It’s been an exciting 2016 already in the realm of cloud computing and patient engagement. As I was preparing for the HIMSS16 conference, I was reflecting on how things are moving so quickly with the addition of new technologies and yet some of the core challenges around gathering the information to provide better medicine are still in the dark ages. So here is the question ringing in my head for this year at HIMSS…
How much longer must we wait to finally have a ‘patient cloud’ – a sharable and relatively complete cloud based health record for each patient?
This is seemingly an obvious prerequisite condition so that providers can deliver better care for patients. The patient controlled medical record is an old idea that goes back to the Guardian Angel manifesto published in 1994 at the dawn of the Internet era and yet 22 years later we have haven’t achieved the first steps of the fundamental core of a universal life long patient record.
If we had a patient cloud,then we could go beyond accessing records during a visit to reliably building out advanced predictive tools that could look into that record to do a variety of things including preventative care and cognitive diagnostics, and to provide N of 1 treatment options to create comparative research across common patients to offer precision medicine. To remind us that the problem is neither new nor solved, in January Kenneth Mandl, MD, MPH, and Isaac Kohane, MD, PhD reiterated the call for a Patient Controlled Medical Record in The New England Journal of Medicine. Dr. Mandl provided a strong and compelling case as to why the challenge is worth working towards across the healthcare value chain and why now is the right time to get it done.
In my discussions with various groups over the past few months, new technologies have been proposed as the next silver bullet solution for health record integration including block chain, Internet of Things platforms, and social networking. For example the winner of a Deloitte sponsored hackathon last Fall in the UK, presented a block chain framework for managing health records. Block chain doesn’t quite explain to me why big investments into public personal health records (PHR)from major IT vendors that were planned to have a disruptive impact in 2008 have not solved the ‘patient cloud’ challenge. This may have been in part because we didn’t have Meaningful Use or a ramp-up into the Affordable Care Act to drive adoption and force interoperability but they also haven’t risen to the challenge in the past few years. The PHR model still is just too hard or too low value for patients to use.
Innovations in security also can’t fully explain why health information exchanges (HIE) are not yet the go to methods for transparency in medical records by physicians and patients alike. It could be that a block chain model or thinking along the path of distributed ledgers adds a layer of security, trust and distribution that will solve some of the remaining trust issues in a cloud medical record. I definitely welcome the exploration on this front that will happen over the next two years.
A big change now emerging is that we are starting to see the results of the progress of HIPAA patient access rights, the over-arching right that patients have to get all of their EHR data any way they want. This has led to HIE compatibility and proof of execution for open access to data for Meaningful Use 2 compliant EHRs. In 2016 most electronic medical records are equipped with the tools to interface through a Continuity of Care Document (CCD) when a patient or physician authorizes access. Maybe PHRs offered by commercial HIE vendors and operators can soon break-out to become the cloud PHRs in various geographies? Maybe the Health Insurance Exchange (HIX) systems will start to incorporate HIE and PHR-type features to bring a state or federal cloud approach to the patient record? EHR vendors promote that the patient portal offered by health care providers into the health record could be the patient cloud. Any of these established groups could be right although it may take some iterations to get patient needs right.
The IoT (Internet of Things) world is continuing to boom around consumer devices and device clouds are expanding to aggregate this data. The organizations creating the consumer wearables are rapidly becoming more involved in establishing platforms for consolidating data across devices to give insight into how to lead healthier lives rather than focusing on the measurement devices. These consumer patient clouds have the potential to grow-up into the ‘patient cloud’ if they can start to ingest clinical records along with their rapid broad distribution of signed-up users.In addition to consumer groups with a deep investment into medical devices have been hard at work establishing ways to bring device data into the cloud through such as the Healthsuite Device Cloud. It will be unlikely that almost any medical device that can contain a sensor wouldn’t have a cloud that the device data is sent to. So regarding the device clouds – they are going to have to feed in or be fed to bridge between IoT & consumer health clouds and the more regulated medical record aggregators to implement the vision of the ‘patient cloud’ but because devices are so rapidly deployed they present a great starting point.
We have been working with a number of different technologies that have the potential to become the ‘patient cloud’. Among them is the ‘Health Cloud’ launching at HIMSS. Health Cloud offers a framework that can be instantly deployed and extended with prebuilt frameworks for the main components of patients, providers, medical records, care plans, and care giver objects. It updates the model for hosting that was a prior challenge for many groups to move to the cloud by proactively meeting many requirements for handling the risk of storing data in a HIPAA compliant model. CRM is not a replacement for an electronic health record (EHR) and as a result it has some of the independence needed to offer one of the new contenders for the home of a cloud-based patient record. The intent is to offer the same sort of core that was offered for the customer relationship management(CRM) industry to front-end ERP systems into the healthcare industry where the ERP system is the analog of the ERP software. In some of the early market testing of the product, patients ‘got it’ that because it was a cloud record, that they would have the record available wherever they went in the same way their photos are now available everywhere when they share them on a photo cloud.
Salesforce.com Health Cloud didn’t come out of the box with a tool for patients to aggregate their medical records across providers through a patient controlled interface into the cloud environment. Over the past month we have been working with a start-up called Carebox to integrate patient-mediated record collection capability into the Salesforce Health Cloud suite. Carebox offers a “mint.com style” way for patients to bring records from their hospital or doctor patient portals (and many other sources of electronic health records that patients can access) into Health Cloud. While it is early days in bringing together these approaches and we still have many clouds to pick from,it is a testament to the power of a cloud-based approach to healthcare computing vs. traditional installed software that we can combine two new technologies and be in a position to bring records from health systems and genomics providers, in only a month.
I can’t say that the patient cloud is here until waves of patients start to converge on adopting a dominant platform or approach, but I’ll be looking around HIMSS for additional evidence of where it is emerging and who is leading the race for ideas and value. I have a funny feeling that it is going to be the patients and their relatives who decide where their health cloud will be and if we focus on what they want the records will swiftly be buzzing up into the clouds so we can get on with creating guardian angels.
Dan Housman is CTO at ConvergeHEALTH by Deloitte