Technologists have worked for years to break down data silos in healthcare. Then, just as it seemed they were starting to figure out interoperability, along comes a flood of mobile health apps that simply don't connect to anything.
A recent report from MedData Group, a market research firm based in Topsfield, Mass., found that many doctors doubt the promise of connected health, even though two-thirds use mobile apps professionally.
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Only 1 percent of the 532 physicians queried this past winter thought the U.S. healthcare system would be fully connected within a year, while 57 percent indicated that it would take more than five years to get there. The doctors cited lack of interoperability more than any other barrier except issues with data security.
While about six in 10 physicians surveyed said they would be interested in mobile access to EHRs, doctors tend to doubt that vendors will be able to create a "fully connected healthcare system in the short run, or that their local hospitals are prepared to implement it," the report says.
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Physicians also expressed concern that new technology will cost them more than it will save them. One respondent suggested that a well-connected healthcare system is "good for patients but nobody will want to ever become a doctor."
"Until [mobile health] information is intelligently managed, which requires high-intensity human oversight, which to date we have been unwilling to program or to pay for, we will continue to have only what our current technology provides: a vast and unmanageable amount of uncontrolled, non-vetted and non-meaningful information," MedData concludes.
That is precisely what Mark Blatt, MD, worldwide medical director for Intel, has noticed. Blatt believes there is a "fundamental problem" in healthcare: "The service that we produce is unaffordable," he says. "Anything that can't really be looked at as lowering the cost of care is already a non-starter."
The mobile apps physicians have flocked to mostly are reference tools, which is fine, but not ideal, according to Blatt. "The real fundamental value in mobile is not data lookup," he says. Mobile technology "allows us to collaborate in cyberspace in real time."
In other words, connectivity will come from platforms that help people work collaboratively, according to Blatt. For example, mobile technology is particularly well-suited to home care, Blatt says, as low-cost videoconferencing and streaming telemetry can easily enable what he calls care virtualization.
"Collaboration is where I want to head, even if I don't start there," he says.
That leaves plenty of opportunity for technology developers large and small, according to Unity Stoakes, co-founder and partner of New York-based entrepreneurship academy StartUp Health.
"What's clear is what's needed, which is a connectivity layer," Stoakes says. "There really is not a connectivity layer at this point, nothing that makes it easy for a developer to plug and play."
Certainly, such platforms are in the works, like the "ecosystems" some telecommunications companies and industry consortiums claim to be building, says Stoakes. "But nothing is mature enough that there is a dominant connectivity platform," he adds.
That may be OK, according to Stoakes. "Everyone's trying to have a winner-take-all scenario," he says. But it does not have to be that way; in the smartphone and tablet markets, Apple's iOS and Google's Android both are strong platforms, but neither dominates, and the competing operating systems can talk to each other via the Internet.
In an immature market like mobile health, it is typical for silos to develop. Stoakes says there is plenty of room for an industry consortium to come together and make rules for developers to follow, though he believes it is more likely that an entrepreneur rather than an association will drive standardization.
Three established players -- HIMSS, the Continua Health Alliance and the HIMSS-owned mHealth Summit -- this year formed a group called the Personal Connected Health Alliance to facilitate consensus-building in digital health.
StartUp Health, for one, is working on its own platform to connect some of the early-stage companies it is incubating, and some of those companies are bullish on application programming interfaces. Basis Science, a StartUp Health alumnus that Intel purchased in March, is among those opening up data to outside developers, according to Stoakes. Fitbit is doing the same.
"If you're not making it easy for early-stage innovators to plug into your system, you will not be successful in the long term," Stokes says.
He also praises a few healthcare data initiatives from the federal government, such as Blue Button and HealthData.gov. "Some of their open-data platforms have been very valuable," he says.
Chaim Indig, founder and CEO of Phreesia, a vendor that makes patient check-in software and other apps to streamline the front offices of physician practices, is among those grateful for APIs that allow Phreesia's app/platform to sit on top of popular revenue-cycle management and practice management systems.
"It's the newer players that have been opening up," Indig says. Older practice management and EHR systems still are "walled gardens," according to Indig. "A lot of those walls are being forced to come down."
Phreesia recently completed two-way integration with athenahealth via a set of APIs. "Our product and their product don't live in silos," Indig says.
To him, Web APIs are superior to what he calls "non-scaleable" HL7 interfaces. "It allows discrete data into the system," not just file attachments, he says, and information can flow both ways. With these integrations, Indig says, "You don't have to worry about how your data gets into athena, back and forth."
The proliferation of APIs is one reason Stoakes is more optimistic than most of the physicians in the MedData survey. "Having a connectivity layer is such an awesome opportunity that someone is going to figure it out in the next 24 months because the market wants it," he says.
"We will figure this out faster than we believe," says Stoakes. "The opportunity is too great. We're not moving on a linear scale. It's an exponential growth curve that we're moving on."