Lab Soft News

Big Pharma Wants Your DNA (But What Will They Do With It?)

It's never been a secret that the consumer DNA labs like 23andMe have always intended to sell their anonymized data to other parties such as pharmaceutical companies (see: Helix Makes DNA Sequencing Available to Consumers;Where Do We Go From Here?,23andMe Customers: Suckers or Empowered Consumers?).This has always been the rationale for offering DNA testing to consumers at very low prices. After a few years, the details of such deals are beginning to emerge. A recent article spelled out some of them (see: Big Pharma Would Like Your DNA). Below is an excerpt from it:

...[T]his week’s announcement that GlaxoSmithKline is investing $300 million in 23andMe and using the DNA company’s de-identified, aggregate customer data for drug research is very much in keeping with the long-term business plan. You don’t make that kind of money selling $99 spit kits. 23andMe customers can opt of out their data being used in research, but the vast majority of its 5 million customers have opted in. The deal comes at a time as pharmaceutical companies are increasingly looking to DNA for new drug ideas. In 2015, 23andMe announced its first partnership with a pharmaceutical company—in which it would study Parkinson’s with Genentech.... Elsewhere in the world, the Icelandic biopharmaceutical company deCODE has sequenced over half of Iceland’s adult population to identify genes associated with diseases. deCODE was acquired by Amgen and then the Chinese pharmaceutical company WuXi in 2015. A consortium of six big drug companies—AbbVie, Alnylam, AstraZeneca, Biogen, Pfizer, and Regeneron—are paying to sequence all the genes from 500,000 participants in the U.K. Biobank, in exchange for exclusive access to the data for 12 months....Regeneron also partnered with Pennsylvania’s Geisinger Health System to sequence 250,000 of its patients. The idea is to leverage large datasets to find people with unusual mutations that can point to targets for new drugs. The best example of this is a gene called PCSK9, which scientists in Texas found by chance when studying people with unusually high and unusually low cholesterol.

It's apparent that various pharmaceutical companies have negotiated multiple types of deals for DNA data acquisition. However, it's important to keep some details about DNA testing in mind such as that 23andMe performs DNA sequencing and not genotyping. Here is an explanation of this difference from the company web site (see: What Is The Difference Between Genotyping And Sequencing?):

Sequencing is a method used to determine the exact sequence of a certain length of DNA. You can sequence a short piece, the whole genome, or parts of the genome (such as the “exome," which are the regions of the genome that contain the the instructions for RNAs ...and proteins. Depending on the region, a given stretch of sequence may include some DNA that varies between individuals, in addition to regions that are constant. Thus, sequencing can be used to genotype someone for known variants, as well as identify variants that may be unique to that person. 23andMe uses genotyping, not sequencing, to analyze your DNA. Sequencing technology has not yet progressed to the point where it is feasible to sequence an entire person’s genome quickly and cheaply enough to keep costs down for consumers. 

Obviously, sequencing data from 23andMe is less valuable than genotyping data but can still be very useful. Moreover, obtaining DNA data from 23andMe is limited by the fact that the accompanying clinical data is self-reported by customers. In comparison, the sequencing data that Geinsinger Health System is providing to Regeneron has the potential to be linked to the health system's EHR data (see: REGENERON AND GEISINGER HEALTH SYSTEM ANNOUNCE MAJOR HUMAN GENETICS RESEARCH COLLABORATION). Nevertheless, the scientists employed by pharma companies will have a priori hunches about the genetic basis for the various diseases they are investigating so they are not starting from scratch. Having only sequencing data plus some medical history from large consumer samples can thus be extremely valuable. We are only now seeing the early forms of collaboration between pharmas and the providers of DNA data; it can only grow more sophisticated as time passes. 

CMS Adds Home Monitoring Reimbursement to Home Health Payments

I have blogged previously about the growing decentralization in healthcare with an increasing number of services provided away from hospitals and with movement toward consumer homes (see: TEN MAJOR TRENDS FACING THE HEALTHCARE INDUSTRY IN THE AMBULATORY SPACE ON A FIVE-YEAR HORIZON; Mobile Health Teams as a Variant on the Theme of Decentralized Acute Care in the Home). New technology is providing cost-effective and useful solutions in terms of home monitoring devices (see: Top 10 Remote Patient Monitoring Companies for Hospitals).

