Developing mobile apps isn’t hard. So why should we be excited about yet another group of startups that have developed mobile apps that join the list of 165,000 apps already available to us?
This past week, Apple unveiled the first few apps for the CareKit, the open source framework launched recently to enable developers to build mobile applications for healthcare consumers. Following up on ResearchKit, the framework for helping launch clinical studies by gaining access to the community of iOS device owners (see my earlier blog on this), Apple is trying to cover the first and last mile problems in healthcare with an innovative approach. Also, for the first time, Apple embraces the open source community.
The CareKit apps launched last week bear the stamp of inimitable Apple UI. Onedrop, the diabetes management app, has intuitive workflows and interfaces designed to help consumers self-manage their condition and also maintain contact with their primary caregiver. Given that most consumers have sporadic interactions with their PCP's during the year, this would seem like a good way to improve the frequency of interaction, especially for chronic conditions such as diabetes that require constant monitoring. (IBM and Medtronic demonstrated a prototype at the CES show earlier this year that a real-time Watson-powered alerting system designed to help the most severely afflicted diabetics). Consumer preferences are tilting towards a mobile-enabled 24x7 mode of interaction with physicians, notably millennials.
Anyone who has dealt with the clunky interfaces of leading electronic record (EMR) systems will welcome the slick and friendly UI of these new apps.
This is all good news for consumers. If.
Healthcare is notorious for restricting access to patient medical records. Apple's CareKit apps have just ignored the problem, leaving it to consumers and their PCP's to deal with it. Other aspects to consider:
-- First, the apps rely on user-generated data for managing their conditions. User generated data is useful if users are diligent about recording their data.
-- Physicians will need to correlate user-generated data with EMR data in back-end systems to make the right diagnostic and treatment decisions.
-- Apps like Onedrop go beyond recording medical data such as blood glucose levels; they prompt users to record qualitative inputs such as mood levels which are increasingly considered important factors in managing patients with chronic conditions. Traditional EMR data models may not include some of these.
It's early days yet and the ability and desire on the part of physicians to take on the burden of analyzing user generated data remains to be seen. Considering the information overload that they are already subject to (belatedly acknowledged by the ONC in their proposed new rules for Meaningful Use requirements in 2017), physicians have to feel motivated to open up to an additional information channel. There may be adequate motivation for them to do that, considering the shift towards accountable care, avoidance of CMS penalties, and the focus on improving patient satisfaction and HCAHPS scores – all of which have financial implications.
Cynics and naysayers aside, I do believe that consumer apps that allow consumers the freedom to interact anytime, anywhere with their caregivers is a good thing in the long term. Consumers desire (and deserve) more control over their healthcare experience and the health system will be able to serve patients better and improve healthcare outcomes as a consequence.
All this represents an incredible opportunity for CIO's and technology professionals to innovate and create value. I expect CareKit will empower a ton of start-ups, many of them working closely with traditional healthcare firms – partly because startups need anchor customers, and also because healthcare IT functions are not always set up to build and manage apps in a fast-paced, agile mode of operation.
So back to my initial statement – developing apps isn’t hard. What is hard is implementing mobile apps in clinical workflows and this requires collaboration between the developer ecosystem, who know how to build cool consumer-friendly apps, and healthcare IT professionals, who understand clinical workflows, data access restrictions, information security and all the other hygiene factors that most start-ups don’t understand well.
The CareKit partners featured in last week’s announcement are the latest addition to a burgeoning startup ecosystem that is zealously taking on the last mile problem in healthcare. Patient IO, a care coordination platform that helps health plans with value-based care programs, focuses on helping health systems improve patient engagement between visits. By developing the kind of intuitive interface that we have all gotten used to expecting from Apple products, patients have the ability to self-report a range of data related to their medical condition, including qualitative factors such as mood and pain levels. The platform is currently embedded into existing care management systems and allows clinicians to develop customizable workflows which can enhance their ability to engage patients, especially in post-discharge clinical protocols.
The last mile in healthcare, the place where healthcare consumers meet healthcare providers, is a cauldron of technology-led innovation today. Addressing it effectively requires the 3 C’s of success with healthcare apps: Consumer orientation, Clinical workflow integration, Collaborative partnerships. We will see many more companies like Onedrop and Patient IO that will make a real difference in the coming years to care management and healthcare outcomes.
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