By Neal Pollack
The Affordable Car Act (ACA) now requires that every patient have a coordinated Electronic Health Record (EHR). Unfortunately, the medical community remains largely stuck in a clunky tech netherworld of questionable software and hopelessly dated hardware. For most doctors, EHRs are a nightmare burden on their already overstuffed schedules. “Digital space in medical is fractured,” says John Fremont, Executive Vice President of Chaotic Moon. “It’s a clunky experience. There’s no single sign on.”
Until very recently, almost all health information existed in digital silos. There was no way for providers to communicate. The industry is slowly realizing that has to change, and hospitals are being strongly encouraged to invest in technology that brings about mobile healthcare innovations. “The economic model for the healthcare system is changing dramatically,” says Matt Zavadsky, public affairs officer for MedStar, a mobile health provider in Fort Worth and 14 other Texas markets. “We’re benefitting from that kind of investment. That’s the new economic model.”
Because of the ACA, doctors and hospitals are being forced to actively coordinate care to reduce unnecessary medical services. One of the lesser-known provisions of the ACA says that hospitals receive an automatic demerit any time an outpatient gets re-admitted, within 30 days, for the same medical condition. If hospitals get too many of those demerits, then they have to pay a penalty of $100,000, or even more. Therefore, they have a strong financial incentive to make sure that doesn’t happen. Mobile healthcare is starting to fill that gap, but the tech isn’t remotely there yet.
“One of the problems,” Fremont says, “isn’t that medical personnel can’t collect electronic health data. They do that quite well given the 90s-era DOS systems that many of them are saddled with. It’s that they aren’t knitting together and presenting that data in a modern way.”
“The health industry has historically failed to look outside itself for innovation, particularly with design,” he says. “You’re creating experiences where you have mission-critical data-capturing moments where people’s lives are literally on the line. When you focus on the wrong thing and don’t create an experience that is intuitive and user-focused for all the different scenarios, you’ll fail miserably.”
DIGITAL PARAMEDICS TO THE RESCUE
“This is all the more frustrating,” Fremont says, “because the industry is finally starting to work out some of its glitches. For instance, Austin-based ESO Solutions, which promises “the end of the disconnect between EMS and the healthcare system,” has developed industry first software called Health Data Exchange that allows Emergency Medical Service (EMS) companies and hospitals to communicate like never before.
In the past, EMS services and hospitals were operating under two completely different data systems. Paramedics would drop patients off at the hospital and never know what happened to them. Important data would vanish into a bureaucratic sinkhole. And patients were suffering because of it. ESO’s software allows the two systems to effectively communicate, by unifying patient records into one file that that provides a seamless record of care. It was introduced in 2013 and has already been adopted by more than 800 EMS providers. “For an entire industry to be in the dark doesn’t make sense,” says ESO’s CEO Chris Dillie, himself a former paramedic. “We take a lot of taxpayer dollars. We should be able to show that we’re doing a great job. This is how you do that. Doctors sending their patients into surgery would never stand for not knowing how that turned out. It should be the same way for EMS.”
Fremont agrees, but says that healthcare providers need companies like Chaotic Moon to help them transition into the modern age. “They need,” he says, “smarter software architecture for mobile devices that makes it faster and more intuitive. That will require smart architecture of the mobile software. It will really help ESO, which, even without a good mobile platform, is achieving tremendous results around the country.”
“At the macro level, it’s been tremendously helpful,” says Dr. Brent Myers, director of EMS services in Wake County, North Carolina, which is using ESO’s software. “Every single one of our paramedics can log on and see what’s happened to their patient. Before, they could take someone who was having breathing trouble to the hospital and never find out if they had heart failure or pneumonia. Now they can.”
CAN MOBILE ROBOT DOCTORS BE FAR BEHIND?
“We’re at just the beginning of a coming ‘golden age’ in mobile health. The field had been stagnant for decades, but it’s changing rapidly,” says Matt Zavadsky. “Before the ACA it was difficult to find hospitals or physician groups that were able to invest money in mobile healthcare. The ACA has infused incentive to improve patient outcomes, improve care and reduce costs.”
Zavadsky says that five years from now, every patient will have a common, fully integrated medical record. This will be continually updated in any number of ways, including by smart wristwatches and apps that will allow them to contact doctors and EMS providers, who will then have instant access to their medical history.
Chris Dillie says he’s already working on software that will allow Fitbits and other mobile monitoring devices to automatically feed data into patients’ electronic medical records. He foresees a very near future where glucose and insulin levels of diabetics are being constantly updated for doctors to access, if need be. It’s an emerging market out of necessity. “Mobile health is a new industry in a lot of ways,” Dillie says. “You have frequent patients who are pounding the system many times a month, every month. What if somebody in mobile health took on that burden? To help coordinate that care better? What kind of difference could we make to the cost of care?”
Innovations are coming rapidly, and are being demanded from EMS workers in the field. “The next thing we want is the ability for the medic at the patient’s side at their home to be able to access the common medical record,” says Wake County’s Dr. Brent Myers. “If we go back to their house a week later, we want to be able to see all their clinic visits, their EKG. We’ve been nagging for that. And I think we’re only 18 months away.”
“Possibly,” says Chaotic Moon’s Fremont. But these ideas and enthusiasm are being somewhat hampered by dated platform design. Young doctors are really going to struggle if they have to use EHRs, coordinated or not, that are using computer technology that was already dated long before they entered med school. “You’ve got a workforce coming online that only knows good user experience,” Fremont says. “If the health industry doesn’t converge its enterprise or businessto- business software at the level of a consumer grade experience, it will fail.”
Given what’s at stake, no one wants that to happen.