In a recent note (see: What Is Digital Health and How Does a Health System Get There?), I began a discussion about the medical information systems of the future which I am calling digital health managers. This note was grounded in the "what" question of digital health. In today's note, I want to explore the "how" question. In my opinion, there will be two separate but interconnected digital health platforms: the personal health manager (PHM) and the organizational health manager (OHM).
PHMs will resemble the current Apple health ecosystem (see: Using the Apple Ecosystem to Support Health Research and Clinical Trials) consisting of an iPhone, an Apple Watch, and various diagnostic devices that can connect with the iPhone such as Omron Evolv Bluetooth Wireless Blood Pressure monitor and ECG monitors such as the six-lead KardiaMobile 6L. Progress in the development of PHMs has been relatively rapid because a company like Apple is not dependent on the permission of EHR vendors nor healthcare executives to proceed with product development.
My vision of the OHM of the future is cloudy because there are no extant systems. It's also not clear how potential OHM manufacturers will deploy their prototypes in hospitals. However, I am confident that some health system executives, dissatisfied with current and future EHR performance, will volunteer to act as test beds for early prototypes. You may also ask, will today's EHRs evolve into the OHMs of the future? I think that there are five reasons why this will not happen:
- Current EHRs have been designed on the basis of, and form a continuum with, the paper patient charts of the past. They serve to collect and organize patient data for the use of physicians and nurses and also serve as billing systems (see: What are the advantages of electronic health records?). Collecting current patient information will be an important but a tangential function in digital health. EHRs will persist but will not dominate hospital computing.
- The most important role of these two types of digital health managers will be to generate actionable goals for patients/consumers predicated on the four types of healthcare analytics: descriptive, diagnostic, predictive, and prescriptive (see: Diagnostic and Predictive Analytics and Their Possible Link to the Future of the LIS)
- Our current EHRs are provided primarily by companies like Epic or Cerner. They have a quasi-monopoly in the market and provide broad functionality. I anticipate that the digital health management systems of the future will be platforms for apps supplied by a large set of vendors. The breadth and complexity of these AI apps will be such that no one single vendor can succeed in developing all of them. Look at the Apple health ecosystem as a prototype of what will evolve on the hospital/organizational side.
- Consumer-generated health data will be an essential component of the integrated medical record of the future. Up to now, we have often characterized health data collected at home by consumers as inferior to hospital collected data. This attitude is changing as new automated diagnostic devices reach the market that can reliably expand the totality of data describing the health status of an individual.
- The various apps running on these two types of digital health managers will be modularized based on standards so that they can be individually replaced/upgraded without affecting the whole platform. This is essential because the science and technology of AI is changing so quickly as is the availability of the huge data sets on which the most useful algorithms will be based.
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