A key element in the success of new ways to deliver healthcare has always been whether reimbursement for new models of care is available. CMS has proposed changes to the Home Health Prospective Payment System that would provide incentives for the use of remote monitoring devices (see: CMS Proposal Adds Remote Patient Monitoring in Home Health Payments). Below is an excerpt from a recent article on this topic:

In [a recent announcement]..., the agency stated that these changes will advance its efforts to put patients over paperwork and prioritize value-based care....Specifically, CMS proposed to allow home health providers to include remote patient monitoring tools as an allowable Medicare cost. This means providers could be compensated for using some remote patient monitoring technologies, making a financial case for the patient engagement tools. CMS defined remote patient monitoring as “the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the [home health agency]....Allowing Medicare patients to receive more care and treatment from the comfort of their homes may have a positive impact on patient satisfaction and quality of life. Research indicates that more patients want to age in their own homes, rather than receive complex treatment inside of a medical facility. Remote patient monitoring makes that preference possible by allowing clinicians to track important patient metrics from afar. When a patient does need in-person medical attention, remote patient monitoring devices typically alert the clinician to the issue, making care seamless for patients.

All of this activity suggests that healthcare professionals will soon be facing a deluge of clinical data, some of which will need to be monitored. However, I have an inkling that hospitals will be slow to embrace home health monitoring and that large companies like UnitedHealth may be leaders in the field. I base my prediction on the following ideas:

• UnitedHealth is already functioning as a major service provider with its rapidly expanding MedExpress business unit (see: UnitedHealth plans to bet bigger in Texas).
• Health data monitoring requires sophisticated information technology. UnitedHealth has this capability with its Optum division that is already providing IT consultative services to hospitals (see: Optum Expands I.T. Services to Help Hospitals Modernize Their Technology Infrastructure, Meet Rapidly Changing Needs of Care Providers and Patients). 
• Companies like UnitedHealth have access to large amounts of investment capital that will be necessary to provide home health data monitoring services.
• Home data monitoring will require sophisticated algorithms to scan incoming data and issue warnings when intervention is necessary, which also requires capital investment to develop. 
• Home data monitoring will yield abundant patient referrals when rapid intervention is necessary which blends nicely with UnitedHealth's MedExpress division of urgent care centers.

I don't mean to suggest with these points that hospitals and health systems will be locked out of the home monitoring market. As I have noted previously, bedless hospitals are being configured as data-oriented centers and would be ideally suited for home monitoring (see: Some Additional Ideas About the Bedless Hospitals of the Future; The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology). Moreover, it will be the hospitals and health systems that have responsibility for most of the patients being monitored so they will be, by default, the organizations with the first opportunity to provide home support.

Google, Facebook, Twitter, and Microsoft Pursue Portability Among Web Services

I have been blogging about interoperability between hospital EHRs for nine years. Here's my first note that used this term: Do Hospitals Really Want Interoperable E-Health Records?. I believe that patients should have the right to download a copy of their EHR records and be able to provide it to other hospitals when necessary. This is sometimes referred to as health data portability (see, for example: Hospitals as a Major Barrier to the Pursuit of EHR Interoperability). Warning: if x-ray and pathology test results and digital images are included in such a download, such files may be huge. However, you can now buy a four terabyte external drive for $120. In this same light, Google, Facebook, Twitter, and Microsoft have now initiated a Data Transfer Project, offering data portability between and among these web services (see: Google, Facebook, Twitter, and Microsoft unite: Data Transfer Project promises portability between services). Below is an excerpt from the article:

Many...should be familiar with Takeout, ostensibly now called "Download your Data," which allows you to back up a copy of all the information associated with your account for most of Google's services. Right now you can even use it to transition your Drive storage between providers, but thanks to the upcoming open-source Data Transfer Project....that data may someday be as portable as your phone.... [T]he GDPR mandates data portability so Google didn't have much of a choice—though it could have easily made a minimum, token effort. With Facebook, Twitter, and Microsoft jumping on board for compatibility, the project is making significant progress. The Data Transfer Project can't unify the different proprietary APIs used by services across the web, but it can make tools that are inter-compatible between them, providing developers and users with a set of standardized data formats. So far the project has constructed adapters for seven different services across five data types. It doesn't require anything so tedious or insecure as a manual download and subsequent re-upload, either. The Data Transfer Project allows for services to make the transfer between themselves directly, service-to-service, using a high-security protocol and privacy-protecting encryption. And since it's open source, the code can be inspected and audited by researchers and enthusiasts alike to ensure that user security and liberty is being protected. You can even review, download, and run the framework yourself for your own projects if you so choose....Contributors have already built support for photo, mail, contacts, calendar, and task data formats for APIs available from Google, Microsoft, Twitter, Flickr, Instagram, Remember the Milk, and Smugmug. 

