As consumers, we expect that when we bank, our ATM card will work in any machine worldwide, dispensing the cash we need and sending the record back to our home financial institution. Similarly, we would be enraged if we bought a new MacBook and couldn’t access our Gmail or load Microsoft Office. We expect this level of connection in so many aspects of our lives. Yet we accept a great deal less from health care than we do from our ATM cards and MacBooks.
How we got to this state is a long and complicated story. Health care has had few incentives to open up to innovation. Hospitals and physician groups have worked on their own closed information systems, hoarding data to keep their care in-network and maintain market share. This practice discouraged innovation and created a generation of ugly, unusable, and disconnected technology that has failed woefully to connect care for patients.
These systems thrived during the days when the hospital was at the center of care. But changes to the health care delivery system – including a shift to value-based care – are making this harder. As patients increasingly become health care consumers, they are choosing to go outside the hospital to seek care, moving instead to retail clinics, community doctors, and urgent-care chains where they can access care easily and immediately. They want more telehealth and more apps, ways in which they can get easy answers for simple health problems. As I’ve traveled the country, I’ve seen major health systems whose emergency care has dropped 20% as three urgent care centers opened up within a mile.
Under this new paradigm, clinical data-sharing between institutions on different platforms is crucial for delivering seamless care to patients, creating value, and ultimately getting reimbursed. Fortunately, declining revenues have a way of pushing even the stodgiest and most bureaucratic players to act.
Consider the partnership between Kaiser Permanente and Target to place Kaiser providers in the retailer’s health clinics. The move offered patients increased access to convenient care, but for Kaiser there was a technological problem: To maintain the longitudinal care for which it’s famous, it needed data from the clinic to integrate with patients’ electronic health records. To find a solution, Epic and my company, athenahealth, worked together to integrate our systems so that patient information could flow along the entire continuum of care, from the retail clinic back to the doctor’s office. The established interface better connects the care continuum. No matter what technology is being used, data is captured and transferred seamlessly.
Take too, for example, the work CommonWell Health Alliance is doing to create a nationwide “search engine” to improve interoperability. The national record locator service gives providers seamless, trusted access to health care information, no matter where their patients seek care. This empowers both providers and their patients with information, as well as satisfies a critical need for health systems practicing accountable care. CommonWell is a major step towards openness by many health IT vendors. The onus is now on health systems across the country to embrace and use it.
To shape a truly interoperable world, hospitals and health systems must actively choose to step out of from siloed data centers and into open networks. Fortunately, market forces have a way of awakening the promise of openness.
The history of Silicon Valley over the past decade offers something of a roadmap for health care in this department. Netflix, Google, Amazon and Apple are all unrecognizable from where they began. They listened to their customers, opened up to innovation, and built delightful experiences that have made them essential to nearly everyone who uses them. I believe this is what is beginning to happen in health care today. At athenahealth, we have embraced openness so that others can integrate their apps directly with our network. Thirty-six groups have already done so – creating apps that do everything from checking-in patients to scheduling appointments on the fly – and many more are in the works. We believe that others across the continuum of care need to open up their systems, too. But legislation and mandated standards won’t be the way to do it. In health care, as in Silicon Valley, we need to allow market forces and our customers to evolve health care into the open experience we need and want.
Ed Park is COO at athenahealth.
Very nice, Ed. What THCB readers REALLY want to know about is the Target / KP integration. Tell us more!
I would like to see a companion piece titled:
“What healthcare can teach Silicon Valley.”
It will be a long piece and a must read for entrepreneurs and the digerati.
Well said! Let’s get on with the inevitable.
Netflix, Google, Amazon and Apple do not share their customer’s data among each other without customer authorization and transparency. There’s no equivalent of CommonWell Health Alliance assembling a hidden record locator service that tracks how I use Netflix, Google, Amazon and Apple. Google, Amazon, and Apple all provide powerful APIs that do not block access to any standards-based application that I choose to connect to my personal data. These APIs do not delay access to my data. These APIs do not require me to sign paper forms in order to connect an app or a Web service to my data.
Here are all of the places that used my medical record in the past year:
– Hospital and Primary Care Practice
– Orthopedic Practice
– Pharmacy 1
– Pharmacy 2
– Health Insurance
– Health Insurance Exchange
– Bank Health Savings Account
– Pharmacy Benefit Manager
– Research Study
– An unknown practice in MS that got my information via Surescripts and the PBM for no reason I have been able to discern
This is 12 in just one year and I am a very healthy person. How many of these will be in CommonWell? How many of them will send me a simple email whenever they share my data with another place?
HIPAA explicitly allows all of the 12 service providers above to expose an API, without access delay, without blocking any apps I choose, and without requiring paper forms. But HIPAA does not give me a right to these data sharing features. That’s why Congress must act to end data blocking.
Patients don’t need another hidden data broker added to the list above. What we need is patient-directed access to our own data even better than Apple, Google, and Amazon provide. http://www.commonwealthfund.org/publications/blog/2016/feb/the-best-way-to-share-health-records by Schneider, Chopra, and Blumenthal is a start. We will know that data blocking is on its way out when my healthcare services actually give me first-class access to the newest and most powerful interfaces. See my comment to the Commonwealth Fund post above for more details.