The following column is one of the last our partner Steve Wildstrom wrote for us. As many of you know, he passed away last week after losing his battle with brain cancer. However, even while he was fighting for his life and having to deal with our healthcare system, he was still using this experience to bring to the fore some of the key issues he saw regarding patient security, the problem with closed systems, the potential virtue of open systems and applauds Apple’s HealthKit program. I know how hard it was for him to write this in June but, as you can see, his mind was still very clear and his writing top notch. With this column, we honor the contribution he made to us and our Tech.pinions audience and he will always be part of the Tech.pinions team.
President, Creative Strategies
For those who have been following me (mostly on Facebook) you know I have had a lot of experience with the health care system. In addition to what has generally been very good treatment, I have learned about the impact of the internet and other communications on medicine. There’s a lot being done but much more is needed.
One of the pieces of news is the protection of patient security is very good. In the fairly infrequent cases such as the hacking of Anthem this winter, the attack on information has involved almost entirely financial, not medical records.
The reason is straightforward. The Health Insurance Portability and Affordability Act (HIPAA), in effect since 1996, imposes both very tough rules and stiff penalties for violation. A leak of information in the hospital is likely to produce seriously discouraging prosecution. Make the cost expensive for those who want to pass info on and you discourage trying.
But the HIPAA effort is far from free. The big problem is it is one of the major policies that gets in the way of effective sharing of information among doctors, medical centers, and hospitals. Electronic medical services, from general companies such as IBM and GE to specialists such as Epic and Cerner, should keep track of whatever is going on, from record keeping by doctors during exams to blood tests to pharmacy data to MRI and CT tests, and just about everything else.[pullquote]One piece of news is relatively younger doctors seem much more comfortable with the technology than their older colleagues.[/pullquote]
Of course, how well this is all used depends on how good the administrators are in making it useful. One piece of news is relatively younger doctors seem much more comfortable with the technology than their older colleagues. Another is the effective use in facilities both hospitals and centralized medical centers. I am a patient of Kaiser Permanente’s staff-based HMI and their national complete usage of the Epic system works well (except for occasional network problems).
Closed systems. These are, however, effectively closed systems, whether relatively small or a massive operation like Kaiser. Johns Hopkins Hospital in Baltimore has a close relationship with Kaiser Permanente Mid-Atlantic and, while both use Epic systems, don’t expect them to communicate with each other electronically. Giving Johns Hopkins copies of MRIs made by Kaiser required me to pick up DVD copies of the tests and deliver them to Baltimore. Written records need to be printed and delivered too.
That’s just a nuisance. Even worse is the situation if you get ill while traveling. If you need medical treatment while traveling, it can be very difficult for the personnel to get your records while complying with HIPAA. It’s safe, sort of–no one else will get it. But it can be ridiculously hard to transfer. Very solid systems have been built, in many cases on 20-year-old technology. There are secure and better systems out there. And, while the government’s caution is valuable, it is really time to develop better systems.
Fortunately, there some real developments. HIPAA makes make it hard–still a mixed challenge–but we are starting to get serious use of the Internet of Things medical devices to deliver important information to medical professionals. Most of these systems begin with the transformation of data on private networks, such as Qualcomm’s 2net Platform and Verizon’s Converged Health Management.
Open systems. As happens in the rest of the IoT world however, we are moving toward more open, more general, and more easily shared systems. Apple, which has a deep interest going back at least to Steve Jobs’ serious illness, has seen the value of iOS devices for the collection of information. And, in a new move for Apple, but in line with techniques strongly favored by developers and researchers, the new software is to be built using open systems.
Apple’s ResearchKit, launched this spring, has made progress in several medical apps: asthma, Parkinson’s disease, diabetes, breast cancer, and cardiovascular disease. Based on iPhone apps with Apple Watch likely to join, they use the device’s ability both to collect and transmit (of course, working within solid security features that are HIPAA requirements) information from the patient to researchers.
For example, Share the Journey, organized by Sage Bionetworks, is for women being treated for breast cancer. They regularly enter information on activity and perform specific tasks to improve researchers’ experience on what is happening in the case, allowing them to study and improve treatment.
Health patients. Stanford’s MyHeart Counts uses the iPhone itself to collect and transmit a considerable variety of information on what’s happening in the body. Unlike other ResearchKit efforts designed primarily for the treatment of conditions, MyHeart Counts wants to look at the data generated by healthy patients to gather information.
It’s not surprising that the ResearchKit efforts are focused on some of the dominant conditions. It’s a likely place for relatively quick gains. The provisions that make the sharing of information through public but secure networks offers an even greater advantage.
I don’t know if Apple finds much business out of this, but it is a big and important deal. To the extent they can push for better communication of health care information of all sorts while maintaining security, it is a even better gain.