With Apple consulting Argonaut Project on health records, interoperability could get the push it needs
Apple is said to be working with the Argonaut Project to integrate more electronic health data with the iPhone, a move experts say could go a long way towards advancing medical record interoperability.
Participants in the Argonaut Project – an HL7-led initiative focused on expanding the use of open standards for health data exchange, notably HL7's FHIR specification – are some of the industry’s most notable vendors and providers: Accenture, athenahealth, Cerner, Epic, McKesson, Meditech, Surescripts, The Advisory Board Company, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Intermountain Healthcare, Mayo Clinic, Partners HealthCare.
It's not a bad place, then, for Apple to get some ideas about better integrating its products into a complex and fragmented healthcare ecosystem.
Argonaut leader Micky Tripathi, president and CEO of Massachusetts eHealth Collaborative, would not comment on anything specific about Apple's discussions with the group, but he was glad to offer some thoughts on what iPhone-based health records could potentially mean for healthcare more generally.
In particular, Tripathi seemed excited that Apple could play a significant role in improving interoperability – especially with regard to consumer-mediated exchange.
"There has been more and more effort and attention being paid to empowering patients with the ability to aggregate their own data, and then do more with it than they otherwise would have," he said. "That's the idea, and the hope people have. There are many challenges to that, but we're making incremental progress on the way."
Tripathi said he could envision a world where a patient is able to aggregate all of their records on their device, and "use that as the vehicle for sharing."
For instance, a diabetic could use an iPhone-based diabetes app and populate it with his or her own health data. "They could say, 'Alright, app, go to the API at Beth Israel Deaconess Medical Center and get my diabetes-relevant information.' Maybe that's lab results related to diabetes, but it's not everything – those records could be voluminous, but the app is able to go out and get just that information that's important to me."
The big challenge, at the moment, is that healthcare is still largely lacking when it comes to a "trust ecosystem," said Tripathi. But that's another area where Apple, with is nearly unparalleled familiarity, could offer an answer.
Opportunities for trusted exchange
In addition to to pushing for broader use of the FHIR standard, the Argonaut Project also champions the OAuth 2.0, an open profile for authorizing apps to access FHIR data.
"If I have a trusted relationship with an organization and they offer me credentials, OAuth is really good, from a technical perspective, at my being able to go to another organization, and, rather than having to have separate username, password, whatever credentials I need for that organization – if that other organization trusts the original organization who made the credentials, then they can just make an OAuth call back and say, 'Someone is presenting themselves as Micky Tripathi. Do you have a Micky Tripathi?' If the response is yes, they pass a technical security token and that enables me to be able to access that third-party thing."
It's an exciting technical concept: A patient has an app and can go to five different hospitals to get their data. The challenge, though, is that there's a sprawling healthcare ecosystem right now with no obvious answer to who could play that trusted role.
"Health insurers? Maybe. The problem with insurers is that they're really fragmented, they're all over the country, and people jump around from insurer to insurer," said Tripathi.
"Or could large providers play that role for each other? In Boston, Mass General may be willing to trust Beth Israel, and vice versa. But they're local organizations. And you have this n-squared problem: Does every pair have to trust each other in that way? Or does everyone trust Mass General, and is that weird because they're a competitor?"
Apple, on the other hand, could potentially offer that trust. "One could imagine Apple playing a role that very few other organizations can play," said Tripathi.
"Hospital A, Hospital B, Hospital C, rather than issue their own credentials, would be willing to say, 'Oh, if Apple trusts them, that's fine. We'll let the app in to do what it's going to do,'" he said. "That's one area, where I think it could lay a firm foundation for a consumer-driven ecosystem that would help with consumer enablement of being able to get their healthcare."
Beyond patient engagement
The concept of consumer-mediated exchange is just as intriguing.
"What if you were able to aggregate your records on your iPhone, and essentially solve the interoperability problem yourself?" said Tripathi.
The most "clunky" and basic way to do that, is to simply say, "Here doc, here's my iPhone, take a look at my record," he said.
"But perhaps a more mature approach could possibly be that you would have provider organizations subscribing to an Apple service, say, where they subscribe and, as an Apple patient, I have all my records there. They could go down a list – Beth Israel Deaconess, check; Harvard Vanguard, check – and access my data that way, almost like a health record bank."
The notion of a health record bank has been around for about 10 years, but hasn't gained much traction, thanks again to issues of fragmentation and trust. "No one organization is prominent enough nationally to be able to have everyone across the country say, 'Yes, sure, I could imagine trusting them,'" said Tripathi. "Obviously, Apple has that kind of visibility and that kind of place in consumer consciousness."
Apple could also ease many clinicians when it comes to patient-mediated data, he said.
"Providers have a degree of mistrust of information that has been handled by the patient. Not because they don't trust them, but you just don't know what happened in that circumstance. Did it get garbled, is some stuff being left out because they don't want me to know something?
"Apple certainly has the technical smarts to be able to establish data provenance with those records, so if I got the record through some Apple service, through various existing security and non-repudiation kinds of mechanisms that exist today, I would be able to know that this record hasn't been screwed around with since it came from Beth Israel. It just happened to be in the patient's control, they haven't changed anything."
For his part, Tripathi feels that there's been something of a sea change with public perception: how they see their data, and how they see their smartphones.
"If you had asked five years ago, there would have been a different sense to this. It just feels to me, intuitively and anecdotally, like we've had some sort of a change in the way we think about privacy, and protection of privacy," he said
Earned or not, Tripathi thinks people have a much higher degree of comfort in trusting their data with companies such as Apple.
"People have much more of a sense of their phone being an extension of themselves,” he said. “Your phone is much more a part of you and a reflection of you, and something you trust it to have personal information – sometimes deeply personal information.”