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Apple's WWDC unveiling of HealthKit in iOS 8 grabs the attention of doctors

post #1 of 47
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Behind the apparently simple premise of Apple's new Health app in iOS 8 is the potential to "solve one of the single worst problems in healthcare today," wrote one healthcare professional: "the inability to easily transfer patient records from one care location to another."

HealthKit iOS 8


Responding to a question on Quora asking "What do doctors think of HealthKit?" an Emergency Room doctor in training named Jae Won Joh shared a perspective that's since earned upvotes by scores of other doctors and healthcare workers.

"It has tremendous potential," Joh wrote. But that wasn't his first impression. "I watched the keynote last night, and initially Healthkit seemed fairly unremarkable, just another way for consumer apps like Nike+ and sleep trackers to output their data into pretty charts," he stated.

"A cursory look at their website (Apple - iOS 8 - Health) would seem to support the view that HealthKit is targeted at those obsessed with the 'quantified self' movement."iOS 8's new HealthKit "has tremendous potential"

Joh wasn't impressed with a idea of a system app designed to simply track and graph what he called "fitness-oriented data," such as calories burned, sleep and heart rate, the three dashboards visible in Apple's Health app screen shot (above left).

However, looking at the second "Health Data" screen (depicted by Apple in the above right image), Joh observed that "from a clinical perspective, there are 4 key points of interest, particularly since Epic Systems (one of the largest EMR vendors in the nation) was mentioned in the keynote."

He highlighted Diagnostics, Lab Results, Medications and Vitals, and also called attention to a third screenshot showing a Medical ID, with Medical Conditions, Notes, Allergies & Reactions, and Medications.

HealthKit iOS 8


"Suddenly, I'm interested," he wrote.

"Imagine if with just your phone, you could travel with all of your former imaging studies (e.g. chest X-rays, CT scans). Your verified vaccination records. Your biopsy results. Your list of allergies. Your lab tests from the last 10, 15, 20 years. All the medications and doses you've ever been on, for what time period, and why. Your heart rate and blood pressure measurements from every clinic visit you've ever made. What if all of this was kept in the cloud, with instant access through your phone?" he wrote.

The onerous problem iOS 8 Health has the potential to solve



"Take a moment to see how medical records currently go from institution to institution," he wrote, linking to an outline he presented of the convoluted, archaic, problematic series of steps that hospitals and doctors currently struggle with.

"Facsimile.

"Yes, you read that correctly. In the 21st century, when the power of the internet can provide instant secure connectivity to transfer enormous quantities of data, U.S. hospitals pour millions and millions of dollars into EMRs that aren't compatible with each other, necessitating reliance on an ancient technology from the '60s unknown to the majority of human beings born in this country past 1995."

He then detailed the difficulty of getting information from patients, who might be unconscious, unable to communicate, or without the capacity to consent access to necessary information.

If the patient remembers where they were previous treated, the attending doctor is then tasked with looking up the institution, if it is even still in operation, and then fill out an extensive form by hand that the patient can sign to release access to their medical information.

Part of the consent process requires that the doctor "spend time explaining to the patient why access to prior records is necessary," and then "deal with patient reaction."

The attending physician then has to send, by fax, the written consent, ("If this step fails, try not to feel too much frustration that I spent over 2 decades studying to become a doctor only to be stalled by a piece of hardware that even my parents didn't own" he wrote) and then wait for hours for the other facility to find and return the patient's medical records.

After finally receiving a reply, Joh commented that that incoming fax is likely to be "a bundle of grainy scanned papers from other facility," which can't be electronically searched, resulting in the need to "search through the entire stack (sometimes hundreds of sheets, depending on patient's history) by hand to find what I need."

Scenarios solved by patient carried, Touch ID secured Electronic Medical Records



"This could be revolutionary," Joh noted, describing a couple scenarios where the technology behind HealthKit could both make life easier and even deliver life saving information.

In introducing HealthKit at WWDC, Apple's software chief Craig Federighi noted that The Mayo Clinic is working with Apple on a patient monitoring tool that ties into Health, so that when a patient takes a blood pressure measurement the data can be saved and checked against previous personal results. If a reading is abnormal, the data can be automatically sent to the patent's doctor for quick and seamless response.

Health app iOS 8


Apple's discussions with the U.S. Food and Drug Administration indicated that Apple executives feel that mobile devices can do more to help people learn about themselves, and that they feel there "may be a moral obligation to do more."

Filings revealed by the agency stated that "Apple will work closely with the FDA as they develop future products," and that the company believes that "the earlier FDA is involved and advising, the less likely that Apple would be caught by surprise later when they wish to release a new product, if that product must be regulated."

