Epic CEO, Judy Faulker, recently expressed her view how Electronic Health Records are evolving into Comprehensive Health Records—a term that evaluates more than just a specific window of sampling an individual’s health from doctor visits. CHR is a term that may be invented as the new EHR, incorporating more data and analysis of a patient that stems from their in-clinic or hospital visits and their time outside of a medical facility too. Foraging into a new technology frontier that implies a near-constant evaluation of a person’s well-being may sound like an answer that physicians have been looking for, but anyone who is ever a patient (all of us) could be under the scrutiny of patient tracking technology that could be always on, always tracking. Yes, the benefit is physicians can understand the entire gamut of a patient’s health by seeing comprehensive snapshots of activity from day to day, but do the costs outweigh the benefits? Are we already in the pathway of the “Big Data” steamroller? Let’s take a critical look.
Are We Already Headed Down this Path?
Many individuals are already familiar with utilizing in-home tracking devices and food intake monitoring, so the “at home” concept of tracking health isn’t new. Wearable fitness trackers coupled with diet and exercise apps are near ubiquitous in society today. There are also several medical grade devices like blood sampling devices or blood pressure monitors to see how trackable vitals are measured outside of the doctor’s office and clinics. But now that CHR is becoming a reality for EHR corporations, there are implications to consider about how this data would be collected into a central repository. If CHR will incorporate the data from consumer-grade devices into an EMR system, how will this data transfer occur? Would EHR software developers have to build integrations for the hundreds of various fitness apps and wearables that are available on the consumer market. Would we need to entrust app developers and wearable manufacturers with the responsibility of building those integrations? We could see EHR software developers create their own consumer apps and wearables, but that raises even more questions. Would software developers even want to enter the arena of app development and medical device manufacturing? And if they did, how do get a patient to willingly utilize something they may not want to?
CHR and Big Data: How Accurate is the Information?
A patient may be under the scrutiny of a doctor for monitoring their food intake for diabetes, and it’s likely a common thing some individuals may “cheat” on their diet—maybe someone once logged a dinner of chicken and vegetables when instead they indulged a large burger and fries. That second iced mocha of the day might get “forgotten” when it comes time to update their food log. The same propensity to “cheat” when recording time spent at the gym lifting weights, or doing yoga can creep in if we are entrusting the patient to log their own activity. So manual input data needs to be examined and taken lightly if it’s to be wrapped into CHR. Plus, there’s the question of accuracy of wearable devices—many aren’t as devices used in hospitals, clinics and doctors offices. How accurate is a pedometer? How accurate is a sleep tracking device you can purchase off the shelf? Can that be incorporated into a medical health profile? And furthermore, even if the comprehensive data is used for analysis for health, can that be considered an invasion of privacy?
Is the CHR Data Secure Enough?
With potentially thousands of different devices tracking different variables such as food intake, steps taken, heart rate, and other measurable factors, there’s a concern of how all that data might be transferred to EMR systems. Since hospitals have begun implementing BYOD practices among their staff, securing has become a massive point of concern. Medical grade computers are specifically designed with a number of privacy safeguards built into them to protect patient data. Now imagine the security risks if data is being transferred from millions of unsecured consumer devices. We’ve discussed at length in the past that patient medical records are even more valuable on the black market than an individual’s financial data. Now you have to consider millions of new vulnerabilities for hackers to try and exploit. So how would a transfer happen? Wireless transfer? Patient web portals? If CHR is to incorporate an unknown breadth of data, will HIPAA laws need to be rewritten to account for vulnerabilities that can’t be controlled by a healthcare facility or a doctor’s office?
CHR Data and the Implications of Insurance
Insurance companies evaluate a patient’s medical history gauge what their premiums should be. It’s a given that if someone smokes, healthcare is more expensive for them. If we are to enter a new era of healthcare data, can insurance companies utilize more comprehensive methods of evaluating someone’s health? If a patient claims that they run three times a week, and yet their pedometer shows no activity outside of walking, will that reflect on their bill? How far does the willingness go to track aspects of someone’s life? CHR is prepped to track not only how we treat ourselves, but our social lives too. Will all these medical and social effects on our well-being be reflected in insurance companies and their premiums? While the intent of CHR would be to compile the most comprehensive view of an individuals health, the information could very easily be used to create more “high risk” pools by insurance companies, and could even price some users out of the market completely.
These are just a handful of questions to ask as the encroaching concept of CHR starts to hit EMR companies. They’re evolving, perhaps for the better of our lives and health, but there are strong implications of privacy, accuracy, security, and unfortunately impact on wallets too. For now, EMR systems have not yet seen that evolution, and quite frankly they shouldn’t until these questions are answered. We’d love to hear your thoughts as well. Please comment below and let us know what you think about CHR.