Don't expect to be able to download your medical records any time soon and I am not actually advocating for such an option. However, EHR interoperability among hospitals is critical, particularly for patients with unusual diseases or aggressive neoplasms (see: Promoting Interoperability (PI)). In these latter cases, such a record transfer should include all available digital imaging studies from both radiology and pathology, if available (see: FDA Approves the Philips Digital Pathology WSI Solution for Primary Diagnosis). Incidentally, second opinions for complex cases, particularly cancer patients, are increasingly common and should be reimburable (see: Subspecialty Second Opinions Often Critical to Patient Care). These costs could be waived if the patient is transferred to the consulting hospital. Incidentally, providing co-access to a patient's EHR records in the case of a local hospital and a cancer center would be an ideal scenario for improving the diagnosis and continuing care of cancer patients throughout the country.

Sunquest Announces the Integration of Its AP-LISs with Its Genetic Analysis System

The modern laboratory information system (LIS) evolved in the late 1970's and was a "turn-key" system designed to manage test results from the chemistry and hematology labs using interfaces to the analyzers in these two labs. This market need was driven by the large amount of data generated in these labs and also because numerical data was relatively easy to manage and report as opposed to textual data. The earliest anatomic pathology systems, now referred to as AP-LISs, were initially similar to word processors and were designed to publish surgical pathology reports.

LISs, managing mainly numerical data from CP labs, and AP-LISs, to use the modern term, evolved on different paths. I have posted a number of notes over the years calling for closer integration between the disciplines of clinical and anatomic pathology (see: Integration of Anatomic and Clinical Pathology) and also their computer systems two unify the specialties. This is not an unreasonable goal because there has always been a high degree of integration in the field of hematopathology with these practitioners knowledgeable about both the morphology of normal and abnormal blood cells as well as the interpretation of the various tests from the hematology lab.

The rapid progress in molecular pathology and genomics now requires that surgical pathologists have a deep understanding of the morphology of malignant lesions as well as the molecular and genetic tests performed for these patients. A recent press release by Sunquest announced that its two anatomic pathology systems, PowerPath and CoPathPlus can now be integrated with its Mitogen Genetic Analysis tool (see: General Availability Sunquest Anatomic Pathology Solutions Can Now Integrate with Sunquest Mitogen Genetic Analysis). Below is an excerpt form it:

With the availability of this integration, AP labs conducting next-generation sequencing (NGS) can now benefit from integrated, actionable reporting, combining the power of our pathology-focused LIS and our genetic variant annotation and interpretation offering. More specifically, labs integrating AP and genetic reporting will benefit from:

• Single, integrated reports... that combine pathology and genetic testing results

• Elimination of manual and duplicate data entry in multiple systems

• Contextual access to results

•[Unlocking] the power of AP and genetic data in one solution

•[Unlocking] efficiency and ...[reducing] turnaround time

•[Improving] patient care and safety with diagnostic insights from combined resulting

Surgical pathology, from its earliest years, has been based on the the gross and microscopic appearance of a lesion plus additional information that could be gleaned from, say, special stains to arrive at a diagnosis of a lesion. This was particularly true in hematopathology. Surgical pathology is now being transforming such that the molecular and genetic analysis of a lesion, particularly tumors, will soon be the major factor leading to a diagnosis with the morphology used to confirm these conclusions. The term AP-LIS will thus shortly become obsolete with one information system in place in pathology departments -- the LIS.

