Interoperability of clinical data remains a huge issue in healthcare. Looming even larger is getting the clinical data into the hands of the consumer – the patient – and associating costs to that data, providing price transparency to taking care of a person’s health. What if there was a platform, like Mint.com, where the onus would be on the consumer to initiate trust with different systems and applications for which they have an account? One in which it would put the onus on the consumer to be the stewards of the share of their data rather than individual providers, hospitals and health systems.
While not a novel idea, or one that would be guaranteed of much success, the concept seems like it should have traction in a healthcare marketplace shifting from a traditional to retail model.
Some will argue that this idea has already proven to be unrealistic given the past failures of Google Health and Microsoft HealthVault. However, those failures were arguably due to timing (EHR adoption was still in its infancy), and lack of proper incentives (value based care was a nice concept, but at the time an afterthought; the data needs to be captured digitally in order to be leveraged).
The idea behind Google Health was to get millions of people to put their health records—medications, lab results, immunizations, chronic conditions, and the like—on the Web in a central, secure repository accessible to them and their caregivers. “The idea I had was that in order to help anyone be healthier, you would need their health data,” he says. “This was in 2006, when only 10 percent of doctors had access to electronic health records, and only 10 percent of them would share it with patients, meaning that 99 percent of people weren’t able to get their own health data electronically.”
Further, what is being proposed is not patient portals – they are largely vendor specific and only have the data tethered to a specific system.
Admittedly, while the analogy is far from perfect – Mint.com is a financial management application, and clinical data is much more complex than financial data – it would serve to solve the interoperability issues that plague the industry today. Amid all of the controversy surrounding EHR vendors becoming more interoperable, one can argue that this isn’t their role.
When it comes to interoperability, EHR vendors have great incentive to maintain the status quo as they shift from a gold-rush period of maximization of their footprint to that of PaaS (platform as a service). They want to further lock-in their client base and guarantee footprint and revenue streams for years to come. Chilmark Research’s recent report – 2015 Platforms in Healthcare: EHR Vendors’ Capabilities for Interoperability – supports this notion
EHR vendors realize data is the true oil and are now taking aim at ISVs (independent software vendors). You see, each of the EHR vendors have visions of being the Apple of healthcare. That is, an ecosystem of innovation on a platform they control. It’s their value-proposition to continue to be relevant as they evolve from being a glorified data repository with some clinical decision support wrapped around. From John Halamka’s recent blog on stratic planning:
However, current EHRs are in an early stage of development and are data capture tools rather than customer relationship management systems. As we gather requirements for FY16, we’re thinking about the projects that could be innovative breakthroughs, replacing human work with a next generation of technology and workflow.
Healthcare NEEDS the aforementioned type of transformational platform to facilitate an ecosystem of innovation. Bearing in mind the model and analogy for Mint.com, think for a moment of the endless possibilities:
- Concierge care consultants similar to the role financial consultants provide today
- Targeted marketing to the end consumer (the patient) much as Mint.com does today (you are paying 300% more than the average individual does for your car insurance)
- Comparison of clinical profiles analogous to comparing the financial profile of those with similar age and socio-economic status and integration with forums such as PatientsLikeMe
- Good-health discounts, similar to good driver discounts and integration with applications such as MapMyRide or MapMyRun
The key is to make it about the money. Arguably, people will not change their behavior unless it starts hitting their wallet. If Mint.com was able to show how you can save money by changing health, this could be compelling for people. For organizations providing insurance for the consumer, the financial incentives should be obvious: statistics show that employees with a body-mass index above 28 cost their employers an extra $2,000 per year in healthcare expenses.
Data wasn’t the answer. The Mint-like approach, Bosworth had realized, was working more like a stick than a carrot. “All these people would enter their height and weight and lab data, and immediately we would tell them, ‘You suck. You’re overweight, your blood pressure is too high, your cholesterol is too high, you must change.’ They were gone in 60 seconds,” says Bosworth. “They know what it’s doing to their life expectancy, and they still are not doing the right thing.”
Where do we start? It starts with getting access to the data. As previously stated, most vendors are “opening” up their platform with the hopes of driving innovation and monetization of the true asset housed in their systems – the data. A recently published article from Chilmark Research outlines an approach to expose feature-rich APIs and moving towards a patient relationship management system.
The proposed approach does not come without its potential holes. Of chief concern is the coalescence and harmonization of the data as well as the validity of that data – especially in the cases of patient-reported data. Look no further than ePatient Dave to learn of the dangers of the source of the data – claims, patient-generated, etc. Further, questions arise such as: In the instance of duplication, what source trumps another? What methods are used for patient identification and matching?
What do you think? Does the idea have merit beyond its good intentions? If so, is the timing right and will the marketplace support it? In closing, we echo the sentiment of e-Patient Dave: “Gimme My Damn Data”. A Mint.com for healthcare would be a strong step in the direction towards true data liquidity.