hData: Electronic Health Records Go Mobile for Better Patient CareFebruary 2012
Topics: Health Innovation, Mobile Technologies
Imagine a future in which mobile access to personalized interactions with medical professionals and one's complete medical history enables patients to better manage their health—everything from chronic ailments, symptoms, and medication regimens to prescriptions, appointments, and just-in-time health education. This would simultaneously improve patient care and reduce healthcare costs.
We're not quite there yet. But with hData, a MITRE-developed standards framework for secure, electronic healthcare information exchange, this future is a step closer to becoming a reality. 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. 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.
"If doctors can engage with patients through devices such as smartphones and tablet computers, this will be a huge breakthrough in improving compliance with treatment regimens," says Mark Kramer, a MITRE principal software systems engineer who works on the hData project. The hData standards for packaging, verifying, and securing the exchange of clinical information were recently validated as draft standards by two standards bodies, Health Level 7 International and the Object Management Group.
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. (See "Enabling Mobile-Assisted Healthcare," below.) That day is coming, and hData will be part of the overall transition from paper records to electronic records.
"RESTful Services" Enable a Mobile Health Data Breakthrough
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."
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."
Simpler Is Better: The Motivation for hData
The health data exchange standards approved by the government today, such as the C32, were designed to provide a clinical summary of patient information. However, these standards are not easy to use for software developers developing data views. "After working with the current standards, including the C32 document, in an internal research project to develop an open source test bed, MITRE realized the need for a simple approach for exchanging health information," says Sleeper. "We need something that a software developer can get up and running in an hour and use to demonstrate a prototype in a couple of hours. Trying to read a patient summary from a C32 document with no errors took four months. This motivated us to to specify hData as we did."
"RESTful Web services enable any specific piece of health data, such as a patient's medication list, to be represented by a URL," Kramer explains. "RESTful is really just a fancy name for the style of information exchange that's widely used on the Web today. So with hData, your medical record, or a part of it, is represented by a unique URL."
Accessing these URLs requires authentication to keep the data secure. "You, your doctor, or your insurance company would come through a security gateway and make an online request for the data, and it comes back in the requested format for your specific device."
While it isn't yet common for patients and doctors to interact via mobile devices to manage chronic ailments, with hData the technical building blocks are in place to enable this transformation to occur.
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. hData is well-aligned with the way mobile devices already communicate."
With hData servers able to access patient information, a single clinician can monitor hundreds of patients electronically for compliance issues. "Doctors can monitor patients' progress through their mobile devices, communicate through hData-enabled servers, and proactively push alerts to patients or even trigger a request to send a healthcare worker to someone's house, if the situation warrants. So it's not just the patient and his device, but also health practitioners getting actively involved."
As hData moves closer to becoming an official standard (see "The Evolution of a Healthcare Standard"), MITRE's Sleeper envisions a future in which patients play a better-informed and more active role in their own medical care.
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.
"We know these capabilities will eventually be available on a broad scale. What hData, and MITRE's research program in general, tries to do is demonstrate the future, identify gaps to be filled enroute, and make this innovation happen faster."
—by Maria S. Lee