Will Smartphones Make Interoperability Easier?

In its most basic form, healthcare interoperability involves digitally sharing medical information with ease. There’s a range of opinions as to how we can make this a widespread reality. “Our goals are pretty simple,” federal interoperability coordinator Micky Tripathi recently said, “and simple is hard.”

In May 2021, ONC (the government agency handling interoperability) asked for “aspirational, achievable, and measurable Interoperability Outcome Statements” that imagined how data sharing would change healthcare in the coming years. Over 700 responses poured in, covering everything from easier health records access to data-driven medical treatment. This promotional campaign, called Healthy Outcomes 2030, successfully got health IT nerds like us excited about interoperability’s next decade.

Surprisingly, only about 3% of the responses mentioned cellphones* - the device that most of us won’t leave home without.

Did these commenters take phones for granted? Phones are already a part of interoperability. In fact, adding a phone number to a patient record search increases the chance of locating a patient, and the number of records found.

I know my doctor asks for my number each visit. Maybe mobile devices are so deep-rooted that commenters didn’t need to mention them at all. 

Financial startups are the closest parallel to interoperability startups, and the growth of consumer-focused fintech companies couldn’t have happened without smartphones. Would Venmo have become a household name if it was browser-based?

One reason why we haven’t seen as many easy-to-use healthcare apps is that it was harder to get patient records until recently. “This ability to build something new is akin to when Plaid opened up banking data,” Particle CEO Troy Bannister wrote last year. In Troy’s words, Particle has finally unlocked Interoperability 3.0 - the developer’s era. 

Particle’s API helps developers build consumer-friendly healthcare experiences. In a few years from now - much sooner than 2030 - we look forward to seeing healthcare data platforms like Particle power better experiences for consumers, including on their mobile devices.

Let’s explore phone-related feedback from the Healthy Outcomes campaign, and three ways it gives us a roadmap for mobile interoperability.

1. Engaging with individual records

If interoperability means we can share medical records, then where should those records go? A good option would be to reach Americans where they're already engaged. App analytics firm App Annie estimated that the average American spent over 4 hours per day on a mobile device in 2021.

🗣️ “I will be able to carry my complete medical record on my phone.”

🎤 “Patients will be able to safely and securely receive their health information quickly and easily on a mobile app of their choice.”

📣 “I hope that we have patients have access to all of their data in a way they can get fully engaged with … on their smartphones so that they’re in control.”

—Healthy Outcomes 2030 user submissions

In a record high, 15% of patients accessed a patient portal from a smartphone app in 2020, according to ONC research. This increased usage can be attributed to both the pandemic and greater API use. But the experience may have left something to be desired, as the frequency of patients accessing their portal did not change year over year.

Sounds like we’re trending in the right direction, but note that access to a portal is different than access to every portal. Judging by Healthy Outcomes comments, a number of patients are looking forward to un-siloing and aggregating their data. 

Access to records is just a start. For many, permanently getting those records onto an easy, secure phone-based app is the goal.

Logging into a web portal can be a multi-step process, but patients use smartphone apps every day. Phones have already shown that they can hold patient records - Apple’s built-in Health app comes to mind. Having more data (or synthetic data) will make it easier for smaller developers to build great solutions too.

2. Care management and record sharing

Actually doing things with medical records is even harder than collecting and combining them. Nevertheless, it sounds like these complex use cases are supported by currently interoperability data formats:

🎙️ “Patients will be able to share select pieces of [their] medical record with whomever they wish, with no special effort and from the ease of the mobile device utilizing an app of their choice.”

🙋 “Complete control of the patient to opt in or out for any file sharing.”

🗨️ "Patients will no longer have to fill out multiple registration forms in order to enroll and can easily and electronically convey their proven identity using their own mobile device.”

🗯️ “[Patients will] manage their care … and check their claims from the same portal on their phone.”

—Healthy Outcomes 2030 user submissions

FHIR, the next generation healthcare data format, supports sharing select pieces of information. Particle’s API connects developers to that information. Now the race is on for developers to put this information into a consumer-friendly package.

With the right security infrastructure in place, patients could authorize treatment decisions and record sharing between providers from their phone using identity-based biometric methods, like FaceID. If the Healthy Outcomes comments are any indication, patients want to know when their data is shared so that they can help make it happen.

Anchoring price comparisons and claim payment in a smartphone, from the same app that stores your medical records, is theoretically supported by next-generation data formats as well. FHIR R4 already supports claims data, and you can already check out at stores from your phone.

3. Device-based decisionmaking

✍️ “[I want to] create long term visualizations of my … conditions as they change over time.”

💬 “I want to pose questions regarding my healthcare to my provider and receive answers using images I send from my cellphone.”

—Healthy Outcomes 2030 user submissions

Developers of digital therapeutics have already realized the importance of phones in interoperability. Digital therapeutics are evidence-based software products that manage healthcare conditions, like asthma, insomnia or anxiety. In many cases, digital therapeutics are health coaches - not a new concept. The key to their success has been that they’re with patients in their pockets. 

Evidence shows that digital health interventions can have beneficial effects. The same challenges that other tech companies regularly deal with - like how real world use affects the user journey, and what info to display to users - can directly affect care outcomes. Adding advanced features, plugging them into a user’s care journey, and expanding the use of instant decisionmaking are some of digital therapeutics’ next steps.

Eight years is a long time in technology. It’s possible that the Healthy Outcomes 2030 crowd expects that we’ll move to VR headsets by then. But maybe one way you’ll know our healthcare system has achieved interoperability is when you think of your phone as a key part of getting care. 

A goal of interoperability is for consumers to take greater control of their care, and if you’re searching for consumer-friendly tools, there’s no better place to find them than an app store. One thing is for sure - we’re heading towards a future without fax machines.

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