Embedded Health Data Chips
for Interior Alaska
A Feasibility Study
Expert Panel
Graduate Advisory Committee
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Dr. Robert Perkins, Advisor
Dr. Ming Lee
Dr. Leroy Hulsey
Embedded Health Data Chips
for Interior Alaska
A Feasibility Study
Prepared for the
Engineering and Science
Management Program
Presented by UAF Masters Candidates
Lien Huang
Steven Roscovius
Frank Toth
Overview
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Study Statement
Introduction to Tanana Chiefs Conference
Background and Options
Criteria and Analysis
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Stakeholders
Economic
Legal and Ethical
Social
Program Schedule and Costs
Conclusion
Is there a problem?
Feasibility Study
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Is there a better way?
We are challenged to explore new
technology
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But we are bound to do it ethically and
morally
Task Force
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We approached this as a task force
Tanana Chiefs Conference (TCC)
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Chosen for its unique health care situation
We were challenged in our study
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Discovered that numbers and dollars may
not always sum up the story
Tanana Chiefs Conference
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Mission Statement
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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
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The Department of Health Services
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Mission Statement
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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 Center
Jim Kohler - Director
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15,000 beneficiaries
43 villages
$44 million health budget
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Health data management is vital and continually challenging
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1.5% for data management and communications $660,000
Electronic Health Record was implemented in February 2005
Quality of care and proper reimbursement
Affects pharmacy, lab, radiology, continuity between providers,
scheduling, and billing
Communication with 43 different villages
Challenges
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Flat budgets with double digit cost increases
Staff shortages
What is the problem?
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Identification of patients
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Unconscious
Disabled
No identification
Very young
Elderly
What are some options?
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Do Nothing
Radio Frequency Identification Chip
Personal Data Assistant Devices
ID Cards
Do Nothing
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No apparent costs
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Are there hidden costs?
No change in current situation
RFID Chips
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New technology
Implantable
Does not require batteries
Type for consideration is ID number
only
Can’t lose it
Personal Data Assistant
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Carry your entire medical history
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X-rays
Diagnostic scans
Medical notes
Lab tests
Compatibility Issues Exist
Can be lost
Rural use?
ID Card
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A card embedded a unique ID number
Quick check-in
Cheap
Easy to lose
Do you want another ID card?
The Best Option
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Ranked in 4 categories
Categories scored by weighting
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Initial capital costs for implementation
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Information stored on the device
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10%
Availability of the device in an emergency
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15%
40%
Practicality of using the device for special needs
individuals
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35%
Scoring
Options
CATEGORIES AND WEIGHTS
CAPITAL
STORED
EMER
SPECIAL
COSTS
INFO
GENCY
NEEDS
15%
10%
40%
35%
TOTAL
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
VeriChip
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Chip was originally developed to track
livestock and wildlife
October of 2004, FDA approval for
human implantation and use as a health
device
VeriChip
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Approximately the size of a grain of rice
Implanted into subcutaneous fat
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takes less than 20 minutes
Performed by physician
Contains 16-digit unique number
Scanned using VeriChip device
Information via the internet
VeriChip
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No reported complications or side
effects
At least 10 year lifespan
Some have concerns with magnetic
resonance imaging (MRI)
Reversible with minor surgery
VeriChip
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Who would benefit the most?
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Impaired speech
Memory loss
Loss of consciousness
Chronic illnesses
Common names
Mistaken identities
VeriChip Case Studies
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Alzheimer's Care in Palm Beach
Infant Abduction
Brittan Elementary School
Mexican Attorney Generals Office
Hackensack Emergency Program NJ
Alzheimer's Care
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2-year project
280 patients
Starts in May, 2007
Provides emergency department staff
easy access to those patients’
identification and medical information
Infant Protection
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116 abductions from health-care facilities in the last
22 years
Infant mismatching
Halo – infant protection systems
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Chip is in bracelet
Brittan Elementary School
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Sutter, California
RFID tags embedded in student badges
tracked students throughout the school
Ended by parental pressure
Mexican Attorney Generals
Office
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Originally reported by AP in 2004
18 members are tagged
Controls access to secure areas and to
restricted data
Combat corruption
Hackensack Emergency
Program
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Average increase of more than 1.5
million visits per year
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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
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Trial Period
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5 Years
1500 people that would most benefit from
this technology
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Mental or physical handicaps, dementia, elderly
or very young
Full Scale
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After trial
Is it feasible?
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Need to analyze
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Stakeholders
Economic
Legal and Ethical
Social
Program Schedule and Costs
Stakeholders
Economic
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Trial period
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Capital Costs
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Annual Costs
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Medical Scanners
Training
RFID Chips
Fee
Full Scale
Economic
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Capital costs
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Medical Scanners
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Training
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We estimated 43 scanners for the villages plus
12 to cover the facilities in Fairbanks
55 scanners needed.
