lab  tests,  diets,  etc.   EMRs  cannot  nor  should  not  try  to  be  all  about   the  patient.    If  for  no  other  reason,  someday  the   patient  will  leave  the  institution.    This  happens   everyday  to  a  US  soldier  under  the  ALTA  EMR,  or   a  Military  Veteran  under  VistA,  or  a  Kaiser   patient  under  the  highly  customized  Epic  EMR   system.      When  a  patient  leaves  a  closed  harmonized  health  network,  and  requires  health  care,  they  become  a  stranger  in  a  strange  place.    In  fact  they  may  be  worse  off,  for  when  they  are  within  their  closed  health  network,  they  rarely  fill  out  a  form  and  do  not  need  to  remember  all  their  personal  health  information  and  history.          January  2011     Page  4  
    •     An  Overview  of  Global  Public  Health         Issues  &  Solutions    So  what’s  the  missing  link—a  very  patient-­‐centric  PHR  that  can  harmonize  and  non-­‐disruptively  synchronize  with  any  EMR  at  any  institution,  clinic,  dentist,  pharmacy,  anywhere,  anytime.    Once  again,  just  like  the  global  banking  system  has  done  successfully,  so  should  our  global  health  system.  So  where  is  our  global  health  system?   ATM  Link-­‐for-­‐Life™  Global  PHR  Automated  TeleMedicine,  Inc.  (ATM)  believes  an  individual’s  PHR  should  be  available  to  the  person,  anytime,  anywhere  they  require  any  health  care,  dentistry,  medication  or  other  health  services.    An  individual’s  PHR  should  not  be  able  to  become  lost  or  unavailable  for  any  reason.    An  individual’s  PHR  should  be  100%  secure.    An  individual’s  PHR  should  be  private,  very  private.    An  individual’s  PHR  should  be  accessible  securely  to  any  www-­‐connected  device.    The  PHR  should  not  require  the  person  to  have  access  to  a  computer,  or  any  computer  skill,  nor  require  any  literacy  skill.    An  individual’s  PHR  should  be  available  to  the  caregiver  on  a  need-­‐to-­‐know  and  only  with  the  personal  biometric  permission  of  the  individual  or  their  authorized  guardian.    The  PHR  should  never  disrupt  the  institutional  electronic  medical  record  (EMR)  system,  yet  should  instantly  exchange  appropriate  information  at  any  and  all  points-­‐of-­‐care  (PoC),  in  real  time.      The  PHR  should  automatically  recognize  the  caregiver’s  credentials  and  permit  access  to  the  relevant  health  care  information  germane  to  each  specific  caregiver.    The  PHR  should  enable  accurate  linguist  translation  from  the  caregiver  to  the  individual.    The  PHR  should  automatically  align  with  any  EMR  system,  at  any  PoC.    The  PHR  should  be  accessible  to  health  care  professional  within  any  health  network,  worldwide.    The  PHR  system  should  provide  a  free  professional  EMR  to  any  health  care  professional  who  needs  one  for  their  private,  secure  and  unrestricted  use.    The  individual’s  PHR  should  remain  with  the  person  for  their  entire  life  regardless  what  health  network  they  use.    The  individual’s  PHR  should  become  complete,  accurate  and  helpful  rapidly  over  time.  The  individual’s  PHR  too  should  be  very  close  to  free!    ATM  Link-­‐for-­‐Life™  is  99¢per  year,  per  person.    January  2011     Page  5  
    •     An  Overview  of  Global  Public  Health         Issues  &  Solutions    We  the  people  should  never  be  in  need  of  healthcare  and  a  stranger  in  a  strange  place  without  our  complete  and  accurate  health  record.    We  the  people  should  expect  our  health  caregiver  to  have  exactly  what  they  need  to  perform  fully  informed  care  to  us  at  any  PoC.    This  is  not  a  luxury—but  a  necessity  of  life.           Contact:   Howard  Asher  ◊  Howard@ATM-­‐Health.com  ◊  +1.619.997.5900  January  2011     Page  6