Patient data is at the core of deriving insights into patient behavior and developing predictive models around outcomes. A patient’s clinical history, coupled with their socioeconomic status and wellness behaviors (e.g., exercise and sleep patterns), creates a much clearer prediction of whether interventions will be successful than a self-reported health risk assessment.
These new data sources create a more holistic patient view, allowing for more tailored initiatives with a higher success rate.
Health Apps: Privacy First, Data Management Not Far Behind
There is a slew of considerations associated with data collected with consumer health apps. Even though it is moving differently, it is still PHI. When acting on behalf of a patient/ member, the priority must always be protecting it and only providing this data to appropriate parties. Luckily, ONC has mandated the use of SMART on FHIR to secure the transaction. SMART on FHIR provides reliable, secure authorization for various app architectures with the OAuth 2.0 standard.
This profile is intended to be used by app developers that need to access FHIR resources by requesting access tokens from OAuth 2.0 compliant authorization servers. It should be noted that this only covers the exchange of data and the storing and use of the data needs substantial oversight to ensure that it is appropriately secured.
With security in place, healthcare organizations will need to focus on integrating massive amounts of data to realize benefits for members/patients. They will have to overcome such challenges as ingestion, standardization and normalization despite the strong FHIR standard (HL7 4.x). This will require an upfront investment and skill sets that might not be readily available.
A Clear Path to Interoperability
The 21st Century Cures Act laid out a host of initiatives to improve transparency and data flow in healthcare. Though this has caused some concerns about completing the work, it has also created even more excitement from other stakeholders in the healthcare ecosystem. It creates an opportunity to access data that has historically been siloed and walled off.
Over the coming years, we should expect to see the use of the various data exchanges (e.g., APIs, Payer-to-Payer Data Exchange, QHINs) to increase the movement of data substantially. HHS and ONC have laid out a roadmap for interoperability and information blocking with a clear mandate: Patients should be empowered to access their data to support decision-making and advance consumerism in healthcare.
The ONC Final Rule lays out regulations to prevent information blocking practices by providers, health IT developers, health information exchanges, and health information networks as of April 5, 2021. Per the regulation, for effectively all EHI requests, physicians must respond and release patients’ medical records unless an appropriate exception can be identified.
Additionally, health payers were mandated to publish publicly facing FHIR-enabled APIs to allow individuals to access the Provider Directory and Patient Access data (including clinical, demographic, claims, and drug formulary information for a member) and will soon be mandated to provide insights on prior authorization status through these same APIs.
Providers are required to publish similar Patient Access APIs by January 1, 2023, which will allow clinical data to flow out of an EMR to the patient. Though challenging for everyone, these regulations are paving the way for shared data and the future of healthcare.
What Do the Next Few Years Look Like in this Space?
HHS called the 21st Century Cures Act rules “the most extensive healthcare data sharing policies the federal government has implemented.” Don Rucker, M.D., national coordinator for health information technology, has previously stated the importance of technology to give patient access to health information.
You can imagine the federal government is not done with its efforts to improve healthcare interoperability. I believe you will see more APIs and new data sets (e.g., social determinants of health, commercial insurance members, increased clinical insights) becoming available over the next few years. We’ll see healthcare organizations either develop or outsource capabilities needed to solve data ingestion, standardization and normalization challenges. I believe that consumer-facing health app data will help transform individualized healthcare and better health outcomes overall.
Patient empowerment is a vital tenet of the 21st Century Cures Act, so I would expect to see substantial opportunities arise around this data to improve patients’ ability to navigate the healthcare ecosystem.
Watch our panel discussion, “The Future of Consumer-Facing Digital Health Platforms and Apps” to learn more.
