Is the smartphone the interoperability tool of the future?

In April last year, the not-for-profit industry group Continua, event company mHealth Summit and the Health Information and Management Systems Society (HIMSS) got together to form the Personal Connected Health Alliance (PCHA) with the intention of representing the consumer voice in what they are calling personal connected health.

The idea is to ensure that the technologies that consumers are increasingly using for their personal health data, including smartphones, mobile apps, sensors and personal health tracking devices, are user-friendly, secure and can easily collect, display and relay that data.

While there is a lot of hype around the potential of consumer devices for healthcare, boosted immeasurably by Apple's entry in to the field with its Health Kit last year, there seems little doubt that consumers are increasingly looking to use their personal devices for healthcare purposes.

This may initially manifest in using their smartphones to track their fitness and wellness, but they are also beginning to look to their devices as the preferred way to communicate with the healthcare system itself. After all, two US studies from 2013 showed that many consumers look at their smartphones between 110 and 150 times a day.

So if consumers are increasingly looking to use their devices to connect with healthcare providers, is it possible that smartphones can lead the way and solve some of the problems that have long plagued the healthcare system, not the least of which is the lack of interoperability in healthcare technology?

George Margelis, physician, adjunct professor and all-around health IT geek, has taken up a role as the Australian chair of the PCHA and put forward the intriguing question of whether personal connected health is the answer to interoperability at the eHealth Interoperability Conference in Sydney late last year.

Dr Margelis said upfront that he wasn't going to provide a definitive answer, but said it was option that needed to be explored. “Having been in healthcare for 30 years, you hear a lot of claims and you see them crash and burn, but at some stage I suspect the right answer will come out,” he said.

Dr Margelis showed a Continua-produced video from 2006 in which a lot of visionary claims were made about how personal health technologies and integrated, interoperable systems were going to revolutionise health. That has yet to come to pass, of course, and this was even before the iPhone and iPad had been released.

“This is one of the major challenges we face,” he said. “This is a future video shot eight years ago that is now totally out of date. Eight years later, everything in there is ancient technology. And yet the BMJ published an article a few years ago that showed that innovations in healthcare take 17 years to be adopted by the healthcare system.

“So we have this conundrum where we have adoption of new technology chugging along at a great rate, and a governance model which requires governments or some other local authority to attempt to play a role in managing all this.

“We have to start asking ourselves, is healthcare too important to be left to governments? Is healthcare so important that individuals need to play a much larger role in managing the system around them?”

Motivating consumers and patients to take more responsibility for their own healthcare is not a new idea, but it is one that has proved a hard road to travel. Empowering patients is a popular buzzword, and yet the burden of lifestyle-related disease continues to grow.

“Part of what looking at with personal connected health is saying: how do you empower individuals to better manage their health?” Dr Margelis said. “Be they healthy young people on fitness regimes, people with chronic disease, or complex elderly patients with multiple problems, the locus of control needs to shift more towards the patient rather than to the system.

“Generating awareness is important. Availability is important. Understanding the technology is important. But ultimately it comes down to education of individuals and building personal responsibility. How do we provide them with the tools to empower them to take advantage of that personal responsibility?

“We’ve been pushing personal responsibility in healthcare for a long time, but the reality is without the right information, without the right tools, patients can’t take personal responsibility for their healthcare.”

Dr Margelis said that as the focus was changing from top down management of healthcare to bottom up management, the challenge of how information models, data models and clinical models can keep pace with the development of new technologies was arising.

“We need to have a much more integrated model of care that utilises all this,” he said. “Maybe the phone in your pocket will be the ultimate integrator of interoperable healthcare. That’s a model we are looking at. I’m not saying it’s right, I’m not saying it’s wrong, I’m saying it’s something we need to think about.”

One factor that may very well prove the tipping point – in an industry that has seen many alleged tipping points – is cost. As governments struggle to manage the rising cost of healthcare and the economics of healthcare is receiving as much attention as outcomes, the use of eHealth is being seen as a way to both increase interactions with healthcare providers but to also make that interaction more automatic and efficient.

Consumer tech perhaps has a role to play here, Dr Margelis said. “Consumer technology is now at a stage where it is cheap, it is really powerful and people are getting multiple use cases out of it, so they can do multiple things with it,” he said.

“Governments are getting frustrated with the cost of healthcare, and we also have an informed patient. Patients are now starting to take a much more active role, patients are now saying 'I want a better system'.

“Something is driving patients to play a much more active role in healthcare, and this is coalescing together to a point where we actually now are starting to have critical masses with some of these technologies in place.”

The role of organisations like Continua that are active in the standardisation of technology is important here, Dr Margelis said, because once you standardise technology, you can take devices that cost a thousand dollars and turn them into devices that cost five dollars., with sheer market forces then changing data and clinical models.

Even here, common technologies can be harnessed to open up the healthcare system. As one audience member at the conference pointed out, healthcare providers can easily put health records up in the cloud and allow mobile access using technologies like SMS authentication straight back to the patient's phone.

These basic technologies can also be used to connect health services to the patient through the same device no matter what state or country they are in.

“If mobile phones do become a personal health buddy, is this the brave new world of healthcare?” Dr Margelis said. “If that is going to require us to make everything talk to the phone, could that help solve interoperability issues? It's something to think about.”

Posted in Australian eHealth

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