It's Time for the Integration of Virtual Health Services Based on a Timeline

I was struck by a passage in a recent article about the rapid growth of virtual health services for the majority of encounters at Kaiser Permanente, for example, falling into this category (see, for example: (see: In-Person Health Care as Option B). Below is one key passage from this article:

Progress in this direction is already under way. At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.” The organization has been able to innovate in this area in part because it spends about 25% of its annual $3.8 billion capital budget on information technology. Nevertheless, these virtual visits only scratch the surface of what’s possible with today’s technology. Virtual visits involve secure email and video engagement, and the patient–clinician interaction time required is similar to that of an in-person visit. Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome.

Although I have commonly used the term telemedicine to refer to remote care with a telelink, I now think that the term virtual care is superior for all e-services. The former term, focusing on face-to-face interactions, ignores many of the elements of virtual care including email, instant messaging, e-prescriptions, and home monitoring. Moreover and going forward, I believe that the major challenge to the growth of virtual care is to define the various elements contributing to the virtual care of a pateint. They then need to be integrated into a cohesive work flow. 

One way to visualize an end-to-end virtual care process is to represent the various elements on a time line. At various points on such a time line, processes such as a televisit, an e-prescirption, and home monitoring of vital signs can be represented. The passage quoted above also suggests that there is a linkage between the rapid growth and success of virtual care at Kaiser Permanente and the percentage of the health system's budget allocated to IT. I think that this may not be an appropriate line of reasoning. I would rather compare virtual care to standard care in terms of clinical efficacy.

Data Breach Reported at LabCorp, One of the Two Largest Reference Labs

LabCorp, one of the nation’s two largest reference labs in the U.S., is investigating a security breach that could have put health records of millions of patients at risk (see: LabCorp Investigates a Possible Data Breach). The company, in a filing with the Securities and Exchange Commission, says it detected “suspicious activities” on its network the weekend of July 14 and “immediately took certain systems offline as part of its comprehensive response to contain the activity.” LabCorp says it has not yet discovered any evidence of the unauthorized transfer or misuse of data it holds. The company added it has notified authorities and will cooperate in any investigation. 

Data breaches are not unknown for reference labs. In December, 2016, Quest Diagnostics, LabCorp's major  competitor, announced that an "unauthorized third party" hacked into the MyQuest patient portal, accessing protected health information (PHR) for about 34,000 patients including name, date of birth, lab results and in some cases, phone numbers (see: Quest data breach exposes private health information of 34,000 patients). It said the breach did not include Social Security numbers or credit card, insurance or other financial information. MyQuest is used by the patients of physicians who submit specimens to Quest to view their personal test results.

Update on 7/30/2018: LabCorp still recovering from ransomware, won't say if it's SamSam

 

Orchard Offers Trellis to Manage Point-of-Care Testing for a Laboratory

Point-of- care testing (POCT) is becoming increasingly important for health systems as healthcare becomes even more decentralized (see: TEN MAJOR TRENDS FACING THE HEALTHCARE INDUSTRY IN THE AMBULATORY SPACE ON A FIVE-YEAR HORIZON; Mobile Health Teams as a Variant on the Theme of Decentralized Acute Care in the Home). Patients are being served via telemedicine visits or in smaller ambulatory care settings such as walk-in clinics in retail drug stores. Remarkably, some surveys show that patients are often more accepting of telemedicine than physicians (see: Telemedicine is getting trendy, but doctors may not be keeping up).

In a parallel fashion, some lab testing is being transferred from central labs in hospitals or bedless hospitals (see: The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology; Some Additional Ideas About the Bedless Hospitals of the Future) to POCT devices (see: Does Point-Of-Care Testing Save Money or Cost More?). In addition to the oversight of central labs, pathologists and laboratory scientists are thus facing the prospect of managing hundreds of decentralized small analyzers. Compounding this complexity is that the operators of POCT devices are not usually pathology employees or extensively trained in lab QC.

In response to this challenge, Orchard Software offers a POCT management product called Trellis that is interposed between the POCT devices and the LIS/EHR. Here is a description of Trellis copied from the Orchard web site:

Orchard Trellis is an advanced POCT management and integration software solution that provides remote administration of all POCT activities across multiple locations, including device and operator competency assessment tracking. It transmits POCT results to the LIS and EHR, reducing manual entry errors and automating POCT billing. Trellis offers a high level of flexibility in its implementation for various POCT scenarios that enable your POCT program to help providers make faster clinical decisions, include POCT results in analytics, and promote patient satisfaction.

