Not long ago, we were beholden to the abysmal mobile app stores from AT&T and Verizon. When the carriers made the strategic decision to allow iOS and Android app stores, consumers benefitted greatly, while the carriers have benefitted from vastly expanded use of their networks. A recent ruling by the Office of the National Coordinator for Health IT and what's being discussed in Stage 3 of meaningful use have the potential to have a similar impact on the mHealth ecosystem.
Currently, healthcare still operates in the equivalent of a pre-iOS/Android world, where there is a monoculture of mobile apps. That is, most mobile apps connected with EHRs come from the same vendor. The ONC recognizes that healthcare providers will benefit if there is a more diverse ecosystem of mHealth app developers. Consequently, the ONC is nudging the industry in that direction through meaningful use guidelines.
ONC unleashing mHealth innovation
The essence of what the ONC is trying to achieve is to unleash new applications that are enabled by the equivalent of standards (such as HTTP and iOS/Android app stores) that unleashed the web and led to thousands of web services and mobile apps. In 2012, the ONC rolled out the Automated Blue Button Initiative, which is an important step toward unlocking the latent power trapped inside of stove-piped systems.
In a week, we'll be in the thick of the HIMSS13 conference. Vendors will breathlessly make announcements such as "investing $25 million in patient engagement" that include developing mobile apps that are the equivalent of the Verizon app store. We know how that turned out - depending on one vendor greatly limits what patients/providers have available to them. In contrast, the ONC just announced a ruling (details below) that is another big move to unleash innovation. While some of the ONC's moves can appear small at first, the market signaling effect can turn the snowball into an avalanche of new EHR-agnostic apps in the iOS, Windows and Android app stores. Further, it can have an impact on business strategy. John Lynn, a healthcare journalist, speculated on how the recent ruling could give health systems an alternative to the expensive practice of buying medical practices to buy loyalty.
Jan Oldenburg (editor of the seminal book on patient engagement entitled Engage! Transforming Healthcare Through Digital Patient Engagement) tweeted "This looks like the first ONC acknowledgment that patient (portal) experience needs to have community data." (Disclosure: I had the honor of helping write and edit that book with Jan, Kate Christensen and Brad Tritle. There is also a track at HIMSS13 focused on the Patient Experience, where we'll highlight the business case for patient engagement.)
Recognizing that breaking down information silos is paramount to improving outcomes, the ONC's ruling gives healthcare providers using EHR-agnostic (i.e., systems not from the EHR vendor themselves), multi-provider, patient-facing apps a major advantage over those using the old model of siloed EHR patient portals.
Here's an example to describe the benefit: A primary care physician sends a patient to an endocrinologist. After seeing the endocrinologist, the patient logs into an app that's shared by the PCP and the endocrinologist. The bonus for the PCP, then, is that he/she gets credit for that patient logging into the app, even though the patient logged in after visiting the endocrinologist, not the PCP. Had the endocrinologist and PCP not shared a portal, then obviously he/she would get no credit for the patient logging into the endocrinologist's portal after the patient visited the endocrinologist.
As a leading health IT pundit, Leonard Kish, stated, "This is a big step forward in patient engagement that recognizes consumers prefer a tool that's similar to Quicken or Mint in personal finances, a place where all their information can be brought into one place that's portable, and if need be, shareable within a larger community. While diminishing patient options, the single entry to a portal also diminishes the ability of the hospital to build the relationships with a network of outside providers and patients who are so critical to improving care, and ultimately, bringing more patients to the hospital. The key for both patients and providers is building a community of shared information that can drive improved outcomes through group learning."
What's next
The aforementioned ruling applies to a requirement to have 5 percent of patients view, download or transmit their health information. I can empathize with the ONC, as they are getting an earful to slow things down, but they also recognize that lives are literally at stake when things get slowed down. The EHR vendors stand to benefit from the aforementioned ruling. A reason they are complaining is they are overwhelmed with a boatload of new requirements and customers (thanks to meaningful use incentives), not to mention a host of new requirements from the shift to fee-for-value reimbursement. At the same time, EHR vendors are duplicating their efforts in building me-too patient portals/apps in order to meet requirements. Few, if any, are using patient-facing apps as their core differentiator. Thus, the logical response is to partner for capabilities one doesn't differentiate on.
I don't know of anyone who lived a full life who has had only one doctor their entire life. This is especially true with the 50 million Americans moving every year and many more changing jobs (and thus health plans/providers). I took stock of my family of four - we had a healthy 2012 and still went to seven different providers, and I don't want seven user ID/password combinations. We've also been on three different health plans in the last four years. The best patient portal in the world has limited value if you can't take that information with you. That healthcare still applauds "patient-centric" organizations that charge $1 per printed page of your health records when you leave their health plan/system speaks volumes. There would be Congressional hearings if financial institutions prevented consumers from downloading their transactional history or they were charged $1 per printed page of their history, yet the equivalent of that in healthcare has oddly become the norm.
Fortunately, it appears the ONC is going to rectify that in Stage 3 of meaningful use by having the default be that a patient can choose where his or her data is sent. That single move could unleash a wave of mHealth innovation, as they can select their favorite app/website as a destination for their data.
One can only imagine the criticism the federal government would receive if, after sending $28 billion of taxpayer money on encouraging EHR adoption, consumers were unable to get their own data (not to mention the $750 billion waste in healthcare) sent to their designated app. The fact that this is still a topic of discussion is stunning. Having spent time with the ONC leaders (see also Mr. Obama, Tear Down This Walled Garden), I have 100 percent confidence in Dr. Mostashari's leadership that his organization will demonstrate to EHR vendors that they can gain a market advantage from enabling more open systems. Anything less would be the missed opportunity of the century.
Dave Chase is the CEO of Avado.com, a patient portal and relationship management company used by providers ranging from large health systems to solo practitioners. Previously he was a management consultant for Accenture's healthcare practice and founder of Microsoft's $2 billion health platform business. He's also the co-editor of Engage! Transforming Healthcare Through Digital Patient Engagement and is a speaker during the Patient Experience forum at HIMSS13 where we'll highlight the business case for patient engagement. You can follow him on Twitter @chasedave.
