For years, universally accessible health records have been a major goal of health care professionals and technology entities alike, and their benefits are well documented.
Such a system would enable medical staff at a large hospital to see the same information about a patient, at once and without the possibility of misinterpretation; the ability of a specialist to see precisely what a primary care physician sees; and critically, the capacity of the patient to access his or her medical records easily and in a format that is readily understood by a layperson.
Unfortunately, this ideal has only seen limited success in the real world. According to an article published in the Journal of the American Medical Association (AMA), “The benefits of electronic health records (EHRs) are well documented, yet their introduction has been greeted with reluctance and sometimes resistance. Indeed, current usage rates are quite low.”
In a 2008 study published in the New England Journal of Medicine, a national survey of 2,758 physicians found that only four percent were utilizing an “extensive, fully functional electronic records system, and 13% reported having a basic system.”
The consumer counterpart of these systems, such as Google Health and Microsoft HealthVault, have also not achieved their predicted success. Google shut down Google Health as of January 1, 2012. Google’s official blog stated, “…we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people… we were not able to create the impact we wanted with Google Health.” Google continues to be involved in EHRs, however; in January 2015 they were named as a partner of a PricewaterhouseCoopers-led $11 billion electronic health- record contract bid for the U.S. Department of Defense.
The past few years have seen more strides into this area with the adoption of electronic health records. According to the Centers for Disease Control and Prevention, 74% of physicians’ offices had an electronic health record system in 2014, up from 67.5% in 2013. The percentage of physicians sharing patient health information with external providers such as specialists was considerably lower, however, calculated at 32.5% in 2014.
The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, written into law as part of the American Recovery and Reinvestment Act (ARRA) has accelerated the adoption of EHR technology. This portion of the bill provided incentive payments to eligible hospitals and providers that demonstrated “the meaningful use of a certified electronic health record (EHR) system.”
These incentives were provided starting in 2011 up until 2015, at which point the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services (the agency given authority over the stimulus program) could begin levying penalties for failing to demonstrate such “meaningful use.”
Individual adoption of fitness trackers, such as FitBit, and the data they generate could be considered a form of personalized health record, and certainly indicate a greater desire on the part of the general public to know more about its health data.
Enter Health2047, a new company that intends to meld technology with health care in new ways, including widening the adoption of electronic health records and the associated patient data sharing.
Founded by the AMA, the company describes itself as an “integrated innovation company whose mission is to develop, guide, and commercialize disruptive ideas that enhance — at the system level — the practice of health care.” The AMA will invest $15 million up front in the venture, and will be heavily involved in its work.
The CEO of this organization is Dr. Douglass Given, a physician and businessman with health care, venture capital, and drug development experience. That includes experience working in public health and academic medicine, as well as running traditional pharmaceutical companies and Vivaldi Biosciences, Inc., a biotech firm involved in the development of flu vaccines.
Concerning the issue of EHRs, Given believes that development must focus on quality and the user experience, and the central role of the physician as “pilot” of the system, stating, “We believe that desirable features and enhanced usability will be what drives adoption.” He envisions EHRs that serve the needs of both patients and their physicians by giving “actionable information,” from patient data that is both high-quality and accessible. He also prioritized patient knowledge, data security, and user experience as vital for a next generation of electronic health record system.
Dr. Given believes a major fault of current EHRs is that only a small of fraction of the data collected is useful in “assessing and addressing health outcomes” – less than 25%, in fact. This happens because the way data streams operate in EHRs; they don’t enable data analysis and therefore, it is difficult to get “actionable” information (read: information that can be used for a diagnosis).
A major emphasis of Health2047 is on partnerships and collaboration with AMA physicians and other stakeholders. Dr. James L. Madara, CEO and executive vice president of the AMA, will serve as board chair of Health2047.
According to Madara,
“Improving the health of the nation is at the core of the AMA’s work and Health2047 will build partnerships to create new solutions for physicians and their patients that improve health care delivery and health outcomes. Health2047’s product orientation and entrepreneurial DNA will help forge new paths and bring commercial solutions to market faster.”
Given has outlined several sectors as particularly open to innovation: medical education, chronic care, “value-based” health care and payments, connected health solutions, and networking technology for physicians, providers, payers and patients. He said of medical networking technology, similar to EHRs and other systems that enable physicians and specialists to communicate, “It’s a mystery to me why it doesn’t exist, why physicians aren’t using this in their practice.”
Given said that the company will be working with multiple partners across what he calls “asset classes.” These are the media, wireless and mobile technology, consumer technology, enterprise technology, health care provider systems, medical and pharmaceutical product companies, and health benefits providers.
He also intends to work with venture-backed emerging companies that have “strong product/service offerings,” which have health care applications. Health2047 will assist these companies to meet health care market needs by leveraging their own inside perspective of physicians – giving an “unparalleled physician-level view,” in addition to regulatory expertise from the AMA. “You think about the $3 trillion-plus health marketplace, with less than a million practicing physicians,” Given said. “Think of the leverage they have.”
Health2047’s planning focus is still at the strategic level, as they are a fairly new company. Given said that these areas of strategic focus include: system-level solutions to chronic disease, value-based health care, connected health solutions, and collaboration models for physicians, providers, payers, and patients.
A specific health care problem the organization would address, other than the EHRs listed previously, would be what Given describes as the “the mismatch between the mobile world that patients and individuals live in and the tethering of doctors and providers to the physical world.”
Given stresses involving the physician perspective as well as applying “system engineering thinking” in order to solve these problems. As he says, “Simply dropping discrete products into the healthcare system doesn’t work. All you get is fragments of benefit and that is unacceptable.”
Regarding the overall climate of health care challenges in the United States, Given had this to say:
“With the shifts from acute illness to chronic illness, and from in-patient care to outpatient and ambulatory care into the home, there are clear system-level issues we must address to improve healthcare…To fix them, we must innovate across the continuum—from products and services, to business models, regulation, distribution, and financing methods. That means enlisting critical constituencies – including physicians, healthcare providers, regulatory and policy experts, venture capitalists, technology providers, scientists, designers, software developers and consumers – to arrive at the best possible solutions.”