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Like the Rest of Healthcare IT, Limited Interoperability is a Big Challenge for Digital Health

March 20, 2017 Digital Health No Comments

Digital health updates are written by LoneArranger, an anonymous industry insider.

In the Connected Health Pavilion at the recent HIMSS17 conference and exhibition, several attendees commented during a Q&A session that “connected health doesn’t seem to be very well connected.” It is easy to understand why they may feel that way.

There has been a proliferation of individual consumer health apps over the past several years, though many of these could be classified as “fitness” vs. “health” apps. Although consumers are increasing their adoption of digital health tools according to a 2016 Rock Health report, they are not necessarily connected in any way to each other or to mainstream provider or payer HIT systems.

Tethered apps offered by healthcare providers and payers don’t always include data from other healthcare settings or insurers and often don’t accept wearables data. Therefore, most consumers (and their providers) cannot easily maintain a complete longitudinal health record.

Most major EHR vendors offer customers mobile apps that are extensions of their patient portals, but these are essentially closed systems. Although some vendors offer platforms to exchange data across their different customer sites, they do not generally include the ability to share data easily across different vendor platforms. The CommonWell and Carequality initiatives are starting to address this gap, but it will take time to expand their footprints.

Wearables are not growing as fast as anticipated and although younger consumers are adopting them in large numbers, older consumers are not, even though they might actually benefit more from doing so. In fact, only 10 percent of Baby Boomers own a wearable device.


According to the same Rock Health report, the majority of health tracking is done mentally, with 54 percent of people who track weight and 58 percent of people who track medications doing so in their heads. Of those tracking their health electronically, the most common metrics recorded using an app are physical activity (44 percent) and heart rate (31 percent), which are clearly more related to fitness and performance than diagnosed health conditions.

There are many innovative platforms and apps emerging that offer more comprehensive capabilities, but they are still often limited by the inability to exchange data with legacy systems and other digital apps. Although HL7 FHIR offers substantial promise for the future, there are few implementations that are currently operational in production environments and the normative standard is not yet finalized.

For providers, the data from external sources also need to fit into their workflow to be useful. This requires full semantic interoperability, or at least cross-mapping of common data elements, beyond just basic data exchange. In most cases, this requires customized integration and terminology services.

There are some glimmers of hope emerging in this market space, with a variety of middleware solutions for feeding patient device data to EHRs starting to gain traction, and increasing willingness by providers to accept external health data and share data with others. Remote patient monitoring seems to be gaining ground recently and is delivering real value to both patients and providers. The remote patient monitoring market grew considerably in the last year, with 7.1 million patients worldwide enrolled in some form of digital health program featuring connected medical devices as a core part of their care plan, according to recent research data.

These tools are generally prescribed or recommended by providers and connected to their EHRs and/or care management systems. However, their focus is primarily on patients with chronic conditions or those who are recovering from acute procedures. The clear benefit is keeping track of these patients and reducing hospital admissions and readmissions while allowing patients to remain at home or in a community rehab setting.

In the long run, digital health applications have tremendous potential for adding value and improving care, but they must first overcome similar interoperability hurdles as those faced by the rest of the HIT industry. They must also become more tightly integrated with clinical and financial systems and associated workflows and offer a more nearly seamless user experience to both patients and providers. The future of digital health is looking brighter, but the open question is how long it will take to get to the tipping point where these tools are fully integrated with mainstream healthcare infrastructure.

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