In the current, fragmented US healthcare system, physicians have limited visibility into their patient’s medical records.
This inability to see a patient’s full picture prevents optimal medical care, and results in avoidable cost and potential harm. But beyond the obvious disservice to patients that can result from such limitation, this lack of connection between one record and another highlights the still-unsolved challenge of interoperability.
Solving interoperability means enabling the sharing of patient information in a single, actionable patient record. Despite the obvious need, adoption of interoperability solutions is far too slow, causing providers to make educated guesses, putting their patients at increased risk.
There are several reasons – both economic and technical – for this gap. Without question the healthcare industry wants to achieve the end goal of interoperability. But various stakeholders, including provider networks and EMR vendors, have business interests that they must manage within the developing reality of interoperability. After all, interoperability will lead to greater competition among providers with all having access to the same patient data.
There is also the issue of IT burden when implementing interoperability solutions. And while the long-term payoff of interoperability will be a feather in the cap of the IT teams, the short-term approach may be akin to ripping off a band-aid. In other words, the upfront time and resource investment by the IT teams will hurt, but the payoff of improved patient care and reduced cost will be worthwhile.
So, while there will be pain for the IT teams, both on time/resources, and some stakeholders will need to relinquish some control over patient data, the benefits to our healthcare system, i.e., providing the best care for patients, is worth the investment.
While we understand the impact on providers and IT teams, what about the patient? After all, in an increasingly patient-centric system, this “customer” must come first.
How to push interoperability forward
Patients are increasingly becoming more active participants in managing their own health. For years, there has been exponential growth in the number of healthcare apps available to consumers. In 2017 alone, 78,000 new health apps were added to major app stores (Android and iOS), bringing the total to 325,000 available mobile health apps.1 More importantly however, and perhaps serving as the true disruption to the healthcare industry, is the entry of major consumer tech players such as Apple, with its HealthKit and new Health Records function, granting consumers access to their full medical records on their smartphones. We may be in the midst of the tipping point that will put the healthcare consumer in the driving seat for interoperability.
Today, consumers have more access than ever to their own health data through wearable sensors, sleep tracking tools, fitness bands and mHealth habit tracking apps. According to a Pew Research Center survey, the amount of time Americans spend tracking their health habits is second only to the time they spend surfing the Web.2 It is becoming even more common for consumers to approach their doctors with data from their wearable devices when outlier behaviors or other out-of-the-norm health indicators are detected.
Today, no one would disagree that consumers have the right to be proactive advocates for their own health. And now, armed with access to their own complete medical records, consumers hold a more complete and enriched medical record than their own physicians, who receive piecemeal medical information due to the lack of interoperability. This means that consumers must become the central node in the interoperability matrix. Consumers can become the master gatekeepers of their own data and can ensure their providers are fully informed and aware of all their relevant personal medical information.
Put simply, it could be that we are looking at a dynamic where patients are being counted on to provide medical information to providers, rather than vice-versa. Not only is this incredibly empowering for consumers, it may be the missing link to solving interoperability.
But access to medical information is not enough on its own.
Making Sense of Consumer-Owned Health Data
Consumers can be the owners of their medical data. They can complement their medical records with supporting information collected through wearable devices and other sensors. The combination of their full patient record, with the supporting “wellness” data provides much richer and in-depth context on a person’s health status.
The valuable next step will be translating this new-found data access into better and safer care. Providers and consumers need the tools to make sense and dissect these huge volumes of clinical data in a way that will facilitate better clinical decisions. This challenge calls for solutions that can parse through massive stores of data, to connect unseen points, identify patterns and point consumers, caregivers, and providers to potential threats and vulnerabilities that may hide in these vast heaps of data.
Take the following case: A cardiologist prescribed aspirin to a patient three years ago, for ischemic heart disease. Recently, the patient was diagnosed with cancer and chemotherapy treatment was initiated, resulting in low platelet counts. The oncologist is not aware that the patient is on aspirin and the cardiologist is not aware that the patient’s recent lab tests showed low platelet count, which puts the patient at a high risk of bleeding, especially while treated with aspirin. This is the current state of healthcare with its interoperability challenges. However, AI-based tools layered over the patient-owned medical record can identify this medication conflict, flag it, and the patient can then approach both providers to make the necessary changes.
It is clear that adding this sophisticated layer of AI-driven clinical analytics and decision support tools on top of the consumer-collected data can empower patients to conduct more knowledgeable discussions with their providers and better assess the quality of care they receive.
Reshaping the Patient-Clinician Relationship
What this means is that better data access held centrally by consumers and made available to providers will cause a shift in the patient/provider relationship. Having clinical data interoperability, combined with sensor/wearable data in their mobile devices, patients and providers can have more wholistic, informed discussions. Critically, the patient can have these discussions with any provider, as each clinician will have the full context of the patient's health performance, driving better overall care.
Placing Interoperability in Consumer Hands
Interoperability at the patient's fingertips, along with the relevant decision support tools and layers of AI that can extract actionable health insights, will reduce the probability of treatment conflicts between various providers. No provider will be an island, isolated from the treatment plans of their colleagues. This will also lead to a reduction or early identification of adverse drug events that would arise when physicians worked in silos.
Most importantly, giving control to patients will allow them to assess and compare the quality of care they receive from their providers. This may lead to fiercer competition among providers for patients, but it also means that providers must ensure they are delivering the best product to their customer, i.e. the patient – quality care.
We are at this tipping point in which consumers can take the reins and possess more control over their own health. Companies like Apple are providing the technology and accessibility to create galvanized patients. If patients take advantage of these tools, they can drive better, safer care. Are providers ready to answer this call?
1 Research2Guidance, 325,000 mobile health apps available in 2017 – Android now the leading mHealth platform
2 NYU Langone Health / NYU School of Medicine. "Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US." ScienceDaily. ScienceDaily, 17 January 2018.
By Dr. Gidi Stein, CEO and Co-Founder, MedAware