Rising Standards, Open Systems: Brainstorming What’s Next for Data Sharing in Healthcare

with Matthew Galetto, CEO at MediRecords and Koray Atalag, CHIO at The Clinician

In this special addendum to our interview with Matthew Galetto, Koray and Matt chat through the impact of standardisation on health data and the possibility of a truly untethered patient record.

Koray Atalag: The patient portal was the fashionable thing—so to speak—around the mid-2010s, and everyone, especially the PMS (practice management system) vendors, started to implement their own patient portals.

But these portals were all very limited: they didn't allow for other systems to connect, they were tightly coupled with their own particular PMS or EMR (electronic medical record) system. And some of those patient portals are, more or less, still in use.

But with all the current innovation going on, and these best of breed systems handling prescriptions, or providing patients with an understandable version of their discharge summaries, or patient tracking apps—the list goes on—I think the new trend is to actually open up your system and then create your own ecosystem of applications for the use of FHIR and terminology standards.

So the trend over the past several years has certainly been creation of these ecosystems, but again it's a way for vendors to create their own niche—to select partners and then create that innovation and bundle those different apps together to create more value.

MediRecords, but also the big EMR vendors like Cerner, Epic, Allscripts—they all have their own marketplaces. And the good thing is, when you use FHIR it's like you cut once and then use many times.

Do you see this happening without the drive from government, but instead just because it creates value to vendors and partners regardless of whether there's a regulatory push?

That might be wishful thinking, but it's certainly what the FHIR community is hoping for.

Matthew Galetto: We're certainly confident that long term, regardless—with regulation or without, in all honesty—we will see the marketplace mature in the way you've described it.

And not too dissimilar to what you might see in other verticals: finance, accounting, task management tools, those sorts of things.

In fact, we're building that capability in our system at the moment where we will support not only the marketplace, but also a system within the MediRecords product itself that supports the workflow from the MediRecords system to a third party, and back.

I’m talking about maybe a custom field that sits within the application being attached to the patient record, that will allow the end user to click on the field and push out (through single-sign on), automatically move onto that system, take all the workflow they need in that third party system, and then have that information flow come back.

As you know, MediRecords operates across a number of different settings, and from what I’m seeing I think the public hospitals or state and federal government agencies seem to be much more forward-thinking than the private sector.

We've got cloud-first policy sitting in with most of the state health jurisdictions now, with the state governments and therefore their health ministries. Federal government is also adopting cloud-first, and even tenders issued by the defence ministry, while they have all those requirements for managing security, they are still looking at cloud-enabled solutions as well as on-prem solutions—they know they need to transition from on-prem to cloud.

In terms of the private sector and the GP market, I struggle a bit because I don't see the driver. I don’t see the driver through the association that represents the industry and I don't see enough of the driver from other areas.

We always talk about ‘democratisation of the patient record’ and the patient having control and convenience and access to their information. We talk about how that's going to be a driver, but we’ve been talking about that for a long time...

So I'd like to think the consumer is going to drive some adoption, perhaps with the next generation. I've got a 22-year-old son and he doesn't like to go to the doctor. He's looking for convenience and telehealth and wants access to his records and can’t believe how difficult it is.

But I think if a big private corporate group makes the change and demonstrates the power of this next generation of health technology, if they were to achieve some of the commercial outcomes they would be expecting from the investment: efficiencies, workforce optimisation, patient loyalty and engagement, then that could also be a driver.

My thesis is that it's going to be a step change, driven by government through regulation or big corporate, that will shift the industry.

Koray Atalag: Yes, I think it's not too surprising given the fact that in the Commonwealth countries we have so much more dominance of the government sector on regulation and on setting up the commercial frameworks. Probably the US will be at the opposite end.

But the good thing is that the standards support all stakeholders, no matter what your motivation or powers might be.

One last point that I'd like to raise...

There is an interesting organisation in in the Netherlands called The Patient Federation. This organisation represents more than 200 different patient groups and patient organisations, some of which are condition-specific: cancer survivorship, heart failure management, etc.

So these 200 or so individual patient groups have actually been conglomerated under the Federation. It has its own budgets, strategy report, roadmap and they are running tech innovation projects, mainly focusing on patient empowerment, patient engagement, and this patient-centric new wave of medical revolution, I suppose. It completely changes the dynamic from provider-centric to a consumer-driven approach.

And there are similar initiatives in the Nordic countries. I really think that it will be feasible.

We have our bank accounts and the SWIFT system and everything just works, because the finance sector actually solved this problem four decades ago. I want to think there will be similar independent ‘health record banks,’ if you like. That’s a term that was actually coined by IBM back in 2000s—way ahead of its time and it didn't take off,

Do you anticipate that a completely non-PMS or non EMR-tethered patient record or a PHR could actually take off in the next five to ten years? How that would affect you as a vendor?

Matthew Galetto: I'm not sure about the big EMR vendors. I guess the question centres in what you're referring to as independent patient health record vaults…

We all want to have access to our patient record, of course, and different countries have implemented different models. In Australia we've got a centralised My Health Record model, I think in Slovenia it's similar, in Israel and Singapore might be similar as well, and the U.S. have got a federated distributed model.

But at the end of the day, I'm not sure it matters where the information is stored, as long as the access is there, and as long as it's real time access as well.

I've never heard of the idea of a patient health record in the way that you've described it, but I'm certainly intrigued by what you mentioned in the Netherlands.

I mean, Apple are essentially trying to do that, aren’t they, through their health record that sits on your iPhone. I'm sure big tech will have a play here.

Microsoft tried to build a health record. I think most of the big tech companies have given it over a go in the past, and the challenge was that they couldn't receive the data from anywhere because there were no standards, but now the standards are coming into play.

The silos are being broken down and, probably more importantly, there’s now regulation that dictates a patient should have access to their information, and potentially some of the business models have been broken down as well. So yes, it's entirely possible.

Read our full conversation with Matthew Galetto of MediRecords.