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HLTH Day 1: Patients Owned Data, Mobile App Regulation, Interoperability

At yesterday's HTLH Conference in Las Vegas, there were two major themes present, patients owning their data and the desire for interoperability. Genomics and personalized medicine is being driven by consumers with millions signing up to get DNA tests. Health policy makers detailed how having DNA samples combined with social determinants has made them more effective at drafting public policy.

It strikes me as comical that social determinants is driving any kind of enlightenment with public officials. If your voters don't have good jobs and they don't have access to healthcare, why would anyone presume that their health would not be affected? Typically, we find with public policy makers is that they forget to tell the government workers what the policy is and why public health is important. Instead, workers are trained to combat perceived fraud viewing it as the more important issue. This skewed view of public policy leads to poor decisions.

For example, in the State of Washington, the state sets an arbitrary number of emergency room visits and an arbitrary number of prescriptions that a person can have. Anyone that exceeds the amount is placed on a probationary program which means that they cannot see the physician of their choice. Instead, they are limited to a single doctor and a single pharmacy. When asked how they determine this information, the State said that they perform data mining operations on patient data and a nurse (not a doctor) reviews the billing records (not the clinical record) to determine if the emergency room visit was necessary. Anyone that has ever visited an emergency room knows that the instructions always ask you to return if the symptoms get worse. The public policy issue driving the State of Washington is an emphasis on financial concerns as opposed to patient health outcomes.

Most patients want to know why their medical records are such a big mystery. If the State can get a copy why can't they? The law says that patients own their information, but rarely do hospitals enable full patient access. It is examples like the State of Washington's and the desire for insight into one's health that is driving patients to demand a copy of their medical records in a form that they can easily digest.

Doctors at the conference explained that the challenge with thousands of mobile apps on the market is that the doctors have no reliable way of knowing which is a medical device and which is simply a toy. For example, I saw one startup displaying a heart beat along with a sinus representation of an EKG. Knowing the structure of EKG's and the science behind it, I could see serious flaws with the startup's design. While it may be obvious in the example of the EKG, it is not so obvious with other apps especially those attempting to do more sophisticated things. While physicians were mesmerized by machine learning, the lack of rigorous testing and regulation of these apps leaves doubt in the minds of many physicians as to the validity of the apps' claims. Another complaint about mobile apps is that they often don't fit into the larger system that the hospital is using to provide care, so they largely aren't useful to treat patients.

One group of physicians pleaded with conference attendees to go along with mobile app regulation. Their plea was to frame it in the eyes of the consumer and compare it to consumer warning labels. Any regulation will likely kill innovation due to the cost of testing, but if the doctors are successful in gaining public support regulation will be inevitable.

Another prominent complaint among doctors was the lack of interoperability. Many doctors complained about the lack of a solution that makes it easy for them to work across systems. However, our HEALTHieR Cloud product actually meets this need, they just didn't know about it.

Jenna Bourgeois, CEO, Dynamics Intelligence

(206)483-8610

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