That supports the idea that Apple is working to broaden the scope of iOS 8 Health to include more sophisticated EMR features for patient data. Along those lines, Joh described a situation where there is a hypothetical "lung cancer patient in New York who wants to move to Michigan to be closer with her extended family," who "now has significantly more peace of mind, knowing that her health data can easily move with her.

"She doesn't have to drudge through the paperwork to release her own medical records from her prior hospital system. She doesn't have to make a separate trip to the radiology department to have them burn her a CD/DVD of all of her imaging. She doesn't have to burden her new oncologist with the task of sifting through hundreds of sheets of results by hand, as she can release them into the new EMR with a single tap of a finger. She doesn't have to worry about whether the images on the disc will be compatible with her new radiologist's system, as the cloud automatically adjusts the data format to match."

In a second situation, Joh described a trauma patient "who arrives in a lower-acuity ER after a motor vehicle accident and is found to have a severe unstable ankle fracture on imaging." With that Xray data uploaded to the cloud as part of the patient's HealthKit medical record, he "can now be more easily transferred to a higher-level hospital with orthopedic surgery on call."

As a result: "no drudging through paperwork. No waiting to process a CD/DVD. Less hassle. More clinical care."

Joh concluded, "I feel that HealthKit might well be the first step in creating something akin to a universal EMR. If Apple pulls this off with the right partners," he observed, "they could potentially solve one of the single worst problems in healthcare today: the inability to easily transfer patient records from one care location to another."

Jon Steuernagle, an ICU doctor commenting on the subject added, "One of the most exciting breakthroughs in modern medicine. Getting your physical data, biometric data into the EMR and into your doctors hands. Just needs to be economically feasible for majority of people."

Apple's Health app is somewhat reminiscent of Passbook, the iOS 6 app Apple introduced to manage electronic tickets, boarding passes, coupons and other records. While many critics complained that they thought it wasn't interesting enough, virtually all online ticketing is now made available for Passbook. Apple's Passbook implementation was so brilliantly simple and functional that it has been directly adopted by other platforms, notably Microsoft's Windows Phone.
post #2 of 47
Interesting. I sometimes wonder, though, why the large insurance companies didn't devise a product like this first. You KNOW they have every single record of yours going back decades, even if you've had to switch providers several times. It's in their financial interest to have the detail so they can find those fine points to dispute and not pay your claim, or rule that the expense was 'beyond customary' etc.

All Insurers had to do was make this information available to the doctors and better (maybe even less expensive and redundant ) patient care would result. Could they have found a way to sell this back to doctors though? Maybe not.

Well perhaps Apple can tie into their databases ( with patient permission) or maybe they will just do an end run around it.

What about the specific database the insurers use to decide if they will offer Life Insurance and at what price. There is a hospital database that logs every time you have any major surgery. I had this explained to me years ago by an insurance agent, believe me, they have records like Equifax. Although the Affordable Healthcare Act has now restricted insurers from discriminating against you they still have those records I'm sure.

All of this stampedes straight into privacy areas, however, in an emergency room that's one thing you probably don't want. It's amazing that ER physicians do as well as they do, being kept out of the loop of information that the Insurers already have.

Please excuse my clumsy writing, I think better than I write.
What is really factored into the price is a kind of perpetual sense of disbelief that any company could be as good as Apple is. ~Retrogusto
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What is really factored into the price is a kind of perpetual sense of disbelief that any company could be as good as Apple is. ~Retrogusto
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post #3 of 47
I always suspected that Apple's health and medical thrust is going to go way beyond goosed up fitness monitors, what with Apple talking to the FDA, hiring all those high-powered med tech people, as well as a person who is supposed to be an expert in shepherding tech products through the FDA approval labyrinth (her last name is Nag, how appropriate). I even ventured that maybe they're thinking of taking a stab at fixing the Great Big Electronic Medical Records Mess with a platform that the smaller clinics can afford. Maybe that's not mere fantasy after all.


Furthermore, especially with medical records, whom would you trust to keep your records safe and private? Google? Amazon? Microsoft? Maybe Microsoft but I still trust Apple more. If only because secrecy is so ingrained in its culture so they already have the mindset and the procedures that engender privacy protection.
post #4 of 47
Quote:
Originally Posted by palomine View Post

Interesting. I sometimes wonder, though, why the large insurance companies didn't devise a product like this first. ...

 

Health records are a mess, just as this article points out, but it's more complicated than your post. Every institution has a different system and it doesn't talk to the others. And they don't want them too, as doctor comments could easily create liabilities and different software systems are fortresses to retain customers. The technology to achieve an EHR system is much simpler (though not simple) than the implications to policy, business and health and human impacts. While insurance companies are powerful, medical systems are too and they push back for their own interests (and thankfully as I don't want my insurance company to know my medical history!). As it is, these organizations interact via billing codes and contractual agreements around these codes.

