Mobile slowly becomes a path to health information exchange

By Neil Versel
12:10 am
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commonwellInteroperability clearly was one the main themes at the just-concluded Healthcare Information and Management Systems Society (HIMSS) annual conference in New Orleans.

Probably the biggest vendor-related news to come out of HIMSS13 was the launch of CommonWell Health Alliance, a partnership between Cerner, McKesson – including McKesson health information exchange subsidiary RelayHealth – Allscripts, athenahealth and Greenway Medical Technologies to promote interoperability based on open standards.

While the participants did not give specifics of how their collaboration will work, they apparently are taking mobile technology into consideration. "Allowing data to flow more freely fits the needs of a mobile society just as providers are taking on more financial risk in coordinating care," Greenway President and CEO Tee Green said in a press release.

Still, mobile is just starting to make its way into HIE. As MobiHealthNews reported earlier from HIMSS13, Dr. Kate Christensen, medical director of Kaiser Permanente's Internet Services Group, said that 22 percent of traffic to Kaiser's patient portal comes from mobile devices. "The use of smartphones is also skyrocketing among older people, and I don't really think it's a barrier until about [age] 85," Christensen added.

Kaiser, of course, tends to be ahead of the curve when it comes to all sorts of health IT, connectivity and interoperability – and it has an advantage over other healthcare providers because it is a tightly integrated organization that also includes a payer side. But others will have to catch up soon because the "meaningful use" electronic health records (EHR) incentive program requires them to in order to earn Medicare and Medicaid bonus payments.

Stage 2 of meaningful use, which begins for some hospitals as soon as October, requires several forms of interoperability. For one, healthcare providers to send electronic summary care records for half of all their patient transitions and referrals. This must include at least 10 percent of transitions to external providers using an EHR system from a different vendor.

Hospitals and medical practices also must allow 50 percent of their patients to view and download their own medical records through online portals or personal health records (PHRs). And 5 percent of patients actually have to send unsolicited communications through such portals or providers will lose out on the incentive money.

"Making the data available is just not enough," David Rowe, director of product marketing for Caradigm, an analytics joint venture between GE Healthcare and Microsoft, said during a HIMSS panel on patient engagement. Information needs to be integrated into the "patient's workflow," he said.

HIE and connectivity vendors are rapidly figuring out that the patient's workflow, such as it is, is likely going to be mobile, at least some of the time. "I think mobile technology is a great equalizer between patients and providers," said Dr. Bettina Experton, president and CEO of Humetrix, maker of iBlueButton, a graphical user interface that structures and organizes plain text downloaded from patient portals and EHRs as part of the federal government's Blue Button initiative. Experton described iBlue Button as a "mobile exchange platform."

Last fall, Del Mar, Calif.-based Humetrix introduced an Android version of iBlue Button that employs security-enabled QR codes instead of Bluetooth communication, which does not work well across software platforms, mobile application architect Steven Mickelsen explained.

The barcode itself contains half of the record locator and half of an encryption key. The other parts are embedded in the device. "We really see this as a vision for the future," Dr. Christopher Burrow, Humetrix's executive VP of medical affairs, said.

Some of the CommonWell Health Alliance partners are doing more than paying lip service to mobility. Athenahealth shelled out $293 million to acquire Epocrates early this year. At HIMSS13, Allscripts announced two acquisitions of its own: HIE conduit dbMotion and a small, Springfield, Ill.-based health management services vendor called Jardogs.

Jardogs offers a patient-controlled "universal" record, kind of a hybrid between a portal and a personal health record. CEO Jim Hewitt acknowledged that untethered PHRs have gained almost zero traction in the marketplace, but also said that patients will not want to log into portals from multiple providers in the future. "As a patient, how does that work? I'm not going to manage five portals," Hewitt told MobiHealthNews in his first media interview since Allscripts announced the purchase.

Similarly, accountable care organizations (ACOs) also want a single portal for the entire organization, according to Hewitt, who had also been the CIO of Springfield Clinic until a week ago and is a former Allscripts CIO. The Centers for Medicare and Medicaid Services recently clarified Stage 2 regulations by saying that if a portal crosses multiple providers, each one gets credit toward the usage requirements every time a new patient joints.

Morristown, N.J.-based Atlantic Health System CIO Linda Reed, who also is president of Jersey Health Connect, a HIE serving the northern half of New Jersey, agrees that the presence of multiple portals, each tethered to a single provider, could be problematic. "The HIE potentially will draw everything together," said Reed.

"If you're going to want data, you're going to have to give data," Reed continued, adding, "HIE can evolve from a platform business to a data business."

Atlantic Health System, a longtime user of RelayHealth for connectivity, has included mobile in its connectivity strategy. The organization has a "virtual desktop" so clinicians can log in from any of a number of devices and Reed said she has had discussions with RelayHealth about mobile access to clinician and patient portals. "Nobody's going back to a PC," she said.

MobiHealthNews coverage of the HIMSS13 event in New Orleans is sponsored by AirStrip Technologies.

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