Digital health: why is it a luxury good in a world crying for health as a commodity?

Why digital health still struggles to find its stride. Those of us in the healthcare field, especially Grizzled Pioneers, have been wondering for the past decade why Digital Health’s Year is always Next Year. Or Next Decade. 

Looking back only to 2000, we’ve had 9-11, a dot-com bust, a few years in between when the economy thrived and the seed money started to pollinate young companies, a prolonged recession that killed off many, and now finally a few good economic years where money has flooded into the sector, to good companies and those walking the fine line of mismanagement or fraud. We’ve seen the rise/fall/rise of sensors, wearables, and remote monitoring, giants like Google and Microsoft out and back in, the establishment of EHRs, acceptance by government and private payers, quite a bit of integration, and more. All one has to look is at the investment trends breaking all records, with funding rounds of over $10 million raising barely a notice–enough to raise fears of a bubble. Then there’s another rising tide–that of cyberattack, ransomware, insider and outsider hacking.

Is it this year? It may not be. Despite the sunshine, interoperability holds it all back. Those giant EHRs–Cerner, Epic, Athenahealth, Allscripts–are largely walled gardens and so customized by provider application that they barely are able to talk to their like systems. There are regional health exchanges such as New York’s SHIN-NY, Maryland’s CRISP, and others, but they are limited in scope to their states. The VA’s VistA, the granddaddy of the integrated system, died of old age in its garden. Paul Markovich, CEO of Blue Shield of California cites the lack of interoperability and being able to access their personal health data as a major barrier to both patients and to the large companies who want to advance AI and need the data for modeling. (China and its companies, as we’ve noted, neatly solve this problem by force. [TTA 17 Apr]) Apple is back in with Health Records, but Mr. Markovich estimates it may take 10 years to gather the volume of data it needs to establish AI modeling. Some wags demand that Apple buy Epic, as if Epic was up for sale. BSC, like others, is testing interoperability workarounds like Notable, Ooda Health, and Manifest MedEx. Mr. Markovich cites interoperability and scaling as reasons why healthcare is expensive. CNBC

And what about those thriving startups? Hold on. During the Google Cloud/Rock Health 3 June event, one of the panelists–from Partners HealthCare, which works both side of the street with Pivot Labs–noted that hospitals have figured out their own revenue models, and co-development with hospitals is key. Even if validated, not every tech is commercially ready or lowers cost. And employers are far worse than hospitals at buying in because they ultimately look at financial value, even if initially they adopt for other reasons. In addition, the bar moved higher. The new validation standard is now provider-centric–workload, provider satisfaction, and implementation metrics, because meeting clinical outcomes is a given. Mobihealthnews

And still another barrier–data breaches and cyberattack–is still with us, and growing. Quest Diagnostics’ data breach affects nearly 12 million patients. It was traced to an individual at a vendor, American Medical Collection Agency, and it involved Optum360, a Quest contractor and part of healthcare giant Optum. The unauthorized person had access to the network for eight months – between 1 August 2018, and 30 March 2019–and involved both financial and some health records. Quest now is in the #2 slot behind the massive 79 million person Anthem breach, which, based on a Federal grand jury indictment in Indianapolis in May, was executed by a Chinese group in 2015 using spearfishing and backdoors that gathered data and sent it to China. There were three other US businesses in the indictment which are not identified. Securing health data is expensive — and another limitation on the cost-lowering effects of interoperability. Healthcare IT News

Digital Health’s Year, for now, will remain Next Year–and digital health for now will remain fractional, unable to do much to commoditize healthcare or lower major costs.

NYeC’s 2017 Gala and Awards (NYC) 1 November

Wednesday, 1 November at the Edison Ballroom, NYC, 6:30pm

The New York eHealth Collaborative, which promotes healthcare in NY State and elsewhere by leading, connecting, and integrating health information exchanges in New York, will again host their annual evening Gala and Awards in NYC. This year the lead award (Transformative Leadership) will be awarded to David Blumenthal, MD, President of The Commonwealth Fund (the home of the Triple Aim). Having been to this event in the past, it is attended by the leadership of most major health organizations in New York such as New York-Presbyterian, NYU-Langone, Maimonides, and payers such as Aetna. Click here for more information and for tickets. The revenues support the work of NYeC in promoting interoperability through entities such as the Statewide Health Information Network for New York (SHIN-NY), which links New York’s eight regional health information organizations (RHIOs) or Qualified Entities (QEs) throughout the state. They also fund NYeC’s work in developing policies and standards supporting the use of health IT and EHR adoption. Hat tip to Jesse Giuliani of NYeC and Sarianne Gruber of Answers Media.

EHRs can’t exchange patient records? $$ in workarounds.

Some of the Excedrin/Panadol Headaches (#11, #14, #23 and #54) in healthcare are around the very ‘miracle technology’ that was supposed to make it all seamless, non-duplicative, time/cost-effective and coast-to-coast–EHRs. The exchange of patient records between hospitals, within health systems between sites and with medical practices plus vice versa–works haltingly if at all. It works best within well-established, highly integrated delivery systems –the VA, DOD, Mayo Clinic, Kaiser, Geisinger, Intermountain Healthcare. But once you’re away from it–good luck. Where are the problems? The closed standards of the major hospital EHRs–Epic, Cerner, Allscripts, McKesson and brethren; the extreme customization most health systems demand (nay, a major Epic selling point!); structured versus unstructured data and how handled; a lack of a secure interoperability standard are but a few. Where is the gold? Getting patient health records exchanged, accessible and transportable, among systems that were essentially designed not to speak with each other. (more…)

Patients’ records could be shared between NI and New York for clinical trials!

Patients’ records could be shared between Northern Ireland and New York as part of a proposal to improve healthcare and research. NI Health Minister, Edwin Poots was recently in the US for high-level talks about developing the collaboration with the New York State Health Department. Read more… TANN Ireland

Editor Donna note: Though not stated, this well could take advantage of the expansion of the SHIN-NY health information exchange (HIE) connecting hospitals, medical practices and nursing homes along with medication and management interfaces. See NYeC Digital Health Conference 2013, especially the link to the HITECH Answers article which has more information on SHIN-NY. 

NYeC Digital Health Conference 2013: the trends

Updated 21 November

The third annual New York eHealth Collaborative (NYeC) Digital Health Conference in New York City attracted several hundred people from the worlds of hospitals, public health, academia, policy makers and health insurers–and the myriad related products and services which will enable these entities to improve their health IT, organization and engage patients in their own health. If there were three buzzword phrases setting the tone, they were interoperability, patient portals and technological innovation. All relate to data–data transfer of patient records between providers to be available regionally (RHIOs) and throughout the state via the SHIN-NY health information exchange (HIE); using data to help people visualize and improve their health;  putting data into ‘whole person’ context for providers, integrating it into workflows and to save lives; using data to serve process improvement and tougher standards. And finally there is that old devil cost: reducing the cost of care, reducing expensive readmissions plus co-morbidities and making those tools to do this job more affordable for providers and patients.

NYeC has developed considerably since its early days seven years ago (more…)