 

Obamacare has many provisions in it that have been asked for from the medical community for decades and it will improve things over time. It's all big and complicated so nothing will move quickly or perfectly, but it is progressing.

 

Look up "Meaningful Use" to get an idea about the direction of electronic medical records.

post #5 of 47
Quote:
Originally Posted by palomine View Post

Interesting. I sometimes wonder, though, why the large insurance companies didn't devise a product like this first. You KNOW they have every single record of yours going back decades, even if you've had to switch providers several times. It's in their financial interest to have the detail so they can find those fine points to dispute and not pay your claim, or rule that the expense was 'beyond customary' etc.

All Insurers had to do was make this information available to the doctors and better (maybe even less expensive and redundant ) patient care would result. Could they have found a way to sell this back to doctors though? Maybe not.

Well perhaps Apple can tie into their databases ( with patient permission) or maybe they will just do an end run around it.

What about the specific database the insurers use to decide if they will offer Life Insurance and at what price. There is a hospital database that logs every time you have any major surgery. I had this explained to me years ago by an insurance agent, believe me, they have records like Equifax. Although the Affordable Healthcare Act has now restricted insurers from discriminating against you they still have those records I'm sure.

All of this stampedes straight into privacy areas, however, in an emergency room that's one thing you probably don't want. It's amazing that ER physicians do as well as they do, being kept out of the loop of information that the Insurers already have.

Please excuse my clumsy writing, I think better than I write.

Most of what you want in the ER is lost in what the Insurance company has.   ER staff want your data[in about 10 minutes], not your diagnosis/procedural Hx.  The want your last Angiogram report, and ideally your EKG image, your troponin tests, CK or CK–MB tests, and serum myoglobin test results (to rule in/out a heart attack diagnosis for example).  

 

Insurance companies DON'T want that data (Images, Labs, diagnostic reports) sent to them by the medical orgs, because it's not business necessary and therefore a security/privacy risk.

 

They do however, want you to enter it.  (and most have EHR apps for that, and have it set up to get MDs usernames/passwords to enter into your record on your behalf).

 

They do have your meds, and diagnostics, but they don't have the details, your family history, and that combination is getting close to pre-PreExisting Conditions [you're getting Pap Smears annually, and your mother had early onset cervical cancer....  maybe we should raise your rates because you're likely to get uterine/cervical cancer... because... you're doctor thinks so]

 

There is a clearinghouse for all prescriptions and insurance data that for a fee, you can query and determine their 'current risk.'  It's illegal for you to pull an individuals record (it's supposed to be anonymous... for use in pool rating information [the common use is a big employer giving an insurance company their employee list [ssns] and get a 'cost of care' [most large business self insure] scenario for the next 1-3 years for them to adjust particular benefits payoffs to fit their benefits budget]... but you can run the test twice once with the person, once without in a pool of 'control data' and see how the results skew on the inclusion of an individual.

post #6 of 47
Insurance companies DO have some of your X-rays and lab records. Yes doctors still use pen and paper to 'push back' against insurers, their comments are your private records. But Diagnoses, tests, images go to insurance oftentimes. At least they used to, which I know from personally disputing a claim. They are in the business of second guessing the doctors.

The billing codes are a common language that cuts across the mess of health records from different doctors and hospitals. Those billing codes are quite specific, they ARE your medical history, minus, of course, your doctor's private notes. In other words, your insurer does have your health history indeed. Like I said, they are like Equifax, they aggregate info from everywhere.

If you apply today for a big life insurance policy you can believe the insurer will check that hospital database, and will see that for example, you omitted the fact that you have stage 3 cancer in your left cheekbone and went for surgery. It used to be the same for healthcare policies.

Insurance is an industry I have a hard time finding a rationale for (outside of fire insurance and basic term life maybe).
Kind of like stock analysts, they don't add anything positive. They *could* be used for good if they hooked their back end database into Apple's kit ( with privacy permission). But then, somebody would have to pay somebody, which is what I find despicable about the whole system. 1hmm.gif
What is really factored into the price is a kind of perpetual sense of disbelief that any company could be as good as Apple is. ~Retrogusto
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What is really factored into the price is a kind of perpetual sense of disbelief that any company could be as good as Apple is. ~Retrogusto
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post #7 of 47

A lot of media have latched onto the Mayo clinic partnership because they've heard of the Mayo Clinic, but that's largely window dressing as far as I'm concerned.

 

The really interesting partnership is with Epic. Epic Systems is the 800 lb gorilla of electronic health records, by far the largest EHR vender in the country. If you could instantly export data from Epic to the patient's Health app on his phone, that would be beyond awesome.

post #8 of 47
Quote:
Originally Posted by palomine View Post

Interesting. I sometimes wonder, though, why the large insurance companies didn't devise a product like this first. ...

