Electronic Health Records (EHRs) are all the rage these days. Beyond meaningful use, I suspect that EHRs are hot in part because Silicon Valley dreamers are frustrated with our unsustainable curve of spending on healthcare. There is not a silver bullet for bending this curve. It takes courage and actions. Some solutions are politically hot potatoes, such as allowing more bright young men and women to enter medical schools and serve a profession desperately in need of supply. Others are ethical dilemmas, such as whether we should divert medical resources from end-of-life care toward the care of younger populations. Since Silicon Valley geeks can’t change any of that, they focus on what they can change: the way information is handled in medical practice.
Lucky for us, this is a big deal. If you have shadowed a medical practitioner, or even been seen by a busy specialist, you will understand why. I work in the ophthalmic medical device industry. Ophthalmology and optometry have become data intensive. The advance in imaging technology has drastically improved the quality of care. As one renowned retinal specialist put it, “I don’t need to meet my patients anymore as long as I have their reports.” Longitudinal data is essential in diagnosing chronic diseases such as glaucoma, where progression is measured on the order of decades. Therefore, the accurate and efficient transfer of medical information, in this case, eye imaging reports, becomes extremely important because patients don’t necessarily stick with one provider. The tendency in the U.S. for top doctors to have their own private practices doesn’t help the data sharing either.
So, how do we solve this? Here is my dream: medical records that are stored in the cloud and belong to patients. The data can be accessed through a web portal. Patients have the life-long data accessed by providers when needed. Yes, it sounds a lot like Google Health.
There is no shortage of opinions about why Google Health was less successful that Google and I hoped it would be. Let me throw mine out there. Unlike the Internet ecosystem, the value chain of healthcare has been gradually established during the past thousand years. Among others, there are four key parties in this game: patients, providers (doctors, nurses etc.), payers (insurance, Medicare etc.), and biomedical vendors (pharmaceutical companies and medical device vendors). They all have significant stakes and influences in this value chain. In order to be successful in an established industry, an innovative business model has to offer something for everybody. Google Health focused heavily on just the patient, the consumer they were so good at serving in other markets, who is somehow the least powerful party in the health game. My suspicion is that there wasn’t much to offer for the rest.
Enough speculation. Here is what my dream model offers for all parties. There’s undoubtedly a lot that such a system would do for patients, payers and providers, and that many people are more qualified than I am to talk about. I will focus on what is to me an equally interesting and little discussed topic – the value of a patient-owned, cloud-based EMR to biomedical vendors.
For pharmaceutical companies, the access to this pool of data speeds up their clinical trials. It is expensive and time consuming to go through clinical trials for new drugs. Given that drug patents only provide protection for 20 years, time spent in clinical trials is indeed money lost. If current trends continue, the claims of new drugs are more specific and targeted than ever. This makes recruiting patients at the right stage of the right disease, void of other conditions, more time consuming and expensive than ever. Pooled data from PHRs could enable drug companies to efficiently find the right patients for their trials. As the hope for the next blockbuster drug is diminishing, drug companies are focusing on niche diseases. Pooled data is also a gold mine for marketers to identify unmet market needs and conduct targeted marketing.
For medical device vendors, PHRs can promise to free them from the patient management business. For example, any modestly complex device, such as a MRI, a CT or even a fundus camera, has to have an internal patient record system in order to match a patent's clinical data with his or her medical record. This is a distraction for device vendors from their core competency. If the devices can be plugged into a central patient data pool and push the data into the patients’ records, device vendors would be able to focus on what they are best at: diagnosis and treatment.
There must be a question mark in your mind if you follow me all the way here: why do the data have to be owned by patient? The short answer is, to prevent fragmentation. The data have to be comprehensive to be useful for clinical trials. Drug companies need to know whether the patient have other conditions which potentially exclude the patient from a clinical trial. Of course comprehensive data remains elusive, fragmented as soon as patients switch providers. In the seven years I have lived in the U.S., I have managed to have my medical record fragmented by no less than three primary care providers and any number of specialists. They all have a piece of my records, but none have them all. If we continue with business as usual, my health records could be sliced into many pieces, each held by a disconnected provider, by the time I reach old age and most need healthcare innovation created from biomedical research.