Connected Health

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:

1. 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.
2. 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.