 

Insurance companies do not have your medical records, not in detail.  All insurance companies cared are the dates, diagnosis, and treatment performed so they  can determine whether it was reasonable or not.  Hospitals and Clinics hire a large number of "Health Coding" professionals to convert Doctors' medical diagnosis and treatment into standard "medical codes" so the insurance companies could process the claims.

post #9 of 47

Why not just let Google do this? Then they can sell all your stuff to 3rd party advertisers so you can get digital ads for those blue pills after they see you have ED. Just trust Google. They say they're not evil. Good enough for me.

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post #10 of 47

This could be truly disruptive to the medical industry in a good way. Insurance companies and medical institutions have not desire to fix the system because they are currently profiting from it. They don't want to rock the boat. But here comes Apple with a giant user base and few good ideas. It's as if Apple is stepping into an area where it might not belong but because of their "moral obligation" to improve their users' health, a traditionally non-tech industry could get a shot in the arm.

 

Two (among many more I don't know about) major problems that must be overcome are:

 

1) How do you make health sexy and appealing to a mass of users? The doctor gets all excited about this the same way I get excited about announcements like Swift and extensions in iOS. Regular users don't care about such things so it becomes Apple's job to illustrate how life-changing these hardware and software Health apps could be. 

 

2) The doctors seem excited about the possibilities of accessible healthcare innovations like this but how accessible are they? Can only iPhone users benefit? Would this further create a class-based system of healthcare that only benefits those that can afford iPhones and not others? Is this iPhone only or can other platforms glom the info similarly to the way Windows uses Passbook data for their own app support?

post #11 of 47
Quote:
Originally Posted by winstein2010 View Post
 

Insurance companies do not have your medical records, not in detail.

Because it's illegal (in the U.S. at least) for insurance companies to possess full medical records and to possess any genetic information.

post #12 of 47

Yeah health records are mess. I am not sure Healthkit will solve it, but it does shine a light on it. The problem is wide and scary. From incompetence and laziness on the doctor and insurance side, to real concerns of privacy.

But the framework is a step in the right direction and there is going to be a wealth of information available as it is inevitable Google creates their own framework and developers harness it in creative ways. This is a BIG BIG DEAL. Seems obvious now, but it took a major player like Apple and soon Google to shepherd it and distill it.

post #13 of 47

Data integration is key here. I hope Apple would implement either the International Classification of Diseases (ICD) version 9 or 10. Also, it would be best if they can also model this from a datawarehouse standpoint where there is data governance.

post #14 of 47
Quote:
Originally Posted by Ingela View Post
 

Yeah health records are mess. I am not sure Healthkit will solve it, but it does shine a light on it. The problem is wide and scary. From incompetence and laziness on the doctor and insurance side, to real concerns of privacy.

Try incompetence, self-serving interests and corruption on the government side, helped in part by big money from the insurance companies. When they entered graduate school, most physicians had no idea the amount of bureaucracy that was going to be put in the way of their helping patients.

post #15 of 47
Ha, 9to5Mac's wonder kid Mark Gurman actually claimed that Apple redesigned and renamed their Health app because of what he leaked back in March. He even claims to have Apple employees telling him that the previous leak was a superior design than what Apple actually will be shipping with iOS 8. As if Apple would approve of an inferior design just so something they spent maybe 3 minutes max on in the WWDC keynote was a complete surprise.

http://tinyurl.com/nemu2wn

I love John Gruber's take down:

http://daringfireball.net/linked/2014/06/09/gurman-apple-priorities
post #16 of 47
I didn't think Apple would want to get into this mess, but if they do it would be incredible. I was pretty shocked to hear they were actually working with Epic. Everything in the Quora article is 100% true, from county hospitals to prestigious institutions, it's ridiculous how inefficient these medical record systems are, and unsafe; reading a faxed EKG report is oftentimes impossible. Putting the onus on the consumer to carry and manage their information is probably the only way to push things forward, and the iPhone would be an invaluable tool. Patients never remember the drugs they took/are taking, adverse reactions, medical history, etc:

Doctor: Do you have any medical problems sir?
Patient: nope, I feel great
Doctor: I see you're taking lisinopril
Patient: oh yeah, that's for high blood pressure, but it's normal now
Doctor: I see you're taking metformin
Patient: oh yeah, that's for my sugar diabetes
...

Although unlikely, a full EMR system from Apple would be amazing. It is incredible just how bad and unintuitive the various medical record systems are. Some are so bad I honestly think it's unethical to use them. Epic is the best of the worst, and probably improved since I last used it a couple years ago, but there's still huge room for improvement.

   

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post #17 of 47
Quote:
Originally Posted by Cpsro View Post
 

Try incompetence, self-serving interests and corruption on the government side, helped in part by big money from the insurance companies. When they entered graduate school, most physicians had no idea the amount of bureaucracy that was going to be put in the way of their helping patients.

