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E-Patient Update: Enough Apps Already

Posted on September 1, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

New data suggests that while app use is becoming a core activity for mobile, the number of apps people use is dropping. In fact, over the longer term, analysts say, most businesses will need to slim down the number of apps they deploy and do more to retain app users.

Speaking as someone who relies on apps to manage her health, I certainly hope that this happens among healthcare providers.

Maybe you think of my contact with your organization as a series of distinct interactions, and the data something that can be reintegrated later. All I can say is ”Please, no.” I want every digital contact I have with your organization to be part of a large, easy-to-navigate whole.

In fact,  I’ll go further and say that if your organizations offer a single, robust app that can offer me broad access to your administration, clinical departments and patient data I’ll choose you over your competitors any day.

Health app overload

As you may know, the number of health-related apps available on the Google Play and iTunes stores has grown at a dizzying pace over the last few years, hitting approximately 165,000 across both platforms as of two years ago. Most of these are were created by independent developers, and only a small percentage of those apps are downloaded and used regularly, but it’s still a stat worth considering.

Meanwhile, new data suggests that the field is going to narrow further among apps of all types. According to research from Business Insider, somewhere between 10% and 12% of app users remain engaged with those apps within seven days of installing them. However, that percentage drops to around 4% within just 30 days.

These trends may force a change in how healthcare organizations think about, develop and deploy apps for their end users. As users think of apps as utilities, they will have little patience for using, say, one for your cardiology department and another for sleep management, not to be confused with a third portal app for downloading medical information and paying bills.

If you’re part of an institution with multiple apps deployed, this may sound discouraging. But maybe it’s not such a bad thing after all.  Consumers may have less patience for a fragmented app experience, but if you produce a “power tool” app, they’re likely to use it. And if you play your cards right, that may mean higher levels of patient engagement.

My ideal health app

Having slammed the status quo, here’s what I’d like to see happen with the apps developed by healthcare organizations. I believe they should work as follows:

  • Providers should offer just one app for access to the entire organization, including all clinical departments
  • It should have the ability to collect and upload patient-generated data to the EMR
  • It should provide all features currently available through existing portals, including access to health data, secure email connections to providers, appointment-setting and bill payment
  • It makes all standard paperwork available, including informed consent documentation, pre-surgical instructions, financial agreements and applications for financial aid and Medicaid
  • It generates questions to ask a provider during a consult, before an imaging procedure, before, during and after hospitalization

I could go further, but I’m sure you get the idea: I’d like my providers’ apps to improve my health and foster my relationship with them.  To make that happen, I need a single, unified entity, not a bunch of separate modules that take up space on my phone and distract me from my overall goals.

Of course, one could reasonably observe that this turns a bunch of small lightweight programs into a single thick client. I’m sure that has implications for app coding and development, such as having to ensure that the larger apps still run reasonably quickly on mobile devices. Still, smartphones are ridiculously powerful these days, so I think it can still happen.

Like it or not, consumers are moving past the “there’s an app for everything ” stage and towards having a few powerful apps support them. If you’re still developing apps for every aspect of your business, stop.

AMIA Shares Recommendations On Health IT-Friendly Policymaking

Posted on April 17, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The American Medical Informatics Association has released the findings from a new paper addressing health IT policy, including recommendation on how policymakers can support patient access to health data, interoperability for clinicians and patient care-related research and innovation.

As the group accurately notes, the US healthcare system has transformed itself into a digital industry at astonishing speed, largely during the past five years. Nonetheless, many healthcare organizations haven’t unlocked the value of these new tools, in part because their technical infrastructure is largely a collection of disparate systems which don’t work together well.

The paper, which is published in the Journal of the American Medical Informatics Association, offers several policy recommendations intended to help health IT better support value-based health, care and research. The paper argues that governments should implement specific policy to:

  • Enable patients to have better access to clinical data by standardizing data flow
  • Improve access to patient-generated data compiled by mHealth apps and related technologies
  • Engage patients in research by improving ways to alert clinicians and patients about research opportunities, while seeing to it that researchers manage consent effectively
  • Enable patient participation in and contribution to care delivery and health management by harmonizing standards for various classes of patient-generated data
  • Improve interoperability using APIs, which may demand that policymakers require adherence to chosen data standards
  • Develop and implement a documentation-simplification framework to fuel an overhaul of quality measurement, ensure availability of coded EHRs clinical data and support reimbursement requirements redesign
  • Develop and implement an app-vetting process emphasizing safety and effectiveness, to include creating a knowledgebase of trusted sources, possibly as part of clinical practice improvement under MIPS
  • Create a policy framework for research and innovation, to include policies to aid data access for research conducted by HIPAA-covered entities and increase needed data standardization
  • Foster an ecosystem connecting safe, effective and secure health applications

