Wednesday, March 23, 2016

CareKit as an Enabler for Patient Generated Healthcare Data

As we move from fee for service to alternative payment models/value-based purchasing we will increasingly measure our progress based on outcomes and total medical expense.

HealthKit was an enabler that led Beth Israel Deaconess to create BIDMC@Home, an iPhone and iPad app that uploads internet of things (blood pressure cuff, glucometer, scale, activity, sleep data etc.) to our electronic health record.

CareKit, announced by Apple this week, takes us one step further on our wellness-focused journey.

Our vision is that objective data such as weight and blood pressure needs to be combined with subjective data such as activities of daily living, mood, and adherence to care plans in order to create a true measure of outcome.

If you take  your beta blocker for blood pressure control but feel listless and unmotivated, that is not a good outcome.

Apple’s middleware (HealthKit, Research kit , Carekit) has enabled us to connect devices in BIDMC patient homes and this Summer will enable us to collect answers to clinician generated questionnaires with dashboarding of the subjective and objective combined results.

We believe that mobile devices such as iPhones will become the predominant means by which patients interact with BIDMC.    Your phone will be the repository of your medical record, the means by which you collaborate with your provider, and the vehicle for submission of data to your care team.

Today, 80% of all BIDMC publicly available resources (websites, portals) are accessed via mobile devices.  The desktop is dead.   The phone is the future.

Kudos to Apple for enabling simple integration of devices in the home, collection of patient provided questionnaires, and bidirectional exchange of care plans.

I know that the current FBI/Apple security issues are controversial, but if we’re going to use the phone as the means for patients to coordinate healthcare, we need to ensure data integrity.   I support the idea of government entities obtaining cloud-based backups of devices when courts grant subpoenas.   I do not support the idea of compromising the integrity of phones when they are serving as the link between patient devices/patient sourced  healthcare data and providers.

The combination of sensors in the home, patient/family engagement, and security/data integrity is the secret to success in alternative payment models.   We look forward to piloting several new apps in 2016.


Isaac Kohane said...

John, thanks as usual for the thoughtful post. Can you give a brief comparison of healthkit vs carekit for us informatics nerds.

Adrian Gropper said...

Yes indeed, the phone is driving the patient-centered medical record and will merge the highly regulated and siloed world of institutional EHRs with the exceedingly private inputs from our implants, wearables, homes, and social interactions.

With CareKit, Apple is once again showing how privacy can be done right The trusted relationship with our clinicians and decision support sources will gradually shift away from inscrutable and self-absorbed institutional systems to personalized and patient-centered apps on devices that we carry in our pocket and allow us to serve our health records out of our own personal cloud.

John Halamka said...

In response to Zak's question

HealthKit integrates Internet of Things objective data such as blood pressure, pulse ox, weight, and glucometer values with your phone and with trusted apps such as BIDMC@home which sends the data to an EHR/PHR

CareKit is for gathering subjective data such as mood, pain, SF-36, symptoms. You can then show care plans, subjective and objective data on a dashboard. They key components are

• Care Card helps people track their individual care plans and action items, such as taking medication or completing physical therapy exercises. Activities can automatically be tracked and entered using sensors in Apple Watch® or iPhone;
• Symptom and Measurement Tracker lets users easily record their symptoms and how they’re feeling, like monitoring temperature for possible infections or measuring pain or fatigue. Progress updates could include simple surveys, photos that capture the progression of a wound or activities calculated by using the iPhone’s accelerometer and gyroscope, like quantifying range of motion;
• Insight Dashboard maps symptoms against the action items in the Care Card to easily show how treatments are working; and
• Connect makes it easy for people to share information and communicate with doctors, care teams or family members about their health and any change in condition.

Kevin Groff said...

I am curious which devices you decided to put in the home since healthKit supports many and I suspect not all have the same accuracy (e.g. wrist vs arm for BP). Last, the business model. Does BIDMC provide these to inpatients upon discharge as a readmission mitigation strategy? What is the best way to find out the details for your program and how that is similar/different to other patient engagement strategies?