 

 

Yep, how could I leave out the government side. Government: Where bureaucracy, incompetence and corruption go hand in hand on the road to nowhere.

post #18 of 47
Quote:
Originally Posted by Ingela View Post
 

Yeah health records are mess. I am not sure Healthkit will solve it, but it does shine a light on it. The problem is wide and scary. From incompetence and laziness on the doctor and insurance side, to real concerns of privacy.

But the framework is a step in the right direction and there is going to be a wealth of information available as it is inevitable Google creates their own framework and developers harness it in creative ways. This is a BIG BIG DEAL. Seems obvious now, but it took a major player like Apple and soon Google to shepherd it and distill it.

agreed. the problem is wide and scary... Doctor's and Health Organizations are at odds with privacy in practice, because it slows down and/or lowers the quality of care in the happy path (no/low risk).

 

Right now... because it's a finanical requirement all health systems have some level of diagnostic/procedure coding standardization, usually done quite manually (look at the jobs being offered to 'Medical Coders').   

 

Internationally, HL7 is considered an ISO standard.   the ACA requires all FQHP's have an EHR that is patient accessible and it to be HL7 compliant on export.  The problem is and will be the blob/unstructured data, but even that is getting some play in each of the disciplines... and worst case, it will be PDF in the short term.  The problem is tractable, just not cost justified until now (ACA makes it so).

post #19 of 47

This Dr is talking about patient who use an ER as the primary care provider and who move from one hospital to another over time. The average person who take care of themselves do not have this issue since they go to the same Dr all the time and usually do not end up in an ER or a place which does not have their history. I find it interesting that Dr said he has to spend time convincing people why it is important to gain access to their prior medical history. What makes them think they would have copy of their electronic medical history on them so apple solution is not got to solve their problem. Plus we all know the same people who probable us an ER as their Dr are not buying iphone they are getting free Android devices.

 

My family and I see the same Dr for yrs, he has all of our information and history about the my family and extend family as it applies to our situation. We have moved a couple of times and have always requested copies of our files to take to any new Dr. It would be nice if it was all electronic, but paper works well and most Dr rather flip through a paper file then sit in front of computer when they talk to you. It more personal interaction then someone steering at a computer screen. Any time we have to see another Dr such as a specialist our family Dr will reach out to them and shares pertinent information with the specialist and we always ask the specialist to send copies of everything to our primary Dr. Again ist would be nice to have it all electronic and easily transported. However, not interested in insurance companies knowing what was discussed with my Dr or another person knowing about things which are not relative to reason I am seeing them.

 

This is just another example of people who fail to be responsible for themselves and expect everyone else to bend over backwards when things turn bad for them. This is why the US has huge health care issue since people have no interesting being responsible for themselves, they do not take care of themselves and show up in ERs around the country to get free medical care.

post #20 of 47
Quote:
Originally Posted by Cpsro View Post
 

Try incompetence, self-serving interests and corruption on the government side, helped in part by big money from the insurance companies. When they entered graduate school, most physicians had no idea the amount of bureaucracy that was going to be put in the way of their helping patients.

on the US government side, there is very little corruption on the HCFA/HHS side of the house.  The corruption is in the legislative branch.  Compared to the DoD, Medicare (which has driven coding standards for the last 40 years) has performed miracles without payoffs.

 

pedantry:  physicians go to medical school, not graduate school... if they do go to graduate school (and/or residency), they've spent a lot of time on the beaucracy side of helping patients (most spend their 3rd year of medical school just doing charting and dealing with coders calls asking 'what did the doctor do?').

 

And we don't want doctor's knowing the beauracracy... otherwise you end up with either poor care, or fraud/cost shifting ("you mean if we say we did a 'complete history' we get $130, but only a $75 for a 'visit history'.... well, If I ask, 'have you been sick before?... is that complete enough?').

 

The biggest issue is the always, 'how much do my options cost?'  and MDs don't know that, and Insurance companies don't really know, until the claim is adjudicated.   A GREAT Health app would be to have the MD give you the options, and you can push 'Preadjudicate' and your insurance company gives you a +/-25% cost estimate of each option, which you can weigh against the benefits the doctor gives you (surgery or P/T.... Pills vs AngioPlasty), etc etc.

post #21 of 47

I wonder what the leaked Healthbook UI looks like to someone who is color blind.

