Apple is officially in the EHR business. Now what?
After months of rumors, Apple made a jump into the electronic health records game, allowing patients to aggregate their records on their iPhones. The move could effectively pressure EHR vendors to open up access to patients' digital records.
"This creates a high-profile and instant demand for the EHRs to provide this information to patients," said John Kelly, principal business adviser for software firm Edifecs. "It's a way for the patient to become an agent of interoperability."
On Thursday, Apple began allowing patients of select healthcare organizations to gather their records from those organizations in one place: the Health app on their iPhones.
This move will force EHR vendors to provide access to their data through open application programming interfaces, as mandated by the 21st Century Cures Act, Kelly said. "When Apple releases an app like this, it creates demand overnight."
But the Health app's aggregation will do more than just that. It will also lead to the "deconstruction of the monolithic EHRs," he said. "Once those (application programming interfaces, or APIs) are provided, they won't be limited to just this Apple application. This means those APIs are available for all kinds of innovative uses."
Google tried something similar a decade ago with Google Health but ended the service a few years later amid lackluster adoption.
Just as iOS apps unrelated to health pull data from outside, so too could healthcare apps, drawing on newly freed data from EHRs. "Developers around the world will be able to build new and interesting things for patients," said Daniel Kivatinos, COO and co-founder of EHR vendor drchrono.
As a result, EHRs might one day be thought of more narrowly as patient data repositories on which workflow and other applications can be built, Kelly said. "That stuff will no longer have to be done by the EHR vendors themselves," he said. "This opens a whole new avenue."
By and large, the APIs that will make this kind of data exchange possible rely on Fast Healthcare Interoperability Resources, a set of standards for moving healthcare data. That means that with the push to provide patients with their digital health information comes a push for FHIR, solidifying the technology's viability as a solution to the federal mandate that providers allow patients to access electronic versions of their health records, said Dr. Charles Jaffe, CEO of Health Level Seven International, the organization that created FHIR.
"The bottom line is that this is another affirmation that FHIR is real, and it will change the way we view sharing data," he said.
FHIR is nothing new, Jaffe pointed out. "All of the health IT organizations and the ones that drive the internet and so forth have FHIR projects," he said. "The Apple announcement came with no surprise to many of us who work with collaborating organizations," he said, though he was unable to provide specifics on those organizations because of nondisclosure agreements.
"For us, it's exciting because it's a significant step toward enabling patient engagement at a level that we hadn't appreciated in the past," Jaffe said.
Though pulling health records into the Health app is an important step toward interoperability, there's still work to be done, Jaffe said, especially when it comes to semantic interoperability. Semantic interoperability is a level beyond technical interoperability, which is just moving the data, as opposed to actually understanding what it means.
"Semantic interoperability means we're not only exchanging the information but that it's meaningful and you can use it," Jaffe explained. It's a challenge we all face in daily communication, and it's a challenge in healthcare too, where there's ever more reliance on computers to do the work of extracting meaning. "We clearly have a long way to go to get semantic interoperability where what I say and what you understand are the same thing," Jaffe said.
Not only is such understanding important for computers, it's important for providers themselves, especially if patients are allowed to push data from their phones back into EHRs.
"In general, providers and institutions have resisted importing information from the internet of things," Kelly said.
They've worried about the provenance of that information and liability. But with data stored on an iPhone, the patient would be the one granting access, easing some of the liability concerns.
"When it's in the patient's hands and directed by the patient and there's a good breadcrumb trail," Kelly said, " a lot of the objections get taken away."
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