by Sri Bharadwaj, president-elect, Southern California chapter of HIMSS; member, HIMSS Value of Provider-Patient Engagement Task Force; and director, information services, UC Irvine Health
If you don’t know about an app that allows you to securely integrate multiple banking accounts into one view, it does exist. Simple to sign up for and the directions step you through the process. Once set up, you can view your accounts through various charts that display expenses versus income and pay bills from the app. The app works seamlessly on personal computers, tablets and smart phones.
The analogous app for healthcare consumers would have similar functionality. Many patients, particularly those with complex chronic or life-threatening conditions (e.g., transplant, advanced cancer), often have multiple portals from multiple provider organizations and specialists. Five portals may not be uncommon; the record I have heard so far is 15.
To make a complex illness less complex,
- Can data from these portals be imported into one app?
- Can that app be easy to use, displaying data from multiple portals and using helpful charts, graphs and alerts that simplify understanding of complex health data?
- Can the data be kept secure and updated regularly?
The good news is: progress is underway. Under Meaningful Use Stage 3 proposed rules, there is an option for providers to create an Application Programming Interface (API) as an alternative to, or as another, stand-alone patient portal. HL7, a standards development organization, is developing the FIHR® (Fast Healthcare Interoperability Resources) Specification. This creates a way to “simplify implementation without sacrificing information integrity.”
Another encouraging trend is that some companies are already developing apps that will make it possible to combine data from a single vendor or multiple vendors. Some EHR vendors are creating app stores. Start-ups that know how to use APIs are eager to develop secure apps for patients. Some healthcare providers, like Duke and Oschner, are using APIs to develop apps for Apple HealthKit. More will follow.
The Transmit function continues as a weak link in the process of View, Download, Transmit (VDT). Although some regions and states have well-developed health information exchanges (HIEs), this is not consistent across the country. Also, many of the patients mentioned above with complex conditions and multiple providers across states, are blocked from having their data transmitted or transmitting that data themselves to coordinate their care and seek second opinions.
Another challenge is correcting errors in EHRs. If patients have multiple EHRs, they may have different medication lists, lab results and problem lists. Patients should be able to request changes in a portal and harmonize their record to prevent errors.
According to Susannah Fox, “We are unfortunately at a very awkward stage where we have a lot of technology at our fingertips, and health care has not quite figured out how to use it.” We are optimistic about moving out of this awkward stage into a “patient-friendly” application environment that is both interoperable and intuitive across devices.
So what do patients need?
Patients over their lifetime accumulate a ton of healthcare data; however, they are unable to aggregate, correlate and keep it all in one single place. Data hidden in EHRs, doctors office files, and in laboratory records prevent them to adapt lifestyles and develop a care plan with the knowledge of demographic and genomic factors.
For example, some companies have attempted – through their initiatives – to develop this type of app, but their efforts have not received the deserved attention. Why? They have tried to maintain this information in their own cordoned marketplace and not use interoperability to become the community where both physicians and patients reach out and seek a common platform for a broader healthcare experience.
It is time we bridge data islands and bring together a cohesive rules-based playground to share between the cared-for and the caring.
- Patient Digital Health Platforms (PDHPs): An Epicenter of Healthcare Transformation?
- It’s time to C-ME (see me): Consumer Mediated Exchange
- Case example from the Office of the National Coordinator
- Case Study: Duke Medicine and Remote Patient Monitoring
- Ochsner first to link Epic to Apple’s HealthKit