 

I care more about the functionality behind the UI than changes to UI elements.

post #22 of 47

edit

post #23 of 47
Quote:
Originally Posted by Cpsro View Post
 

Try incompetence, self-serving interests and corruption on the government side, helped in part by big money from the insurance companies. When they entered graduate school, most physicians had no idea the amount of bureaucracy that was going to be put in the way of their helping patients.

amen

post #24 of 47
Quote:
Originally Posted by Maestro64 View Post
 

This Dr is talking about patient who use an ER as the primary care provider and who move from one hospital to another over time. The average person who take care of themselves do not have this issue since they go to the same Dr all the time and usually do not end up in an ER or a place which does not have their history. I find it interesting that Dr said he has to spend time convincing people why it is important to gain access to their prior medical history. What makes them think they would have copy of their electronic medical history on them so apple solution is not got to solve their problem. Plus we all know the same people who probable us an ER as their Dr are not buying iphone they are getting free Android devices.

 

My family and I see the same Dr for yrs, he has all of our information and history about the my family and extend family as it applies to our situation. We have moved a couple of times and have always requested copies of our files to take to any new Dr. It would be nice if it was all electronic, but paper works well and most Dr rather flip through a paper file then sit in front of computer when they talk to you. It more personal interaction then someone steering at a computer screen. Any time we have to see another Dr such as a specialist our family Dr will reach out to them and shares pertinent information with the specialist and we always ask the specialist to send copies of everything to our primary Dr. Again ist would be nice to have it all electronic and easily transported. However, not interested in insurance companies knowing what was discussed with my Dr or another person knowing about things which are not relative to reason I am seeing them.

 

This is just another example of people who fail to be responsible for themselves and expect everyone else to bend over backwards when things turn bad for them. This is why the US has huge health care issue since people have no interesting being responsible for themselves, they do not take care of themselves and show up in ERs around the country to get free medical care.

 

You obviously didn't read the article, in which the ER doc gives an example of someone moving to a different area, and needing to transfer medical info. However, your point about people not taking responsibility for thier health true to an extent, but society pays for thier care regardless, so better to provide tools to make caring for them easier (it's a lot cheaper to effectively manage blood sugar than to amputate digits and limbs due to diabatic neuropathy); not to mention the ethical responsibility to improve people's lives. Also, it's not as if people live in a vacum. I'd say it's a pretty sad comment on our society that someone's life is so messed up, and/or they are so uneducated, that personal health is not a priority. It is a sytemic social problem that is multifactorial: US is the world leader by far in teen pregnancy rates, child abuse, and prison population per capita. Multiple studies have shown that early neglect or abuse results in lasting physiologic changes through adulthood (changes in DNA, epigenetic changes, chronic stress markers) that predispose to physical and mental illness. To me all these issues are connected. I love the US, wouldn't want to live anywhere else, but we have some work to do.

   

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post #25 of 47
It is all caused by government methods of contracting where profit is a percent of total cost.

The more overhead (clerks and secretaries) the more profit in these government supported organizations.

My insurance pays 99 percent of my medical costs. I get billed directly for the other one percent. Twice th overhead for two billing leads to twice the profit from percent of overhead costs.
post #26 of 47
I caught the end of an NPR program a few weeks ago about a new project called 'Open Record' or some similar name. There was a pilot project being discussed in very glowing terms by all concerned and even initial skeptics. The premise, from what I could gather, was all medical information was accessible via a web interface by the patient who could even add or question data. They were still talking about systems that would not all be compatible between institutions however, so it seems to me this could be the answer. This has to be the way forward, the current system is ridiculous. One area they mentioned as a possible issue is lazy busy doctors using 'scribes' to enter patient records and consults etc. and the associated risk of errors.
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post #27 of 47

I know, I'm in love with iBeacons so here we go....

 

Let's say you have your medical data stored in the secure enclave of your iPhone. You're in an accident and paramedics have your iPhone and want to see if you have any medical information that might help them. How do they get access to it if you're incapacitated?

 

I say give medical staff an iBeacon that has a serial number attached and a PIN number. When they try to unlock your iPhone it detects that it's near a "medical iBeacon" and prompts for a PIN. If the person enters the correct PIN that matches their iBeacon, then your iPhone agrees to unlock and display only authorized medical information on your iPhone for them to see - things like allergies, conditions or any medications you're on. Your iPhone also logs this event and displays the name and ID number of the person who "unlocked" your iPhone so you have a record of it for later on.

 

Take this further, how would the police know who to contact if you're in an accident and your iPhone is locked? They could also enter a PIN that would bring up your customized list of contacts or "in case of emergency rules".

 

I can see a lot of ways where you can allow certain people access to certain information simply based on whether or not they're carrying the proper "key" (iBeacon) to view it. All while still keeping your iPhone locked.

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post #28 of 47
Quote:
Originally Posted by palomine View Post

It's in their financial interest to have the detail so they can find those fine points to dispute and not pay your claim, or rule that the expense was 'beyond customary' etc.

It's certainly in their best interest to have all of that detail so they can cherry-pick it to support their rulings, but it is not in their best interest that everyone else have easy access to the same information.  Information is power when you have it but nobody else does.  The status quo is preferable to them.

post #29 of 47
Quote:
Originally Posted by Ingela View Post
 
Seems obvious now, but it took a major player like Apple and soon Google to shepherd it and distill it.

