Healthcare in the Mobile Age
We’re living in an age where it’s never been easier to collect personal health data outside of a hospital setting. Between Apple Health Kit (and newly released Research Kit), Fitbits, smart-watches, and the plethora of other apps and mobile devices being used, we are generating more healthcare data per minute than ever before in history. Data that can be aggregated to create information with meaningful insight into not only individual health, but also population health patterns. So how do we do it? How do we take the leap forward to where the information collected from these devices affects and improves how we treat our individual and collective health?
The process is underway, but right now it’s transitioning from the baby crawling (which I’m considering installation of EHRs and capturing health information digitally) to learning how to walk. Apple Health Kit has partnered with EHR giant Epic to allow people to view their Health Kit data through My Chart, in addition to partnering with the Mayo Clinic. A huge step forward in combining self-generated health information with EHR generated health information. Organizations, such as the Cleveland Clinic, are providing employees with fitness devices to track their fitness levels in an effort to reduce their health costs and improve their employee health. An effective incentive for both parties. Social media has provided a method for communities of people suffering from similar illnesses to come together and share in each other’s experience and treatment.
It’s clear to see that health data capturing and sharing is beginning to have an impact in how we understand and interpret our health, but also in how we communicate about it.
A 2013 Pew research study found the following:
7 in 10 U.S. adults have tracked a health indicator for themselves or for someone else. Of those, 34% share their health tracking records or notes with another person or group.
26% of internet users have read or watched someone else’s experience about health or medical issues in the last 12 months.
3–4% of internet users have posted their experiences with health care service providers or treatments.
It is clear healthcare consumers* are craving access and sharing of health information. People are looking to make informed decisions about their health, and are seeking and sharing healthcare information like never before. It’s time for the industry to reciprocate that.
*A lot of people will ask what defines someone as a consumer. The best definition I’ve read recently regarding that is by Brian Ahier, “The difference between a patient and a healthcare consumer: A patient simply receives care, a consumer makes informed decisions.” I couldn’t agree more.
The Challenges Ahead
Although we are heading towards an era of vast information sharing in healthcare, it’s like trudging through knee deep snow right now.
Interoperability, Patient Privacy, and Information Security are three extremely important topics in the healthcare industry that must be addressed before we can make rapid progress.
1. Interoperability
Healthcare still lags compared to other industries in terms of interoperability. In banking, for example, you can withdraw your money from any ATM regardless which institution owns it. Healthcare is a little different, however. Each EHR will not export data in the same manner, or even in the same format. Luckily, through pushes by Meaningful Use and HL7, this has improved over the last couple of years and some standards are beginning to emerge (i.e. CDA) but still nowhere near towards what the industry envisions. Furthermore, having different clinical applications interact with each other in a simple manner is still more the exception rather than the rule. Compare that to the travel industry, where you can purchase plane tickets or book a hotel from a plethora of different websites or even various physical locations.
2. Patient Privacy
If you have ever worked in the healthcare space, you have been exposed to HIPAA. HIPAA was primarily written to deal with employees’ health insurance coverage when leaving or transitioning between jobs and simplifying administrative overhead. It also created important legislation aimed at dealing with protecting patient information and what rules govern it (items like PHI, Minimum Necessary, Covered Entities, etc.). It’s important to note HIPAA was written in 1996 and didn’t take effect until 2001, with Covered Entities needing to be compliant by 2003.
At the time, the majority of health information was still being stored on paper records and sharing or releasing that information usually only occurred during transitions of care, legal proceedings, and patient requested information releases. Today, however, we are witnessing Accountable Care Organizations and Clinically Integrated Networks being formed, entities whose success and effectiveness relies heavily upon being able to collect and share a plethora of health information with various stakeholders. A barrier to this open sharing are HIPAA regulations that limit, rightfully so, for which reason and in which manners health information can be shared.
In order to allow innovation to occur at a rapid pace, it may be necessary to revisit HIPAA and information sharing regulations based upon how patient behavior has shifted to being more open with sharing personal health information (a simple Twitter search for diagnostic terms might astound you!).
3. Information Security
Right now, medical identity theft is a huge problem. If you’ve been following the news, you’ve likely noticed that healthcare breaches seem to have increased and that healthcare organizations are being targeting more frequently. It’s estimated that in 2014 alone, roughly 2 million people were affected in some way by medical identity theft. There are some key reasons behind that. A person’s medical records are worth up to 20 times more than his/her credit card or social security number on the black market. In fact, medical identity theft negatively impacts the nation from both a financial waste and an inaccurate health information perspective. Factor that in with outdated hospital security infrastructures and it’s evident why healthcare has become one of the most target industries by hackers.
In order to progress, the healthcare industry must improve both it security and also address the mis-alignment of incentives that makes medical identity theft so lucrative.
Signs of Progress
Although the path to a fully integrated, tech-savvy, and patient-centric healthcare industry will not be easy, progress is being made.
1. Move from on-premise to cloud computing
There is a growing shift towards cloud computing driven solutions in healthcare. These type of solutions make information access and sharing much easier than the traditional on-premise solutions that have been predominant in healthcare historically. Cloud-based solutions also offer more administrative and financial flexibility for healthcare organizations as they tend to be Saas (Software as a Service) based and typically do not require large and costly installations. The current downside to cloud-based solutions is that they increase organizations’ security and administrative overhead since the solutions are more readily accessible from outside the immediate corporate network.
2. Dedicated efforts to improve interoperability
Recent years have also seen a dedicated effort to improve interoperability in healthcare. The HIMSS definition of Interoperability can be found here. The Meaningful Use initiative has pressed EHR vendors to be make their solutions offer certain types of information sharing. FHIR is a large initiative underway by HL7 to create industry standards for APIs in healthcare. While the current state of these initiatives is far from the desired ideal state, it is promising to see the effort and urgency continually being placed upon interoperability.
3. Increasing emphasis being placed on incentive-driven policy changes
For a long time, healthcare reimbursement was driven by a fee-for-service model. What this meant is that providers would be reimbursed for the quantity of services they provided rather than the quality of care they provided. This was an incentive misalignment from both a quality of care and cost perspective. Currently, a transition to Value Based Care (VBC) is underway. Under this model, providers will now be reimbursed based upon the quality of care provided to the patient. The quality is assessed by performance on certain measures that CMS, NQF, and other institutions create or contribute to. The large driver of VBC is to improve quality while also reducing cost. As a result, Accountable Care Organizations and Clinically Integrated Networks are being created and sharing health information to better understand and serve their patient populations.
4. Improvements in information security
While healthcare has been plagued by security problems recently, the industry has begun taking steps to improve in this area. Open source security standards, multi-factor authentication, and increased corporate awareness of its importance are some ways in which the industry is improving and moving towards a more secure state. It can’t be emphasized enough how important it is to stay up-to-date on security best practices, both as an individual and as a corporation.
The future is bright for healthcare. The journey to improved quality of care, reduced costs, and increased consumer awareness will be an arduous one, but well worth it.
All thoughts and opinions expressed above are solely my own and not affiliated with any entity or organization. Click here to connect on LinkedIn.
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