Introduction

In the past two weeks we have talked about our universal Electronic Medical Records System (EMR) in terms of what got built, or at least how it looks and uses of it, and then how it got built, the actual architecture, technology and thoughts behind it. Today we are going to discuss why we built this and what the benefits are and discuss any drawbacks. Let’s dig in.

Universal Medical Language System

Let’s give credit where credit is due. National Institutes of Health (NIH) provides the Unified Medical Language System (UMLS) to organizations that are bright enough to use it. The UNLS is adequate to document any patient encounter and is already translated into several languages. It contains 189 code sets including the national drug database, RxNorm, Value Set Authority Code, VSAC, and SNOMED_CT. There are also crosswalks to the most popular code sets, ICD, CPT, Epic, Cerner and Athena, included to do translation almost automatically. As far as we can determine, nobody is using the UMLS for its intended purpose, as a crosswalk for various applications and code sets, nor for putting together an EMR.

Benefits of Universality

When we talk about Universality, we are talking about more than one thing. We mean that it isn’t just the UMLS and using one code set, it is a total repository of truth, all in one place for all things health related. Soon, in addition to the EMR and associated applications, as detailed in How to Build a Universal EMR (Part 1) or on our site, Sentia Health's Web Logs, We will complete our practice management system that will automate almost everything a hospital does except for treating the patients. More on that later.

Everything all in One Place

Since we will have the repository of all things you can do in medicine, with the drug database all together, it only makes sense to house everything else there as well. Everything else includes

Integrated health and wellness – We provide patients with a portal that scientifically analyzes the annual (semiannual, quarterly) checkup, automatically produces a printable Health Risk Assessment and automatically prescribes patient education on how to live a healthier, better, and longer life
Integrated Email – We give the patient the ability to contact the doctor via SECURE email.
Self-scheduling – Login and see when your favorite practitioner is available and schedule a time to meet.
Questionnaires – Practices have the ability to design, assign and read questionnaires online. This means you as the patient don’t sit in the waiting room with sick people filling out reams of paperwork. Additionally, this system is part of the EMR itself to customize the system for each practice, according to their own specifications.
Reporting – Individual and Population Health Analysis: the individual gets a printable report of his or her health as it was recorded on the date of the health assessment. Population Health reporting gives the practice the ability to see how they are doing. Efficacy and compliance reporting becomes a one click report instead of a weeks long stare and compare in a spreadsheet. Estimates of patient responsibility.
Compliance – As this product matures, we will be able to differentiate between people who live a healthier lifestyle and those who do not by comparing the individual’s metrics against themselves over time. Those who make demonstrably better decisions will pay lower premiums than those who do not, based on personal metrics.
DICOM Viewer/Growth Charts – Attach images and documents to the medical record, and generate and save growth charts dynamically based on measured values.
Practice Management System - Includes everything you ever wanted to know about billing, appointments, personnel, inventory, assets, facilities, maintenance, scheduling and of course accounting for it all.

This gives us the ability to operate independently of interoperability and having to code links to other systems. Of course we can and will allow other applications to consume our source-of-truth data, we already have all the APIs set up and working, but we have one stop shopping and don’t need other applications to make us a solution.

Interoperability

If you need it we either have it or are building it. All of our systems are fully integrated and can transfer data between them. In fact, as discussed in Part Two of this series, all enterprise data is included in one database, instead of copied between the applications. All the people, all their contact information and addresses and all the companies, insurance information and all enterprise data are kept here. The Interoperability is complete out of the box.

Research and Diagnostics

Imagine a universal system where you could research all symptoms of all diseases and what worked and didn’t to cure them. Since all our data is related, that is, all symptoms are associated with lab tests and diagnoses, you can research exactly that. With everything, all-in-one, this is that system. Gone are the days when we watch Dr. House tottering around on his cane and yelling at people about trying to figure out what is wrong with this week’s patient. Just ask the EMR. If you have a differential diagnosis, you can search that and get a list of expected symptoms. You can then do further testing and confirm the diagnosis.

Training

No longer will you need to send your staff to Las Vegas for six weeks to attend some silly training seminar. If you can provide care, you can use this EMR. It is really very simple and produces a SOAP note. You don’t have to type anything, you just search for the components of the SOAP note and pick them out of a list. The system puts the documentation together.

Templates

You can mark any patient encounter as a template. When you reuse the template, the system copies over all the documentation into the current patient’s record. The templates are kept as a six weeks rolling average ordered by the number of times used. In most specialties this means that your templates will be complete with the first several patients. After completing them, you just pick the template and update any tests to the current values.

