Despite electronic medical records health information remains fragmented. There are interoperability standards but because of inertia – or lack of incentive – health systems do not speak to each another. A patient with colorectal cancer may see a gastroenterologist, an oncologist, a radiation oncologist, and, additionally, have interactions with diagnostic radiologists, pathologists, surgeons, hospitals and her primary care physician. The only thing all have in common is they use different EMRs that do not talk to each another.
Patient Portals – Helpful but not much of a fix
Somebody had a great idea: Let’s put the onus on the patient and have them integrate all this information in a record they control and are personally responsible for (Personal Health Record [i])! We just need to allow them access to their own electronic medical records using a patient portal and then they just have to upload (if possible) or update by hand the information from the gastroenterologist, the oncologist, radiation oncologist, diagnostic radiology, surgeon, pathologist, lab and primary care! What platform do you use for that? Something secure in the cloud. But there are more than 50 PHR providers, 17 of them ‘free’ [ii] with no clear leader. Industry giants such as Microsoft retrenched and are (apparently) retooling [iii].
Australia moves closer to nationwide Electronic Health Record – Problem solved?
Australia started rolling out what was originally called the “Personally Controlled Electronic Health Record”, later rebranded as “My Health Record”, in 2012. Adoption by patients was initially on an opt in basis, and uptake was slow, then the law was changed, and this year (2018), patients must opt out. The idea is that health care providers must use it. This will, in theory, solve the data gathering problem outlined above, and patients can use it, if they like (but are required to sign up). Not surprisingly, ‘participation’ has been skyrocketing, but this is hardly an endorsement of the system. Problems outlined above such as interoperability issues, time-consuming adaptations and inappropriate workarounds are still prevalent [iv].
Health Records on Apple’s Health App
As the preceding makes clear, data integration is the major problem for personal health record. This spring Apple will roll out iOS11.3 which will enable Apple’s Health App to import health records automatically from participating providers, initially 12 large health systems around the nation. It appears that Apple has been working with Cerner, athenahealth and Epic to streamline the process. However, because none of these EMR vendors has a dominant market share, especially with smaller doctor’s offices, it is even more important to be able to interface with many other EMRs by using data standards. According to the screens on the Health app, any health record available as Clinical Document Architecture files can be uploaded in the app and shared with other providers, potentially making the Health the hub for clinical information sharing. However, CDA is only the bare backbones of a health record and a lot of information is lost by relying on CDA alone, therefore Apple’s close collaboration with the health systems to get better interoperability. It appears that Apple is in parallel exploring options of using AI to extract more data out of any accessible health record [v].
The latest question to ask before you decide which Electronic Health Record system to buy
Given Apple’s track record, the convergence of industry, government and provider interest, increasing capabilities of AI, and the ubiquity of the iPhone, it can be imagined that the importance of the individual EMR will diminish, and the relevant question will rather be: Does your EMR play well with the Apple Health app?
[i] A personal health record (PHR) is an electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment.
1) Are managed by patients
2) Can include information from a variety of sources, including health care providers and patients themselves
3) Can help patients securely and confidentially store and monitor health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more
4) Are separate from, and do not replace, the legal record of any health care provider
5) Are distinct from portals that simply allow patients to view provider information or communicate with providers
6) Properly designed and implemented, PHRs can help patients manage their health information and become full partners in the quest for good health. https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record accessed 3-4-17