- Editor's note: The following is a contribution by DataMotion CTO and Founder Bob Janacek.
mHealth — the practice of medicine and public health supported by mobile devices — is receiving a lot of media attention, and it should remain hot with big players like Apple and Samsung deeply involved. But peer under the hood a bit into the clinical workflow needed to make mHealth a success, and the hype, while appealing and sometimes justified, seems to be a bit ahead of reality.
A recent example involving a family member with a week-long hospital stay really illustrates this point. They were admitted to a highly-acclaimed regional hospital and the care received was top notch. Thankfully, they’re now home and will be fine. The hospital uses top-tier EHR systems, and their billing technology was so efficient that five invoices were received in the mail even before their patient was discharged.
So far, so good. But here’s where work needs to be done.
As part of the discharge process, prescriptions were issued and copies of medical records for follow up care were requested. The prescriptions couldn’t be sent in advance to my family member’s local pharmacy since the hospital only sends them (by fax!) to their own on-site pharmacy, which at the hour of discharge was already closed. So a stack of paper prescriptions was handed over. No ePrescribing here.
Following a similar pattern, the hospital couldn’t electronically transmit medical records to my family member’s primary physician since they weren’t affiliated with the hospital. Instead, this required a trip down to their medical records office and resulted in a sizeable stack of paper records being handed over.
Yet, in this paper jungle, there was a glimmer of hope. The discharge paperwork contained a sheet providing instructions for logging into the hospital’s patient portal. There, the sheet promised, would be all of the patient’s medical records, as well as a way to electronically share them with their provider.
Upon getting home, we logged into the portal … only to find that it was blank. No records were transferred about the past week’s visit. And “sharing” is only possible from a predefined list of doctors that are affiliated with the hospital. This system is pre-direct secure messaging (and pre-Stage 2 Meaningful Use) — the secure, email-like protocol developed for healthcare — and it did not yet allow continuity of care (CCD) documents to be transmitted outside of the hospital’s closed EHR/HIE/PHR environment.
The healthcare industry has devoted significant efforts in tackling interoperability issues related to billing and payments. Similar efforts must be made with clinical data exchange, eliminating barriers to interoperability for providers and patients, and improving healthcare outcomes.
Interoperability is a promise that the Office of the National Coordinator for Health Information Techhnology (ONC) and healthcare industry has made, and it is a promise that must be kept. Overcoming interoperability issues is essential for the success of the mHealth industry. Once achieved, mHealth can advance from its current “bright shiny object” stage to being an essential part of better healthcare outcomes.
At present, most mHealth vendors silo patient data in their own proprietary clouds, far removed from the provider’s EHR system. Providers won’t log into another system and they don’t want data overload. What they need is actionable data in the clinical workflow of their EHR system. This will require data interoperability in addition to analytics. While some mHealth vendors are large enough to have health technology vendors integrated with their proprietary API, open standards such as Direct Messaging and HL7 document formats should be used for widespread reach.
It’s a fairly simple premise: only when everyone has the ability to communicate, which requires standards to ensure interoperability, will the great potential and benefits of mHealth be realized.
Improving patient care will require the industry to look beyond the glare of “the new shiny,” get down to basics, and master the fundamentals of interoperable data exchange. A solid foundation is essential for improved patient outcomes. The cornerstone has to be interoperability. Healthcare should first fully leverage proven technology that provides this if mHealth is to gain real traction.
And Direct Secure Messaging is a key to its success.
Bob Janacek is chief technology officer and founder of DataMotion. Since 1999, the company’s SaaS technology has enabled organizations of all sizes to reduce the cost and complexity of delivering electronic information in a secure and compliant way. In healthcare, DataMotion is an accredited health information service provider of Direct Secure Messaging, providing efficient interoperability and sharing of patient data across the continuum of care.