Medisafe

Jon Michaeli

Few would argue that integrating patient-generated with EHR (electronic health record) data – and making sense of the resulting mix – is the Holy Grail of digital/mobile health. In fact, hospitals are already integrating digital-health data into EHRs using platforms like Apple HealthKit. For example, in October 2014,Ocshner Health System implemented HealthKit, and last April Cedars-Sinai Medical Center connected 80,000 patients to the platform.

“Poor medication adherence is a $300 billion per year problem,accounting for almost 10percent of total healthcare costs in the U.S.” 

But doing this at scale with more complex platforms – in particular those that seek to change behavior and have a meaningful health outcomes and cost reduction– is much more involved than adding a few biometric details into medical records, and will take more time. Aside from interpreting terabytes of data, integrating digital-health data involves exceedingly complex algorithms and predictive analytics, not to mention hyper-secure connectivity across disparate systems.  

If we wait for full-on integration between digital-health data and EHRs, too many promising innovations will die on the vine; the opportunity cost for startups to demonstrate traction in other areas (for example, patient adoption, monetization, improved clinical outcomes and others) is simply way too high. Instead, for now, we can give providers tools that allow them to access digital-healthdata directly, ones that are very robust on the back end, yethave simple and flexible interfaces on the front end.  

Cloud-Based Solutions Augment EHR Efforts 
 
Despite years of evolution, many EHRs are still clunky, and clinicians still struggle to get the value they need from them. Perhaps the biggest dilemma is that most EHRs were designed to be at the center of web of enterprise data sources, with many being originally developed before digital health entered the picture.  

Furthermore, as the number of data nodes generating health informationincreased, from laptops to mobile devices to wearables, it isincreasingly difficult to create an architecture that embraces all. Getting EHR vendors to create interoperable data models has been a herculean task; adding digitalhealth data integration to the list only adds to the problem. 

Physicians shouldn’t spend their time worrying aboutEHR integration challenges when they deliver care. It’s our job to offer them access to fresh, pertinent patient data when and where it’s needed, regardless of where it originated. What’s more, the information should be delivered in a way that helps them make good decisions. 

That’s where solutions operating outside of EHRs come into play.Bycreatinglightweight cloud-based platforms and ecosystems, and collaborating with physicians to ensure maximum usability, we can contribute new sources of actionable data, while offering direct channels to patients to influence the course of treatment.  
 
Supporting Physician-Patient Intent 
 
Onerecent study that we conducted illustrates how much valuable digital-health data is being left on the table every day. In thisstudy, we surveyed 151 doctors across five specialties (i.e., cardiology, psychiatry, endocrinology, pulmonology and pain management) to learn how theymanage patientmedication adherence. We chose specialists because they are more likely to be actively managing their patients’ health. 

As many know, poor medication adherence is a $300 billion per year problem,accounting for almost 10percent of total healthcare costs in the U.S. However, 20percent of responding physicians said that they don’t monitor patient medication adherence at all, and another 18percentrely only on patient self-reports to determine how compliant their patients are with their medication regimen. That means at least 38percentof responding physicians are making clinical decisions – and perhaps medication changes – that rely on either questionable patient reports or no data. 
 
Physicians seem open to change. Thoughconventional healthcare industry wisdom holds that physicians find non-EHR data to be overwhelming and distracting, the survey suggested otherwise. In fact, 65percentof respondentssaid that they were willing to receive medication adherence data outside of an EHR, with 28percentopen to getting these reports via e-mail and 12percentvia mobile. Interestingly, both are higher than those specifying fax machines(9percent), which are still a fixture in most U.S. doctors’ offices.  

The Right Data at the Right Time  
 
While this appearspromising, physicians’ interest in receiving and using data outside the EHR will notblossom unless we thoroughly understand what they consider most valuable and make it easy for them to receive it when needed.  

While EHR integration is the ultimate goal, a majority of physicians indicated that if minimum adherence reports (51percent), refill information (54percent) and comprehensive medication lists (47percent) were available to them via a third-party interface and/or alert service, they would initially use such a service outside the EHR. 

Timing is also important. While the most popular time for receiving medication adherence reports was before patient appointments (chosen by 36percent), 21percent said their need for such reports variesby patient to patient, reinforcing the need to keep a wide range of use cases and workflows in mind when developing these solutions.  

For example, rather than or in addition to getting medication adherence reports before every visit, some doctors might wish to set an alert that would ping someone on their care team if medication adherence falls below a keythreshold.

Delivering Actionable Digital Health Data Now 

What is particularly powerful about the platform/ecosystem approach is that, the infrastructure lives in the cloud, so data would be accessible across any digital medium.

It is true that many patient-generated data points hold questionable or indeterminate value and can only clutter and confuse the Dx/Rx process. However, the pertinence of others like medication adherence are clearer, and it is time to bring digital-health data directly to clinicians, in a format they can use, rather than waiting for EHRs to catch up. While full EHR integration may be the goal, we cannotlet the ideal be the enemy of the good.