SOLUTION PROVIDER Q&A
Consumer-Facing Health Apps Data–Reaping Benefits and Facing Challenges
A More Holistic Patient View Patient data is at the core of deriving insights into patient behavior and developing predic- tive models around outcomes. A patient’s clinical history coupled with their socioeco- nomic status and wellness behaviors (e.g., exercise and sleep patterns) creates a much clearer picture into the likelihood interven- tions will be successful than a self-reported health risk assessment. These new data sources create a more holistic patient view allowing for more tailored initiatives with a higher success rate.
Privacy First, Data
Management Not Far Behind There is a slew of considerations associated with data collected with consumer apps. Even though it is moving differently, it is still PHI. When acting on behalf of a patient/ member, the priority must always be pro- tecting it and only providing this data to appropriate parties. Luckily, ONC has mandated the use of
SMART on FHIR to secure the transaction. SMART on FHIR provides reliable, secure authorization for various app architectures with the OAuth 2.0 standard. This profile is intended to be used by app developers that need to access FHIR resources by requesting access tokens from OAuth 2.0 compliant authorization servers. It should be noted that this only covers the exchange of data and the storing and use of the data needs substantial oversight to ensure that it is appropriately secured. With security in place, healthcare orga- nizations will need to focus on integrating massive amounts of data to realize benefits for members/patients. They will have to overcome such challenges as ingestion, stan- dardization and normalization despite the strong FHIR standard (HL7 4.x). This will require an upfront investment and skill sets that might not be readily available.
Upcoming Interoperability
Regulations for All The 21st Century Cures Act laid out a host of initiatives to improve transparency and data
flow in healthcare. Though this has caused some concerns about completing the work, it has also created even more excitement from other stakeholders in the healthcare ecosystem. It creates an opportunity to access data that has historically been siloed and walled off. Over the coming years, we should expect to see the use of the various data exchanges (e.g., APIs, Payer-to-Payer Data Exchange, QHINs) to increase the movement of data substantially. HHS and ONC have laid out a roadmap
for interoperability and information block- ing with a clear mandate: Patients should be empowered to access their data to support decision-making and advance consumerism in healthcare.
The ONC Final Rule lays out regulations
to prevent information blocking practices by providers, health IT developers, health infor- mation exchanges, and health information networks as of April 5, 2021. Per the regula- tion, for effectively all EHI requests, phy- sicians must respond and release patients’ medical records unless an appropriate excep- tion can be identified. Additionally, health payers were mandated to publish publicly facing FHIR-enabled APIs to allow indi- viduals to access the Provider Directory and Patient Access data (including clinical, demographic, claims, and drug formulary information for a member) and will soon be mandated to provide insights on prior authorization status through these same APIs. Providers are required to publish simi- lar Patient Access APIs by January 1, 2023, which will allow clinical data to flow out of an EMR to the patient. Though challenging for everyone, these regulations are paving the way for shared data and the future of healthcare.
What do the next few years
look like in this space? HHS called the 21st Century Cures Act rules “the most extensive healthcare data sharing policies the federal government has imple- mented.” Don Rucker, M.D., national coordi- nator for health information technology, has previously stated the importance of technology to give patient access to health information.
Jonathan Shannon
Senior Director Health Care Strategy LexisNexis®
Risk Solutions
You can imagine the federal government
is not done with its efforts to improve health- care interoperability. I believe you will see more APIs and new data sets (e.g., SDoH, commercial insurance members, increased clinical insights) becoming available over the next few years. We’ll see healthcare organiza- tions either develop or outsource capabilities needed to solve data ingestion, standardiza- tion and normalization challenges. I believe that consumer-facing app data will help transform individualized healthcare and better health outcomes overall. Patient empowerment is a vital tenet of the 21st Century Cures Act, so I would expect to see substantial opportunities arise around this data to improve patients’ ability to navi- gate the healthcare ecosystem.
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