To meet these goals, AMIA issued a set of “Policy Action Items” which address immediate, near-term and future policy initiatives. They include:

  • Clarifying a patient’s HIPAA “right to access” to include a right to all data maintained by a covered entity’s designated record set;
  • Encourage continued adoption of 2015 Edition Certified Health IT, which will allow standards-based APIs published in the public domain to be composed of standard features which can continue to be deployed by providers; and
  • Make effective Common Rule revisions as finalized in the January 19, 2017 issue of the Federal Register

In looking at this material, I noted with interest AMIA’s thinking on the appropriate premises for current health IT policy. The group offered some worthwhile suggestions on how health IT leaders can leverage health data effectively, such as giving patients easy access to their mHealth data and engaging them in the research process.

Given that they overlap with suggestions I’ve seen elsewhere, we may be getting somewhere as an industry. In fact, it seems to me that we’re approaching industry consensus on some issues which, despite seeming relatively straightforward have been the subject of professional disputes.

As I see it, AMIA stands as good a chance as any other healthcare entity at getting these policies implemented. I look forward to seeing how much progress it makes in drawing attention to these issues.

Steps In Integrating Patient-Generated Health Data

Posted on May 24, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As the number of connected health devices in use has expanded, healthcare leaders have grappled with how to best leverage the data they generate. However, aside from a few largely experimental attempts, few providers are making active use of such data.

Part of the reason is that the connected health market is still maturing. With health tracking wearables, remote monitoring set-ups, mobile apps and more joining the chorus, it might be too soon to try and normalize all this data, much less harvest it for clinical use. Also, few healthcare organizations seem to have a mature strategy in place for digital health.

But technical issues may be the least of our problems. It’s important to note that providers have serious concerns around patient-generated health data (PGHD), ranging from questions about its validity to fears that such data will overwhelm them.

However, it’s possible to calm these fears, argues Christina Caraballo, senior healthcare strategist at Get Real Health.  Here’s her list of the top five concerns she’s heard from providers, with responses that may help put providers at ease:

  • Fear they’ll miss something in the flood of data. Add disclaimers, consent forms, video clips or easy-to-digest graphics clarifying what consumers can and can’t expect, explicitly limiting provider liability.
  • Worries over data privacy and security: Give consumers back some of the risk, by emphasizing that no medium is perfectly secure, including paper health records, and that they must determine whether the benefits of using digital health devices outweigh the risks.
  • Questions about data integrity and standardization: Emphasize that while the industry has made great process and standardization, interoperability, authentication, data provenance, reliability, validity, clinical value and even workflow, the bottom line is that the data still comes from patients, who don’t always report everything regardless of how you collect the data.
  • Concerns about impact on workflow: Underscore that if the data is presented in the right framework, it will be digestible in much the same way as other electronic medical data.
  • Resistance to pressure from consumers: Don’t demand that providers leverage PGHD out of the gate; instead, move incrementally into the PGHD management by letting patients collect data electronically, and then incorporate data into clinical systems once all stakeholders are on board.

Now, I’m not totally uncritical of Ms. Caraballo’s article. In particular, I take issue with her assertion that providers who balk at using PGHD are “naysayers” who “simply don’t want to change.” While there are always a few folks fitting this description in any profession, the concerns she outlines aren’t trivial, and brushing them off with vague reassurances won’t work.

Truthfully, if I were a provider I doubt I would be comfortable relying on PGHD, especially biometric data. As Ingrid Oakley-Girvan of Medable notes, wearables giant Fitbit was hit with a lawsuit earlier this year alleging that its heart rate monitoring technology is inaccurate, and I wouldn’t be surprised other such suits arise. Digital health trackers and apps have transitioned from novelty to quasi-official medical device very quickly — some might say too quickly – and being cautious about their output just makes sense.

Nonetheless, PGHD will play a role in patient care and management at some point in the future, and it makes sense to keep providers in the loop as these technologies progress. But rushing them into using such data would not be wise. Let’s make sure such technologies are vetted before they assume a routine role in care.