 

Google?  The net's busiest busybody?  God forbid.

post #30 of 47
Quote:
Originally Posted by Rogifan View Post

Ha, 9to5Mac's wonder kid Mark Gurman actually claimed that Apple redesigned and renamed their Health app because of what he leaked back in March. He even claims to have Apple employees telling him that the previous leak was a superior design than what Apple actually will be shipping with iOS 8. As if Apple would approve of an inferior design just so something they spent maybe 3 minutes max on in the WWDC keynote was a complete surprise.

http://tinyurl.com/nemu2wn

I love John Gruber's take down:

http://daringfireball.net/linked/2014/06/09/gurman-apple-priorities

I read that, too. If you liked that DF take down, you should check out the episode of Gruber's podcast, the Talk Show, where Gurman was a guest. Ouch!

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post #31 of 47

I am both a Doc and a Patient at a major University hospital which uses Epic. The hardware & software for useful & valuable access to patient data has been around for some time. The main stumbling block is HIPPA Health Info Portability & Protection Act. It has fallen heavily on the Protection side making access or transmittal of data hugely problematic. 

Epic has ann App called Haiku (for physicians) from which I can find anybody in a very large system, including myself. It has all my data and can get images. The Patient App, called MyChart, is just about useless as every bit of data has to be "cleared" by the doc before it will show up, and there are large categories of info which are not allowed at all. 

This situation is stupid. The hardware & apps are already here, we just need somebody in DC to rein in HIPPA "protection" and boost "portability."

post #32 of 47
Quote:
Originally Posted by tundraboy View Post
 

 

Google?  The net's busiest busybody?  God forbid.

Oh yeah because getting unsolicited sales pitches from pharmaceutical companies based on what Google sold out of my medical records would be way over the line and totally plausible given their track record.

post #33 of 47
Quote:
Originally Posted by EricTheHalfBee View Post
 

I know, I'm in love with iBeacons so here we go....

 

Let's say you have your medical data stored in the secure enclave of your iPhone. You're in an accident and paramedics have your iPhone and want to see if you have any medical information that might help them. How do they get access to it if you're incapacitated?

 

I say give medical staff an iBeacon that has a serial number attached and a PIN number. When they try to unlock your iPhone it detects that it's near a "medical iBeacon" and prompts for a PIN. If the person enters the correct PIN that matches their iBeacon, then your iPhone agrees to unlock and display only authorized medical information on your iPhone for them to see - things like allergies, conditions or any medications you're on. Your iPhone also logs this event and displays the name and ID number of the person who "unlocked" your iPhone so you have a record of it for later on.

 

Take this further, how would the police know who to contact if you're in an accident and your iPhone is locked? They could also enter a PIN that would bring up your customized list of contacts or "in case of emergency rules".

 

I can see a lot of ways where you can allow certain people access to certain information simply based on whether or not they're carrying the proper "key" (iBeacon) to view it. All while still keeping your iPhone locked.

Well there's reportedly an ICE system app so perhaps a way in via that? A bit like the TSA "passkey" system for luggage?

 

ETA: An ICE card within the Health APP...available from the lock screen according to Apple's iOS 8 info pages. In that description it's called "Medical ID".


Edited by jfc1138 - 6/10/14 at 2:12pm
post #34 of 47
Quote:
Originally Posted by palomine View Post

Insurance companies DO have some of your X-rays and lab records. Yes doctors still use pen and paper to 'push back' against insurers, their comments are your private records. But Diagnoses, tests, images go to insurance oftentimes. At least they used to, which I know from personally disputing a claim. They are in the business of second guessing the doctors.

The billing codes are a common language that cuts across the mess of health records from different doctors and hospitals. Those billing codes are quite specific, they ARE your medical history, minus, of course, your doctor's private notes. In other words, your insurer does have your health history indeed. Like I said, they are like Equifax, they aggregate info from everywhere.

If you apply today for a big life insurance policy you can believe the insurer will check that hospital database, and will see that for example, you omitted the fact that you have stage 3 cancer in your left cheekbone and went for surgery. It used to be the same for healthcare policies.

Insurance is an industry I have a hard time finding a rationale for (outside of fire insurance and basic term life maybe).
Kind of like stock analysts, they don't add anything positive. They *could* be used for good if they hooked their back end database into Apple's kit ( with privacy permission). But then, somebody would have to pay somebody, which is what I find despicable about the whole system. 1hmm.gif

I forget where I read this, but I remember reading someone's analogy that getting insurance is like gambling.  You are betting that something crappy will eventually happen to you.  And when something crappy FINALLY does happen, you win! :\  At least that round.  In the long run, however, the odds are stacked in the house's favor, and you will most likely end your life with a net loss in the "casino" of insurance.

post #35 of 47

At least in the US, Apple can walk a fine line on health privacy issues by focusing on sending data TO medical providers.  Medical data that is stored on your phone that originates there (either through sensors or manually entered),  shouldn't fall under HIPAA rules.  HIPAA would apply when the medical provider receives it and stores it.

