The idea of a connected patient record is a long time coming. When the US federal government started mandating (and funding) electronic patient records, technology was very different. Large ERP systems were the model and vendors were responsible for the end-to-end experience (often more targeted towards business managers than end users — meaning, something that improved claims processing was more useful than something that made it easier to deliver better care).
As with large ERP systems, the next update always promised to solve problems — like a more intuitive interface, or support for a mobile app.
What these systems didn’t consider was the end-to-end patient or doctor experience.
I know this first hand as I struggle to deal electronically with my own doctors and hospitals.
The waste that results is outstanding. It’s kinda hard to justify the high cost of healthcare in the US with the observation that doctors and hospitals seem to be throwing money out the window with their inefficiencies.
In the last week there have been two interesting new moves in healthcare:
- Apple has pre-announced iOS 11.3 with support for using the Apple Health app as a central place to access patient records. The initial release is supported by about a dozen US hospitals.
- Amazon, JPMC, and Berkshire Hathaway have announced a coalition to improve healthcare costs for their million or so employees.
These two approaches are different from each other, driven in part by their own philosophies.
Apple is looking to empower the patient. I can’t tell you how frustrating it is to keep track of medical records and to use the information in them to improve care. There are stories out of Apple that when Steve Jobs was sick, he had similar issues and this is what’s driving Apple in this area. It’s not their first foray into healthcare related solutions; we can see by the nature of their solutions where their efforts lie.
The coalition Amazon, JPMC, and Berkshire on the other hand… well, I can imagine someone just saying “fuck this insanity, let’s show them how it’s done.” I can see them being more efficient and effective at using data to improve the current healthcare/health-insurance process. There’s a ton of efficiency to be had… and today the lack of efficiency for corporate healthcare is shouldered by companies. They want to solve their problems, delivering better care more effectively… I’m not sure they’re going to be as focused on the end-patient as much as Apple. That said, there are a million ways for them to be successful (and sometimes I feel as if I’ve experienced half-of them personally).
In either case, what’s really interesting about healthcare is the presence of a generally accepted universal REST API standard called FHIR. There’s been a lot of innovation at the fringes using FHIR, however, the two recent developments in healthcare stand to move FHIR to more of a mainstream platform for breaking down healthcare silos and delivering innovative solutions to improving people’s health.
I came across an interesting slide by Benedict Evans that talks about S‑curves and innovation along the curve from a video where he talks about 10 year futures. (The whole video is worth watching.)
If we’re at the beginning of a new curve for healthcare, one could think of the coalition as improving the stuff we experience at the start of the S‑curve… I think Apple is headed towards setting the foundation for the stuff at the top.
It’ll be interesting to see how these different approaches play out over time. I’m really excited by the Apple news. Skeptical (and untrusting) of anything provided by employers as I think they’ll have their interests in mind first, not mine. It’s also reasonable to expect some news from Google soon too.
I expect I’ll be writing a lot more about this as we’ve had a FHIR developer portal out there for some time and have some great customer success stories. It’s an area I have a lot of interest in personally as well.