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by Kent Bottles
Three recent events forced me to think about how and when data will revolutionize healthcare. For years I've read and heard about how data, wireless sensors and personal health records will change how I interact with my doctors. Full disclosure: I contributed to this overhyped hysteria.
The three events are: Apple's unveiling of its cloud-based HealthKit platform and Health user-facing application, the annual Health Datapalooza summit of true believers and the reorganization of the Office of the National Coordinator (ONC).
Apple's Worldwide Developers Conference revealed that its iOS 8 operating system will facilitate the development of new health and fitness apps, and that Apple created new partnerships with Epic Systems, Mayo Clinic, UCLA, Cambridge University Hospital in the U.K., Stanford, Penn Medicine and other prominent medical centers.
Apple Senior Vice President Craig Federighi said we need Health and HealthKit because "up to now, the information gathered by those applications lives in silos. You can't get a single, comprehensive picture of your health situation." Health, the user-facing application, will give patients a dashboard to follow their basic physiological and wellness metrics, and HealthKit will integrate data from across different data sources and be open to independent developers.
The usual suspects like Mayo Clinic Chief Executive Officer John Noseworthy used the obligatory "r" word: "We believe Apple's HealthKit will revolutionize how the health industry interacts with people."
Unlike past years, I didn't attend this year's Health Datapalooza. According to Nancy Shute, what I missed was the health data revolution's awkward adolescence. Although there were lots of examples of how data might make care safer, more efficient and less expensive, Shute concludes that "these projects are still works in progress." The conference did unveil the Open FDA Database with its more than 3 million reports on adverse drug reactions, and I found it fascinating to wander around this raw data. However, I really don't think your average consumer will take advantage of this hard to navigate database. Shute sums up the whole affair with this sentence: "Questions about who wants the data, what they want to do with it and who will pay for it remain largely unanswered."
The least noticed event that caught my eye was the reorganization of the ONC that resulted in reducing 17 different offices to 10. I agree with John Halamka that ONC needs to streamline its standards and interoperability framework initiatives and simplify Meaningful Use. The healthcare data ecosystem is simply not mature enough to support these initiatives as currently defined.
My skepticism about these three developments in no way undermines my conviction that eventually data will improve and transform the American healthcare clinical delivery system. I keep thinking about the Gartner Hype Curve with its peak of inflated expectations and trough of disillusionment because we have been at this game changing moment before. When Dave deBronkart tried to use Google Health to manage his metastatic renal cell carcinoma in 2009 with information from his famous academic Boston hospital, the transfer of insurance billing code information created a clinical history full of errors. Mayo Clinic in the past hoped that their partnership with Microsoft Health Vault would be a game changer. How do we know that the Mayo/Apple relationship will succeed when past attempts have failed?
I'm also not sure how these three developments address the problem of interoperability. According to the HHS JASON report, increasing device interoperability could save the health care system $30 billion a year. I think it's great that Epic is finally agreeing to partnerships, but I doubt this Apple announcement solves the interoperability problem.
For these developments to revolutionize healthcare, both patients and clinicians must find devices acceptable. Even if the industry solves the data collection challenges, physicians do not know how to interpret the resulting avalanche of information to improve the care of their patients.
Molly Maloof, M.D., is spot on when she states, "It will be really important for companies to justify their interpretations of the information they provide to achieve physician buy in. Otherwise, these consumer focused devices will be written off as health toys rather than health tools."
Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.
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