 

I'm sure these topics came up when Apple's team went to Washington, to ensure that Apple understands where to draw the line to expand and innovate and still be within compliance.  Data aggregation on a personal device is useful in itself.  And it keeps them out of medical device regulations (until Apple decides it is ready, via iWatch or iPhone hardware).

post #36 of 47

Sorry, slightly off topic.

 

I just discovered the videos from the WWDC sessions are released

 

https://developer.apple.com/videos/wwdc/2014/

 

I kept trying to play them for a few days but one would load in the browser (awards ceremony). Then I saw that you could download them directly and they work, oh well, not sure what was going on,  perhaps my ghostery again.

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post #37 of 47
Quote:
Originally Posted by CoinAPhrase View Post
 

At least in the US, Apple can walk a fine line on health privacy issues by focusing on sending data TO medical providers.  Medical data that is stored on your phone that originates there (either through sensors or manually entered),  shouldn't fall under HIPAA rules.  HIPAA would apply when the medical provider receives it and stores it.

I doubt that distinction would last very long after the capabilities arrive.  Some legislation will get created to regulate that stuff, and Apple is smart that they seem to be preparing for the eventuality now.

 

Thompson

post #38 of 47
Quote:
Originally Posted by TheOtherGeoff View Post
 

on the US government side, there is very little corruption on the HCFA/HHS side of the house.  The corruption is in the legislative branch.  Compared to the DoD, Medicare (which has driven coding standards for the last 40 years) has performed miracles without payoffs.

 

pedantry:  physicians go to medical school, not graduate school... if they do go to graduate school (and/or residency), they've spent a lot of time on the beaucracy side of helping patients (most spend their 3rd year of medical school just doing charting and dealing with coders calls asking 'what did the doctor do?').

 

And we don't want doctor's knowing the beauracracy... otherwise you end up with either poor care, or fraud/cost shifting ("you mean if we say we did a 'complete history' we get $130, but only a $75 for a 'visit history'.... well, If I ask, 'have you been sick before?... is that complete enough?').

 

The biggest issue is the always, 'how much do my options cost?'  and MDs don't know that, and Insurance companies don't really know, until the claim is adjudicated.   A GREAT Health app would be to have the MD give you the options, and you can push 'Preadjudicate' and your insurance company gives you a +/-25% cost estimate of each option, which you can weigh against the benefits the doctor gives you (surgery or P/T.... Pills vs AngioPlasty), etc etc.

On the HHS side of things, regulators are corrupted by their vested interest in stable employment, generous salary and retirement.

Despite what we might think we want, doctors do need to know bureaucracy, at least to give patients appropriate, quality healthcare, such as knowing coding tricks. Good, conscientious physicians know the costs of assays and treatments and order them rationally, rather than over-ordering due to incompetence or to cover their ass and increasing the cost of healthcare. Coding has changed so much that assistants are hired just to code--forming one of the fastest growing employment opportunities. Physicians hire assistants just to follow them around and do the electronic charting. cha-ching! The business of medicine has gotten so complicated and expensive with bureaucracy and insurance costs that private practices are shuttering left and right and the physicians are joining hospitals. Payment to the doctor or hospital might be denied at any of several steps--and knowing the bureaucracy can help avoid being stiffed. Many elite physicians are switching to concierge medicine, priced well out of reach of the vast majority of the populace.

post #39 of 47
Quote:
Originally Posted by thompr View Post
 

I forget where I read this, but I remember reading someone's analogy that getting insurance is like gambling.  You are betting that something crappy will eventually happen to you.  And when something crappy FINALLY does happen, you win! :\  At least that round.  In the long run, however, the odds are stacked in the house's favor, and you will most likely end your life with a net loss in the "casino" of insurance.

Especially in the disability insurance business, the insurance companies love it when you cancel!

 

Maybe the best part of the ACA (affordable care act or "Obamacare") is no more exclusions for pre-existing conditions. So if "something crappy" happens and it doesn't kill you, you can still get health insurance.

post #40 of 47
BTW: Of course not similar but, Microsoft has also attempted a health recording app in past called "HealthVault" which interestingly is available on iOS:

https://itunes.apple.com/in/app/microsoft-healthvault/id546835834?mt=8

Perhaps one of the most unused apps. They have their own platform and ecosystem with Windows Phone, but just lack the vision to make it useful.

They just can't pick one thing and do it right. They somehow have to put their hands in everything and not do even one right.
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