Medical Records on Mobile Devices for Better Healthcare
Imagine a future in which mobile devices such as iPads and Android devices can provide personalized interactions with medical professionals and one's complete medical history. This makes people empowered to manage their own health -- everything from chronic ailments, symptoms, and medication regimens to prescriptions, appointments, and just-in-time health education. The doctors then have a world of resources from the latest publications, complete drug and disease reference, and a patient's full history literally at their finger tips.
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We're not quite there yet, but we are quickly moving in the right direction. Why is mobile access to healthcare data important? Many doctors believe one of the biggest obstacles to improving U.S. healthcare is non-compliance with prescribed medical treatments. This is also very true in developing countries and is critical to the control of diseases such as HIV and tuberculosis. According to an estimate by the World Health Organization, "more than 50 percent of all medicines are prescribed, dispensed, or sold inappropriately, and half of all patients fail to take medicines correctly." Making doctor-patient communications as easy as tapping on a smartphone screen holds the promise of greatly improving health outcomes. These technologies should be done throughout the world.
Before mobile-assisted healthcare becomes the norm, however, more healthcare professionals will need to adopt interoperable electronic health records, or EHRs, to manage patient care. The nation will also need to adopt a data standard that can support the exchange of discrete pieces of health information -- much as we do with other types of data on the Internet today.
"RESTful Services" Enable a Mobile Health Data Breakthrough
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MITRE has been working on a mobile health system with support from the US government named hData. "The hData standard functions using the same types of Web-based services used by Amazon, Facebook, and Google to enable thousands of independently developed applications to access and manage large volumes of data. hData would allow for the secure exchange of data on a national scale, in a format that works for all parties -- patients, doctors, hospitals, insurance companies, and others involved in the health of a patient. This architectural approach, known as "RESTful services," simplifies the process of exchanging medical data on mobile devices, says Harry Sleeper, leader of MITRE's Open Services department. RESTful Web services are simple, low-cost to deploy, and can scale to millions of users, which is why they are used by the likes of Facebook and Google."
Other fantastic low cost services for health deployment on mobile devices are available on OpenMRS.org. This is a software platform and a reference application which enables design of a customized medical records system with no programming knowledge (although medical and systems analysis knowledge is required). It is a common platform upon which medical informatics efforts in developing countries can be built. The system is based on a conceptual database structure which is not dependent on the actual types of medical information required to be collected or on particular data collection forms and so can be customized for different uses.
OpenMRS is based on the principle that information should be stored in a way which makes it easy to summarize and analyze, i.e., minimal use of free text and maximum use of coded information. At its core is a concept dictionary which stores all diagnosis, tests, procedures, drugs and other general questions and potential answers. OpenMRS is a client-server application, which means it is designed to work in an environment where many client computers access the same information on a server.
There are several layers to the system. (Warning, geek-speak ahead!)
- Our data model borrows heavily from the Regenstrief model, which has over a 30-year history of proven scalability and is based on a concept dictionary.
- The API (application programming interface) provides a programmatic "wrapper" around the data model, allowing any developer to program against more simplified method calls rather than having to understand the intricacies of the data model.
- The web application includes web front-ends and modules that extend the core functions -- these are the user interfaces and applications themselves built upon the lower levels.
- Enabling Mobile-Assisted Healthcare
Why can't you get your medical records on your smartphone or tablet yet? In large part, it's because most health data is not readily available electronically. There is a federal mandate for doctors and hospitals to use electronic health records, or EHRs, to allow easier access to medical information by medical personnel involved in patient care, but progress has been slow. In many cases, even when medical information is available electronically, it often isn't in a form that's readily understandable by patients and clinicians.
This means the so-called "meaningful use" of EHRs by clinicians and hospitals using fully integrated medical information systems remains somewhat uncommon. Less than a quarter of U.S. doctors today have access to fully integrated EHR systems, although economic incentives are rapidly increasing that number. MITRE's Center for Transforming Health works in numerous areas to support the transition from paper records to EHRs, from developing standards like hData to serving on advisory bodies with government, industry, and academia. Although mobile management of health data by patients remains an elusive goal -- it's a goal that's on the horizon and achievable in this decade. With the hData standard, medical records present content in a tiered structure that allows for fast and secure access to only the specific data needed at a given time, such as information on a patient's allergies or medications. "Doctors accessing health data on mobile platforms should not have to download an entire clinical record. They just need to access, or link to, the information they need to make a safe medical decision for a patient. This is a core concept in hData."
"Today, the data isn't available electronically like numbers in a bank statement, where all readers can easily understand it," Sleeper adds. "The challenge is: How do we make our medical records available for computational use like we do with social data on Facebook? What hData tries to do is make health data securely accessible so that machine processing and innovative smartphone applications are much easier to build and deploy."
Improving Medical Compliance through Mobile Alerts
A perfect example of this is the set of tools available for mobile management of diabetes. While smartphone apps exist today to perform functions like reminding people with diabetes to check their blood sugar, a stand-alone app doesn't address the larger problem of improving compliance with a doctor's orders. "Today, you can get a Bluetooth-enabled glucose monitor," Kramer says. "This can talk to your smartphone.
Kim Warren, the technical director of MITRE's overall healthcare research program, sums it up by saying, "We believe healthcare applications and services will allow people to manage their complete health information in ways that are most useful to them. For example, a mother -- as the healthcare manager for her extended family -- might use her computer to manage information for herself, her spouse, her kids, and her elderly parents, and then take that environment mobile for coordination with her care providers via her tablet or smartphone.