I came across a post from one of my LinkedIn groups a few months back I found a bit intriguing. It featured a video covering the subject matter of Open mHealth. The basic idea is to develop a framework for integrating different system and sharing information between systems or applications through the framework. An example that comes straight from their website is diabetes patient who is tracking blood glucose, caloric intake and physical activity through different mobile applications. Open mHealth is designed to allow the data from these applications to be merged and analyzed.
Here is a video they use to explain the scenario and solutions:
As a person who has worked extensively in health informatics, I applaud the effort. Similar efforts have been made in sharing languages through LOINC, HL7 and the UMLS among other standardizations. But, it only addresses one part of the problem – moving data between systems, translating (or cross-walking data) or enabling systems to communicate with one another. There’s another huge problem that exists: Getting people to use such systems and enter the data to be integrated.
In the example of the patient with diabetes: The problem of getting this sort of data from the patient and into a system is two-fold. First there is the issue of compatibility between systems. Again, sometimes this can be solved through the use of languages such as HL7 or open APIs as the above video details. But an even larger problem is making it easy for the end-user to get their data into a system or clearly giving them the incentive to do so. In addition, you have to serve a number of users for this type of design: Physicians, Nurses, Patients etc. This is why open PHRs such as Google Health were largely failures. The My HealtheVet project has had similar issues. For me to sit down and enter all of my medical history into a system, there has to be an incentive. One incentive would be that I wouldn’t have to fill out the same paperwork each time I visited a new physician. But this only works if the physician’s office can access your data, uses the same system as you etc. In my opinion, this begs a national standard rather than proprietary systems developed by private vendors such as Cerner and Epic. Companies such as Cerner and Epic should have to begin spending serious money in research to enable their systems to talk to a national standard for a Patient Health Record. (I suspect these companies are more interested in keeping their tools proprietary though given their recent efforts in lobbying.)
It is a lot of work to get data into a system. I have spent countless hours working on federal grants with local hospitals where we were collecting scores of data. The largest problem was always getting the professionals’ time to enter the data we needed. Yes, there were also problems in getting the data in a format we could use. But again, that was half the problem while the other half was just getting it into the system. The problem is even larger with patients who can be very inconsistent and have little incentive.
Incentive in design will be important for these sorts of tools to work. But, I do believe mobile technologies can help pave the way. For example, the iPhone can be paired with a hearing aid now and you can control programs and settings. What potential exists for similar use? This clearly provides the patient with a benefit for using the app. But, calorie counting, carb counting and blood glucose monitoring forces the entry of large amounts of data placing the burden of entering this data on the patient. I know because I have tested myself with these apps and it is a real pain to simply record every meal you eat. I see this as a serious deterrent and wonder if Siri, for example, and language recognition software can be of use in this respect. Another option are bio-monitors that automate this process. I recently posted a short article on this:
I don’t think we are there yet. But these recent developments in mobile technologies certainly provide a glimpse of the future and a sense of new directions.