Seamless Integration
RFID chips
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1500 initial
Economic
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Medical scanners
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RFID chips
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$600 to $3,000
Estimate $50,000
$200 plus hospital costs,
estimated up to another $200
Estimate initial cost $300,000
Annual fee
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$20 to $80
Estimate $100,000 yearly fee
Economic Costs of Trial
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Present Worth (Discount Rate 6.5%)
YEAR
0
1
2
3
4
5
Net Present Worth
COST
$350,000
$100,000
$100,000
$100,000
$100,000
$100,000
$765,000
Upgrade to Full Scale
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Largest cost growth would be in the
RFID chips.
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3 to 6 million dollars to acquire chips
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VeriChip and TCC could find common ground
far below.
No additional scanners
Possible increase in yearly fee
Benefits
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Cost Savings
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Less errors
Improved efficiencies
Improved Health Services
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Intangibles
Benefits
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Cost Savings
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Lack of long term studies
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Estimates of cost savings are difficult
Rand study on electronic medical records
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Although not a true parallel it hints at the
possible savings through increased efficiency
and improved patient care
Benefits
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Rand Study
National Electronic Records
Potential Savings
HEALTH
2 Trillion
BUDGET
INITIAL
SAVINGS
EVENTUAL
SAVINGS
88 Billion
4%
346
Billion
17%
Benefits From Full Electronic
Records
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Initial
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If 90% adopt health information technology
$77 billion from efficiencies
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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
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primarily by reducing prescription errors
Benefits for TCC
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Expected Cost Savings?
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With a annual health budget of $44 million,
even 1% savings can be substantial
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2% = $880,000
1% = $440,000
0.5% = $220,000
Benefits
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Improved Health Services
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Intangibles
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Better patient service
Fewer mistakes
Speedy care
Less exposure to lawsuits
Legal and Ethical
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Identification and Tracking Social
Environment
Privacy & Notice by Institutions
Security
Data Storage Options
Identification and Tracking
Social Environment
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Passive – 16 digit
Active – Up to 100 Pages of Text
Tracking
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Staff and Patients
Substance Abuse
Home Confinement for Inmates
Insurance Profiling
Privacy & Notice by Institution
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Griswold v Connecticut (reviewed privacy)
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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
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Note use of RFIDs
Security
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Encryption – Small Chips Lack
Scanning Range (4”; 2-3 ft; 10 ft)
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Tracking Possible
Dutch e-Passports
2006 AK Community RHIO
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Regional Health Information Org
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Improve health record exchange
Lower costs
Prevent medical mistakes
Health Information Security & Privacy
Collaboration
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Issues of Exchange Health Information
Health care providers; Insurers; Health care
agencies
Data Storage-Option #1
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Option 1
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Patient file at TCC.
Information requests through VeriChip to
TCC
TCC retains ownership
No additional notification or release forms
Health Care
Provider
Request for
Records
VeriChp
Patient
Information
Request for
Records
TCC
Patient File
Data Storage-Option #2
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Option 2:
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Patient file is stored at VeriChip
TCC updates the patients file but VeriChip
owns the data storage used
Additional notification and release forms
required
Health Care
Provider
Request for
Records
Patient Information
VeriChip
Patient File
Updates
TCC
Data Storage - Option #3
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Option 3:
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Similar to option 2
Patient file is stored at VeriChip
TCC leases data server
No additional notification or releases
needed
Health Care
Provider
Request for
Records
Patient Information
VeriChip
Patient File
Updates
TCC
Current Legal Status
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Current Law
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Federal
State
Federal
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No current laws govern RFID
technology
Current Bipartisan Caucus
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Industry, DOD, and Academics
Pharmaceutical authentication,
drug/product recalls, food chain safety,
homeland security, supply chain efficiency
State
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2005 – 12 states have introduced RFID
legislation
Wisconsin
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Legislation to prevent implants w/o person’s
permission
California
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Legislation security/guidelines protect privacy
rights of individuals – govnr vetoed
Two other bills pending
Social Analysis
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Are there social issues in rural Alaska
that are different from Fairbanks?
What are some of the issues?
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Remote population
Language
Culture
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Customs
Tradition
Points of Caution
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Village’s point of view?
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Lack of pressing need
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Skepticism
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Oral Traditional
Economic
Overall
Based on history
Stigmas
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Individuals
Communities
TCC Board
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Approval
Small budget to continue
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What do we do?
Evaluating Social Concerns
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How do we evaluate these concerns?
We need a acceptance plan
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Hire a marketing firm?
Local surveys?
Meetings with TCC?
Meetings with village elders?
Program Implementation
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Creating a implementation team
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Investigate funding
Negotiate with vendor
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Team will be composed of primary stakeholders
Key task will be developing and implementing
acceptance plan
Pilot project?
Evaluate the process
Review
Program Implementation
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Go / No Go
Deploy the hardware
Monitor the outcomes
Re-evaluate
Implementation Tasks
Implementation Schedule
Implementation Costs
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1st year
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Capital Costs
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Initial + Annual Fee
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Implementation Costs
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$450,000
$34,990
$484,990
Is It Feasible?
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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
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Further Investigations are Needed
Economic and Health issues
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Legal issues are not defined
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It will work
Risk involved
Social issues might derail completely
Special Thanks To
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Robert Perkins
Ming Lee
Leroy Hulsey
Jim Kohler
Perry Ahsogeak
Rebecca Madison
Questions
THANK YOU