Hacking Healthcare Device Interoperability

As the volume of patient-generated data expands, one provider is finding a way to connect to that data, pair it with its EHR system, derive insights, and communicate back to the patient in a meaningful way.

Due to the number of data breaches of late, the term hacking is once again associated with bad things. But every now and then we need to remember that hacking is sometimes the only thing that allows technology to achieve a desired end.

In the case of medical devices, for economic and legal reasons, many consumer-oriented medical devices remain disconnected from the Internet. Given those breaches I mentioned, this is probably a good thing until device makers and the public understand that the cost of the device must include adequate security, if that device is to be attached to the Internet.

But this reality leaves healthcare with a problem, which is that patient-generated data about their own health is expanding rapidly. Recently I learned that Sutter Health has been piloting a technology that cleverly pulls that data off of previously disconnected devices right into EHRs.

Using an evolving solution from Validic known as VitalSnap, Sutter's technology consists of a smartphone app capable of using the phone's camera to sense and capture readings from blood pressure cuffs, scales, and other devices in the possession of consumers. Then, through an integration effort with EHR vendors such as Cerner, VitalSnap packages up those readings and pushes them into EHRs.

Last year, Sutter piloted Validic technology for six months with 149 patients with high blood pressure, says Albert Chan, vice president, chief of patient experience and a practicing physician at Sutter.

"We were able to connect to their data and we were able to present the data back to the patients in a meaningful way," Chan says. "They could see how, for example, their walking behavior or their eating habits impacted how their blood pressures were the following day, or even exercise routines and how that affected their blood pressures throughout the day."

While patients could view such results immediately in Sutter's patient portal, Sutter also mobilized a hypertension patient care team to notice 14-day trends and reach out to patients who needed attention, advising them to increase or reduce medicine dosages, increase exercise levels, or have a dietician give advice on changing eating habits, Chan says.

"In addition to that, of course, patients themselves could look at the data that they had submitted and see the trends and understand what impact their blood pressure has," he says.

The Sutter pilot was not a formal randomized study. (Chan wonders how one could be designed. What would be the placebo?) However, 60% of patients enrolled in the trial who previously had not achieved control of their blood pressure "got better," Chan says. "Our insight was [that] it was really empowering to give patients access to data" and the data also provided new insights to the care management team."

"We are now transitioning to actually [partnering] in a more integrated way with the primary care clinics," Chan says. "Primary care is about taking care of a number of patients and trying to make sense of all the data that's available to us about their care. We have the recognition that 99.9% of your life does not happen in the clinic."

And yet, he says, "We're making these decisions about people's care plans based on limited data sets. So in some sense, we're very excited about the opportunity to understand some of the key impacts on people's lives outside of the clinic. That's one of the things that drove us to partner with Validic to try to develop solutions."

Chan does not discount the value of an earlier, pre-digital method of gathering patient data—the log book. It is "a way for patients to engage with their data and record the information," he says. "That part is helpful. The part that's missing from that though, is timely access and timely ability to provide feedback."

"You can imagine any individual that has a really hard time remembering how they felt in a given day," Chan says. "The ability to have this sort of access to data allows us to more acutely connect to their data and give them advice that's much more timely, much more powerful. If you understood, for example, that your blood pressure goes down as you walk, it would be a great insight for you to be able to say well, do I want to reduce my blood pressure overall? Then I should walk more. Tying the outcomes to the data that we see. That's ideal."

Better Than More Data: More Insights

Integrating an emergent trend into the workflows of the care team and patients alike is key to making this work.

"Physicians and patients have developed workflows over time for very valid reasons, to manage the huge number of data points, to try to come up with some new insights," Chan says. "One of my big pet peeves about this whole discussion really is that we say, 'Oh, big data solves everything.' My argument is, I'm a guy who really wants to understand what impacts the patient's health. I don't need necessarily just more data points. What I need is new key insights that I couldn't otherwise develop… it's not simply good enough to just turn on a pipe and send me more data."

The biggest issue with user-generated data is one that bedevils healthcare interoperability in general— physician trust in the data, and in its provenance.

Simply pointing a camera phone at a medical device is unlikely to assuage some physicians' concerns. "What we like about this, and what clinicians like about it is, they know at least that information was displayed on a clinical device, rather than it being something that somebody just typed in," says Drew Schiller, CTO and co-founder of Validic.

"Now could somebody take a picture of somebody else's glucometer? Sure. But I could have pricked his finger instead of mine and done the same thing. The confidence level of providers being able to trust this data is higher than if I was just manually entering it."

I hope Schiller is right. The real trick to patient-generated data is it should happen without security breaches, or smartphone apps, or any of the other hacks (in all senses of the word) that we face in 2016. Sutter's experience is promising, but we still have much work to do.