I have been tracking the Provider footprints of Care Equality and CommonWell alliances and it is great to see continued progress on EHR interoperability beyond the technical standards innovation with HL7 FHIR APIs. Zoom into the NYC / Boston area on the CommonWell area coverage map that gives you a good sense of this progress. The profiled activities in Healthcare IT News last week just scratches the surface of the potential impact. Standard agreements among Providers and streamlined patient access are the only missing components in my mind that will extend complete ubiquity in the US. New digital health innovation layered on top of this new era of interoperable EHRs will be demanded by Providers that will further ink this progression.
It will be interesting to see if this momentum spreads internationally where there has been lacking government EHR subsidies to kick start some level of greater adoption and more disparate market/regional structures and government control health systems that create barriers and insulate old, more dated clinical information systems.
Apple's recent Health Records announcement is based upon the same underlying FHIR APIs and there is a suite of other SMART application / integration innovation in the works, and a rejuvenation of the notion of Personal Health Record (PHR) that had failed in the past due to this interoperability issues.
I suspect this very well could be the start of an accelerated shift towards the EHR being pushed into the role as just a data repository in lieu of new web dashboards highly optimized for each clinician workflow (primary care, specialists, ER, surgical units, etc) and mobile apps centered around embracing untethered mobility. Yes, this means fewer Providers should have to initiate $25M EHR vendor customization efforts and lucrative support contracts. Think how much easier it will be to layer value on top of EHRs and differentiation based upon a suite of clinician and patient engagement tools, data analytics, inferencing, clinical decision support and population health. Yes, the likes of Epic, Cerner, and Allscripts have plenty of integration and customization project work in their pipeline, but they could be commoditized as just infrastructure in the new digital health of the not too distant future.
Finally, wouldn't it be a beautiful thing if we got an actual meaningful reduction in clinician clicks during their day and as patients got more eyeballs our way during doctor appointments.
High on expectations for uncovering more information surrounding my genealogy, I recently decided to purchase the upgrade from 23andMe Health genome service that includes their ancestral mapping.
I was pretty confident of many family bloodlines, including personally tracing 13 generations with my Dad and a great aunt who lives North of Quebec City who only speaks French to uncover our first relative who came to Canada in 1647. Performing such an exercise induces added pride in where you came from. So, you might understand why I was so disappointed when 23andMe did not capture a single trace of French Canadian when it should have approached 50%. Ok, so maybe they only classify this as originating from French European since they did come from the Normandy region of France. No such granularity. The best they could do is 9% French & German.
Turning to my mother's side, I know my grandfather was from an island off Sicily. Unfortunately that 25% of me only garnered less than 10% Italian. Finally, we had some family folklore of some distant Native American in our lineage. That was wishful thinking also with the balance of what was reported being British & Irish, Balkan, Iberian, and vague categorization as Broadly Southern European, Broadly Northwestern European and Broadly European. Then came all the jokes I was adopted (fortunately I look a lot my my Dad).
23andMe should remain focused on their Health report which is very comprehensive for meaningful genetic health risk indicators for diseases, disorders, wellness, and cute things including likeliness for cheek dimples, a unibrow, freckles, cilantro taste aversion (must have passed that on to my daughter), and asparagus odor detection. What the heck have they been doing since the FDA early on had clawed them back to just ancestry reporting? I would have thought they subsequently had applied more effort there.
So while I do feel blessed my Heath report came back good, their poor Ancestry granularity and results makes me question the accuracy of their flagship Health service. I have since learned that Ancestry.com genome services does have much greater granularity and will likely do some more spitting in a cup to seek some sense of genealogy salvation. It also looks like 23andMe no longer lets you just buy the Health service (not worth any sort of $40-$100 bundle uplift price in my opinion). Buyer beware as we venture further into consumer driven digital healthcare innovation.
The future is however bright with continued advancements in genomics, proteomics, growing registries / databases of diverse profiled populations, machine learning, and inferential analytics. Something as technologically complex as genome sequencing is being commoditized and one can now dynamically rent time on a diverse network of available genome sequencers across the country, which lowers the capital equipment barriers to entry for innovators. Meenta is the Amazon / Azure cloud of genomic sequencing. Let's hope we can begin to effectively map the human biome with good and bad bacteria, immunology, and one day psychosocial-emotional-behavioral triggers one day.