The cover story of this week’s edition of The Economist is titled “Doctor You – How data will transform health care”.
The combination of wearable sensors, ubiquitous smartphones and Internet connectivity have led to a massive increase of data about our daily lives: Not just the digital trail we leave behind online when we are shopping, engaging on social media, or sharing interesting articles. But also more and more data about our physical and even mental lives, how active we are, what we eat, where we spend our time, how well we perform with our memory and other cognitive functions. Some have coined a term for this movement and described the quantified self as “self-knowledge through self-tracking with technology”.
The combination of big data, cloud computing and progress in machine learning has enabled a new class of services converting all that data into information and valuable insight (data is the new gold). Interpreting your own data in the context of other groups or populations is not only adding insight, it also appeals to our social instincts of wanting to belong to peer groups, to compete along our chosen dimensions (gamification), to mingle with like-minded people in our pursuit of health and happiness.
As for healthcare, a transformation is underway on both fronts – measuring data about oneself (individual health) and interpreting it in comparison to typical data of other people (population health). Apps and cloud services can help us with understanding and preventing health problems, as well as dealing with them in conjunction with medication or other forms of therapy.
Other trends in healthcare IT are fueling this transformation. A decade ago, federal incentives such as the Meaningful Use stages fueled the adoption of Electronic Health Record systems in the United States. In this article, the Economist charts out the adoption of EHR systems by doctors in local practices over the last 12 years:
This first phase of EHR adoption was focused on making data previously recorded on paper available in digital form and has largely been achieved. Few doctor practices keep patient data on paper these days; however, it is still very common to be handed a clipboard with pen and paper to write down ones demographic or medical information when visiting a doctor practice for the first time. This handwritten data is then manually entered into the EHR system, which is both time-consuming and error-prone – an anachronism in the 21. century.
This points to the second phase of EHR interoperability, i.e. opening the data silos and connecting healthcare system to allow data to flow more freely between systems. Open standards such as HL7’s Fast Healthcare Interoperability Resources (FHIR) are certainly helping with this, but EHR vendors still have less interest in exporting their data rather than importing it. One driver will likely come in areas such as hospitals, where all vendors derive a commercial benefit from participating in a larger ecosystem of health data. Note for example the “interoperability showcase” at the annual HIMSS conference. Still, hospital management systems and large-scale EHRs are not as easily integrated as one would hope; witness the sizable industry of connectivity vendors such as Ellkay, PilotFish, Metal, and others. Even when EHR systems build out a good interoperability platform – such as Epic’s Share Everywhere or their recent One Virtual Worldwide System – such approaches require a quasi-standardization on one competitor’s system, which is antithetical to an open, competitive marketplace with many vendors.
Another driver in this regard could come from patients themselves. By collecting and managing Personal Health Information (PHI), one could imagine apps and sensors transforming the smartphone into an EHR Hub which will empower and decentralize healthcare. Just like the personal computer revolutionized computing and upended mainframes, the smartphone based EHR decentralization could upend current EHR vendors. Consider the following passage from the above Economist article:
THE past decade has seen the smartphone become a portal for managing daily life. Consumers use their pocket computers to bank, buy and befriend. Now this array of activities is expanding into an even more vital sphere. Apple has spent three years preparing its devices and software to process medical data, offering products to researchers and clinical-care teams. On January 24th it announced the result. The next big software update for its iPhone will include a feature, Health Records, to allow users to view, manage and share their medical records. Embedded in Apple’s Health app, the new feature will bring together medical data from participating hospitals and clinics, as well as from the iPhone itself, giving millions of Americans direct digital control of their own health information for the first time.
Of course there are valid concerns about privacy and security, and healthcare data breaches are unfortunately an all too common experience. That said, I look forward to the day when I can share PHI with doctors in the same way as I use my smartphone to process payments based on shared credit card information – paperless, wireless, friction-less. And the spread of standardized PHI on smartphones will usher in a new wave of analytics services to improve outcomes and empower patients everywhere. It is good to know that patients will be in direct control of their own PHI – because you can trust in Doctor You.