Installation

Since this system is a single repository, we maintain it in our data centers world wide. Your practice or hospital just needs to pay a small fee, hundreds or thousands, not tens or hundreds of millions, you don’t need the staff to maintain, extend or fix your All-In-One system.

Reliability and Robustness

Since this is an all-in-one kind of system, and simple, the system is extremely robust and easy to maintain. We have integrated the logging as well, as discussed in Part Two of this series, so that all errors are kept in one place where we can troubleshoot any potential problems and see who is doing what in the system. With the old legacy EMR systems they literally have an application for each specialty and that is not only madness, but it just doesn't work. They have to have tens of thousands of programmers to support all 135 specialties or they won’t support yours at all. This is one reason why they cost hundreds of millions of dollars.

Insurance Integration

Since we are the insurance company, and we wrote and provide the EMR, we can house the patient’s policy and show you right in the Patient Encounter screen what is covered, what is not, and for how much. You can discuss this with your patient, but since we don’t have networks, negotiated rates, medical coding nor denials, everybody gets paid the same amount: 150% of medicare or 110% of the medical consumer price index for that procedure. Since that automates the entirety of what legacy insurance does, we don’t have all the big buildings, millions of employees, and reasons to deny coverage. This alone will cut over 50% from the cost of health insurance without affecting payments to practitioners at all, or increasing them.

Health Risk Assessment

Since we know everything that your doctor knows, including all your measurements and blood work, we can automatically generate relevant articles for you to follow and be healthy. Since we provide these articles, we can offer a small discount for even reading them. These articles are presented in a problem/solution format with a “temperature gauge” showing how close you personally are to having problems. Then a comprehensive solution, tailored to you individually, is presented in the form of patient education.

Americans don’t take care of themselves. The Commonwealth Fund calculates that there are 336 avoidable deaths per 100,000 lives in the population, versus the OECD average of 225.

We assert that the difference between the average of 225 and the 336 that we see in the US is simply patient education. Doctors aren’t paid to educate; they are paid for procedures. Insurance companies are simply banks that only pay for medical care, and they don’t educate patients, so once again, nobody is minding the store and whatever just happens, just happens. Sure, your doctor can tell you to eat right and exercise more, but what does that really mean?

We as a country spend 4.7 trillion on healthcare annually and 84% of that is on avoidable chronic disease and mental health. The math tells us that we spend, therefore, $3.95 trillion on avoidable disease. If we then say that 1/3 of that expenditure is avoidable, that means we could save $1.27 trillion, if we were just as good as the average in the OECD. That is a 26.9% total savings, without changing anything else.

But how are we going to get Ma and Pa Kettle to eat better and exercise more?

We offer discounts on their health insurance for reading and complying with the patient education. They can prove compliance with lower or at least the same numbers on their Health Risk Assessments.

This is another example of Integration.

Single Payer

Because we are doing basically everything, or at least automating and managing everything, and at a fraction of the cost of doing it any other way, this will become your single payer system. Even better, we are doing it without government assistance, mandates or laws. Since we are automating the entire process and cutting out over half the associated costs, this will put the big payers out of business and make us the de facto choice for medicine. The benefit of this is as above: one stop for all things medical and wellness.

Conclusions

We have shown a way to save more than 75% from the cost of health insurance and have addressed both of the big problems with health insurance in the US: cost and education. We have all of this written and deployed in a prototype application. The only thing we really need to get this all started is to clean up that application and turn it into an enterprise system with logging, administration and redundancies in hardware. We will need funding, probably about $10 million over the first year. For comparison, United Healthcare had revenue of $371.6 billion and net earnings of $22.3 billion in 2024. With about 50% upfront savings we should service and retain 90% or more of the 330 million insured people in the US. That gives us a revenue of $36 billion.

This figure shows that this is a viable business proposition.

We have shown a way to make patients healthier by educating them on the consequences of their behavior, and a way to capitalize on that to the sum of $1.2 trillion or about 25%. If we add that to the process automation savings of our solution, we are in the ballpark of more than 75% savings in total. We already have the best doctors and the best equipment; we just need to implement the above detailed framework to give them all the tools necessary for success.

We have this system in prototype now, fully functioning.

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We have built a comprehensive health information system to keep the patient healthy and on the right track with the ability to incentivize healthy living. Implementing this system should be fairly simple and will completely revolutionize the way healthcare is provided and paid for, saving countless lives. We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable.

Benefits of a Universal EMR, Part 3

3/17/2025 4:21 PM