With regard to Trellis, I can't help harking back to the early days of LISs in the 1980's. At that time, the LISs mainly supported clinical labs like chemistry and hematology. A large portion of the core competencies of LIS vendors at that time was their ability to create interfaces with the analyzers manufactured by the IVD vendors. Now, most LIS vendors no longer provide such interfaces but allocate this responsibility to specialized interface vendors like Data Innovations that calls itself a "middleware" company. 

I suspect that Trellis may offer much greater functionality than the best-of-breed LISs regarding support for POCT devices in order to be successful. I am also struck by the reference in the Orchard web site regrading Trellis that it provides "operator competency assessment tracking." This is obviously a very important feature. For decades, pathologists have been concerned about the performance of some of the operators of POCT devices. I believe that walk-in clinics in drug stores will soon provide a much larger menu of POCT lab tests and the issue of operator competency will become even more important. 

Development of a Web-Based Educational Program for the Training of BRCA Carriers

We are in an era regarding genetic and molecular testing when it is often insufficient to simply report certain test results to clinicians and their patients. Sophisticated patient education may then be necessary in order for the patient to understand the implications of certain positive lab results. A perfect example of this is the identification of BRCA carriers. Such patients need to be informed about the implications of their genetic status and their possible responsibility to untested blood relatives. A recent paper discussed the development of a Family Gene Toolkit to achieve such an educational goal (see: Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relative), Below is an excerpt from this paper:

....Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer....The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. ....The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication.

With regard to the implications of a patient receiving a positive BRCA report, the first issue is whether lab professionals, as opposed to test-ordering clinicians, have a responsiblity for patient education. For me, the obvious answer is that both have a role and this is undeniably the case in large health systems where both lab personnel and clinicians are employees of the organization and have a shared obligation for optimal utilization of lab results. Reports of lab test results such as those relating to molecular diagnostics and genomics may often be so complex that we cannot merely issue a report. We often need to educate patients about the subsequent steps that they need to take in response to positive test results. 

Although delivering written documentation about the implications of certain positive tests results to clinicians and patients such as BRCA are necessary and appropriate, I particularly like the approach described above in connection to the Family Gene Toolkit that involve offering live webinars and a follow-up phone call by a certified genetic counselor and an oncology nurse to patients. It's a means to educate large numbers of patients simultaneously and is both cost-effective and necessary given the scarcity of trained professionals in this area. I do not subscribe to the idea that sole mission of hospital labs is to report test results. We also need to ensure the some degree of followup if and when it is necessary.

HPV Test Superior to Pap Smear for Detecting Precancerous Cervical Changes

A recent article indicated that HPV testing is superior to the Pap smear for detecting precancerous lesions of the cervical epithelium (see: HPV test is better than Pap smear at detecting precancerous cervical changes). Has the Pap smear outlived its usefulness in cancer screening programs? Below is a key passage from the article:

A new study found that the HPV test was better than the Pap smear in detecting precancerous changes that can lead to cervical cancer. A test for HPV detects precancerous changes of the cervix earlier and more accurately than the Pap smear....The randomized, controlled study...showed that the human papillomavirus test is more sensitive than the Pap smear, a widely used test that has been a standard part of women's preventive health care for decades but has several drawbacks. Several experts predicted the results would spur efforts to entirely replace the Pap test with the HPV test....Over the last several years, as experts learned more about HPV's role in cervical cancer, most medical groups have recommended that women in the United States get both the HPV test and the Pap smear — a practice called "co-testing." Now, armed with the new and previous studies, some experts say the Pap smear should be dropped. But others disagree, saying that the Pap smear can catch a small number of cases of abnormal cells that might be missed by the HPV test and that co-testing should continue.

I think that it's premature to draw conclusions about the future of the Pap test at this time. It seems likely, at least for the near term, that a common course of action will be co-testing of patients, ordering both a HPV test and a Pap smear. Here's some useful advice extracted from an article that addresses this question from the perspective of a developing country, Brazil (see: Cervical cancer screening: from Pap smear to future strategies). Here is a quote from this article:

Primary HPV screening is an attractive option to health service because the results are not subject to inter-observer variation. However, it requires equipments, reagents, personnel, training, quality control and accreditation. This scenario is far from the real world in different populations, even in developed countries, considering that many women will be screened or may never be screened at all. We must remember the fact that the system for cervical cancer screening with both the Pap test and the HPV test is already working in many practices. There is no reason to disrupt such an operative scheme that is working successfully without adequate evidence of additional benefit of primary HPV screening. Further data are needed on the actual benefits and costs and the impact on the use of colposcopy and other diagnostic tests.

