Things & Thinks XXV
This is the 25th issue of this newsletter. This work is a bit selfish in a way, because I started doing it to digest the various pieces of information I end up reading and to find a way to reflect and find common threads through this disparate information. I hope it has been useful to anyone who takes trouble to give this a read!
In this edition, we will read about some new perspectives about the healthcare data world, a reflection on contradictory data viewpoints and the usual dose of healthtech news. Apart from the Chart and Tweet of the month, to commemorate the 25th edition, this month onwards, there will be longread of the Month section! Happy Reading
⏩US, Electronic health records and Interoperability
US announced in mid-July that The Trusted Exchange Framework and Common Agreement, (TEFCA) the federal government’s nationwide on-ramp to interoperability, will go live in early 2022. TEFCA, a provision of the 21st Century Cures Act, is meant to advance the secure exchange of electronic health information and other data among health information networks.
This is definitely a big step forward as it solves one of the major issues with the EHR era brought in by the HITECH Act. Researchers from Google wrote recently about the shortcomings of the HITECH Act in Journal of American Medical Association and more importantly, also came up with lessons for future.
- Focus on outcomes over process. The key shortcoming of HITECH was the way timelines and process measures reduced EHR adoption to the lowest common denominator of regulatory requirements as opposed to emphasizing the meaningful integration of IT systems for clinical benefits. Policy makers must first define the long-term outcomes of DMI and craft a strategy that accounts for the variation in starting capabilities across the local, state, territorial, and federal level before imposing new requirements on health departments.
- Focus on outcomes over process
- Align governance to foster accountability
- Build for the future instead of preserving the present
- Invest in public health and informatics workforce development
- Take a portfolio approach to incentives and implementation
Of these, I really appreciate the thought of building for the future. As the authors note, ‘Public health must avoid digitizing where the field is today and instead build systems to support where the field is going.’ We are seeing a new data paradigm now, with mobiles and wearables generating health data at higher speeds and volumes. This change in data quantity, frequency, volume and so on requires an entirely new way of thinking about data infrastructure. The authors rightly recommend application of artificial intelligence and machine learning methods to these data can help generate the kind of timely, granular, and actionable information needed to better tailor the essential services of public health (eg, disease monitoring) to specific community and population contexts.
⏩India’s National Digital Health Mission
India’s healthcare policy is also undergoing a monumental shift with the setting up of the National Digital Health Mission. Recently the mission released a consultation paper on the Unified Health Interface (UHI). UHI is intended to be an open, interoperable platform to connect all digital health solutions. This is a good time to re-read a review of the digital health mission published by the Observer Research Foundation from last year. Here’s a quick summary-
- Healthcare data in India is fairly fragmented and scattered, given the interaction of citizens ranges across multiple diagnostic centres, hospitals, medical practitioners and pharmacies.
- Developing an enterprise architecture systems in healthcare has been a challenge, even in developed nations such as UK.
- India’s UHI (Unified Health Interface) has several design features similar to its Unified Payment Interface (UPI). Open APIs, distinct consent and data layers (dubbed as a ‘data empowerment and protection architecture’) and sandbox testing environments are some features that can be seen in both the system designs.
- While the the importance of data ownership by patients has been stressed, the absence of a rights-based framework governing healthcare data (as a class of sensitive personal data) does warrant us to interrogate the role of ownership.
- Three things will be important to make NDHM/UHI a sustainable success-improving interoperability by better data integration and harmonisation, promoting inclusivity in accommodating patient rights organisations in the the building blocks of the digital ecosystem and finding the right balance on privacy, transparency and development
Digital Healthcare news
- In Q2 MobiHealthNews reported on 99 digital health deals worth roughly $6.2 billion.
- Teladoc and Microsoft entered a new collaboration in which Teladoc Health’s Solo platform and Microsoft Teams will integrate clinical and administrative medical office operations. According to the companies, integrating such services directly into clinician’s workflows will ease administrative burden while fostering easier access to their tools.
- Dexcom’s Partner Web Application Programming Interfaces were cleared by the FDA, allowing approved third-party developers, including Teladoc Health’s Livongo for Diabetes and the smartwatch maker Garmin, to connect to the continuous glucose monitoring data of Dexcom users.
- Amazon introduced AWS for Health, an offering of curated AWS services and AWS Partner Network solutions.
- US FDA granted breakthrough designations to several digital health interventions including Biofourmis’ heart failure digital therapeutic BiovitalsHF and Philips’s laser-assisted inferior vena cava filter removal device.
📊Healthcare Chart of the Month:
This chart from IQVIA’s Digital Health Trends 2021 shows proliferation of sensors/wearables in the market for heart rate, steps/distance and calorie count!
🔗Healthcare Tweet of the Month:
This tweet shows a patient journey in which the genome of a patient with the condition was sequenced and a diagnosis made within 13 hours, leading to informed treatment.
📘Healthcare Long-read of the Month:
This article about the 16000 missing cases from UK’s contact tracing system is worth your time!
