Indiana Jones and the Personal Health Record

  • Technological savviness: Will older consumers be aware of and capable of using your application?
  • Split tails: The needs of either of these tails are drastically different, diversifying the necessary MVP feature set you need to service both and making the application more complex. Healthy people look for features that support health maintenance in their day-to-day living, via the aforementioned fitness and diet trackers. Sicker patients look more for clean clinical data aggregation.
  • Provider discovery and selection
  • Appointment management
  • Communication with providers/health systems
  • Billing and payments

How Consumer Data Aggregation Works

Digital Health Aggregation

  • The 2015 European Union Directive, Payment Services Directive 2 (PSD2) was designed to ensure that banks create mechanisms to enable third party providers to work securely, reliably and rapidly with the bank’s services and data on behalf and with the consent of their customer.
  • While not explicitly designating a particular standard, APIs were/are commonly seen as the path to meeting this regulation, leading to disparate formats and authentication methods
  • 2018 UK Open Banking regulation further defined the exact API formats (although only requiring it for the largest banks)
  • The US has no equivalent legislation, so although some domestic banks have exposed APIs, Plaid and others must have robust screenscraping capabilities to be successful.
  • Meaningful Use moved to Stage 3 (MU3) in 2015, the Centers for Medicare and Medicaid Services (CMS) added APIs (application programming interface) as an alternative or complement to patient portals.
  • While not explicitly designating a particular standard, EHRs had to create some sort of API, leading to disparate formats and authentication methods
  • The 2019 ONC Final Rule of the 21st Century Cures Act further defined the exact API formats (FHIR R4)
  • The EU has no equivalent legislation, so although some European nations have local legislation (NL with Medmij, for instance) and some healthcare organizations have exposed APIs, for the time being, screenscraping is still necessary to be successful

PHR Problems

  • Provider discovery and selection — While USCDI/EHI does include the practitioner resource, this is for understanding the patient’s care team at a given institution and doesn’t help with determining what provider is best to go to.
  • Appointment management — USCDI/EHI doesn’t include available slots for scheduling and the APIs do not allow for writing back appointments.
  • Communication with providers/health systems — The APIs do not allow for writing back to the chart or communicating with hospital staff.
  • Billing and payments — USCDI does not return information related to bills or patient payments. This might be addressed with the later EHI deadline.

Who wins?

Traditional Patient Portals

Insurance Companies

Embedded Health

Do it for Shia LaBeouf

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Healthcare integration and interoperability advocate. Language learner. Fierce and unrelenting friend of dogs.

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Brendan Keeler

Brendan Keeler

Healthcare integration and interoperability advocate. Language learner. Fierce and unrelenting friend of dogs.

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