One thing is certain: the number of Pap smears, once a key component of cytopathology, will decline. However, nongynecological cytopathology will continue to grow in part because the sophistication of acquiring tissue samples from various organs will increase. Here's an interesting quote from an article about the expanded role of imaging as it relates to nongynecological cytopathology (see: Expectations and Projections for the Future of Nongynecolgical Cytology 10 Years Ago: Did They Materialize and How Did We Do?):

Guided FNA is usually performed by radiologists, and interventional radiology has grown exponentially during the last decade. Pathologists, clinicians, and surgeons still perform aspirations, mainly with the use of ultrasound guidance. One field that has expanded significantly is the cytomorphology of endobronchial ultrasound (EBUS)-guided FNA that allows for material to be obtained from the lung and mediastinal lymph nodes for the diagnosis and staging of lung (and other) cancer. This creates new opportunities for cytology, especially with the practice of rapid on-site evaluation (ROSE) to verify the quality of the material, thereby facilitating the collection of proper material for ancillary techniques. The role of core-biopsy is still the same in breast, prostate, liver, and soft-tissue tumors, among others. In many situations, this methodology complements FNA. 

Cleveland Clinic and Apple Make EHR Data More Broadly Accessible via iPhones

I have reported previously about Apple's efforts to provide access to EHR data using iPhones (see: Apple Has Plans to Copy EHR Records to iPhones and Apple Watches). I must confess that I was pessimistic about this initiative but it turns out that positive results are now being announced, at least by one hospital (see: Cleveland Clinic puts EHR data onto iPhone with Apple Health Records). Below is an excerpt from the article announcing that Cleveland Clinic patients can access portions of their personal health records via iPhones. Below is an excerpt from the article:

....[T]he [Apple] Health Records feature...together with Cleveland Clinic's version of the Epic MyChart app, offers patients more comprehensive mobile access to their own health data and a way to manage appointments, message their physicians and more, officials said....Synced together and updated in tandem, the MyChart and Health Records apps will let iPhone users access their personal health information – allergies, conditions, immunizations, labs, medications, procedures, vitals – and organize it alongside health data from other providers. They'll also be view upcoming and past appointments, physician notes and details about hospital admissions. They can schedule appointments, request medication renewals and preventive care procedures and message their providers as well. The apps will enable patients to "track important health factors, such as weight or cholesterol or blood sugar, to determine their own personal trends over time," added Dr. Amy Merlino, Cleveland Clinic's chief medical information officer.....Cleveland Clinic was not among the initial 39 health systems to first launch the Apple Health Records service, but it's little surprise that the innovation leader has been quick to embrace the technology. The health system has a long history of developing apps for its patients, and it has made patient engagement and experience a centerpiece of its mission.

This article answered a question that was in my mind by noting that the Cleveland Clinic Health Records app was synced with its Epic MyChart app to provide patients with various type of data including lab test results, medications, immunizations, and physician notes. The article also notes that the Cleveland Clinic was not one of the first health systems announced as launching the Apple Health Records service but now seems to have surged ahead of other hospitals. I also found it interesting that this article about the Cleveland Clinic makes no mention of the term "patient portal" although I would have expected to appear. Perhaps it's going out of fashion with the new types of patient access being announced including the use of iPhones.

I have seen various reports that some large percentage of patients have not been taking advantage of their patient portals, particularly those who are older (see, for example: Patient Portal Adoption for Older Adult Patients Reaches 50%). This experience may reflect lower computer literacy among older healthcare consumers. However, this news above about access to Health Records/MyChart via iPhones is encouraging. Patient adoption of apps for health data access will be a combination of factors such as the functionality off the app, ease of use, patient education programs, and computer literacy. I personally use the MyChart app frequently and the ability to make appointments, get prescription renewals, and to review prior test results has saved me hours of wasted time on a yearly basis. This story can only keep getting better.