In recent years, we have all grown accustomed to having reams of data at our fingertips. Our financial information is easily accessible through online banking portals. Our business emails are stored in the cloud. And if I want to see how many steps I’ve walked today, I only need refer to the ‘health data’ section of my iPhone.
It may seem peculiar, then, that if I want to access my own medical information, I need to jump through so many hoops. A patient in the UK will need to register for GP online services through the practice they’re registered with. If they want to see their Summary Care Record (basic information including allergies, medicines, etc) they will need to speak to their GP. In the US, the complex network of providers and insurers can make the process nothing short of byzantine.
The reasons for this are part technological, part ideological. On the technological side, allowing patients open access to their electronic health records poses challenges around interoperability and data security. And on the ideological side, not all doctors are keen on the idea of giving patients this much control, often citing concerns about sensitive items and the potential for confusion or offence.
Why better patient access is a good idea
There is a growing base of evidence to suggest that patient-accessible medical records are the right way forward. At a time when patient-centricity is becoming paramount, empowering patients to take charge of their own data can lead to better care.
“A few years ago, some doctors felt that it wasn’t the best idea to give patients access to their own health records, but I think those voices are quite quiet those days,” says James Balmain, joint CEO of Induction Healthcare. “Everybody now realises there are huge benefits to patients and to healthcare systems as well.”
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These benefits are particularly applicable to those with chronic conditions, such as diabetes, who tend to consume the bulk of healthcare resources.
“Those patients need to visit their GP or hospital quite frequently, and they’re constantly wanting to know their test results or manage their appointments,” says Balmain. “They’re wanting to see clinical correspondence – if the consultant writes them a letter, they want to have a digital copy of that letter rather than waiting for it to arrive in the post. The value to them in having access to their own medical records is really quite significant.”
Studies suggest that these patients are more likely to proactively engage with their treatment, turn up to their appointments and take better care of themselves, leading improved health outcomes. The upshot is that healthcare systems will save money.
“Healthcare is a business like any other really, and there’s a huge pressure around the world to deliver better care more cheaply,” says Balmain. “If patients are becoming experts in their own condition, ultimately that lowers their costs of the system. So, the desire to empower patients with their own clinical records has been around for a while, it’s just that technology is now catching up.”
‘The last mile of healthcare’
Balmain’s company, Zesty, was acquired by Induction Healthcare last June. The combined entity offers three key product lines: Zesty (a patient portal for hospitals), Switch (a clinical communications app) and MicroGuide (a Dropbox-style app allowing the doctor to store clinical guidance in their phone).
“We’re now beginning to join all of the services together with a particular focus on interoperability with healthcare systems,” says Balmain. “A simple use case would be a doctor who uses the Switch platform, who can now update the patient’s medical records from a smartphone. The health system spends millions of pounds on very expensive electronic health record (EHR) systems, and we’re extending their capability – it’s like the last mile of healthcare.”
The company is also a firm advocate for giving patients access to their own data. Through logging into the Zesty patient portal, patients can receive a copy of their EHRs.
“Technologically that really comes down to the work we’ve done on integration,” says Balmain. “The technology is anything but simple, so it’s a bit of a USP for the company – we’ve put in three or four years of significant work to interface into all of the different legacy systems that hospitals run.”
Accessing EHRs on a smartphone
In October 2020, patients at Milton Keynes University Hospital NHS Trust became some of the first in the country to access their health records on their smartphone. The hospital trust – which uses the Induction Zesty patient portal along with Cerner Millennium (a leading global EHR platform) – has 70,000 patients who can benefit.
“About two or three years ago, Apple launched a service in the US called Health Records on iPhone,” says Balmain. “If you’re being treated by participating hospitals, you can go into the Apple health app on your phone and say I’d like my medical records. Apple has done some work with the major EHR vendors, which allows your smartphone to suck data directly out of the hospital system onto your phone.”
This creates a direct, encrypted connection between the hospital and the patient’s iPhone. It gives patients a central view of their health information, which would previously have been held across multiple locations and would have required logging in separately to different systems. Because the data doesn’t go via Apple – it’s a secure peer-to-peer connection – privacy is protected.
Early last year, Apple picked two partners, Milton Keynes University Hospital and Oxford University Hospital, to help it launch the service in the UK.
“Induction Zesty began a piece of work where we worked directly with Cerner and Milton Keynes and Apple,” says Balmain. “All our users who have an Apple device can now get their clinical records from supporting hospitals, and the Zesty patient portal manages their user identity. We pass an identity-assured user over to Apple, and Apple goes to Cerner and passes the EHR data back to the patient.”
The future of patient access
As for when other patients might start to benefit, Balmain notes the pandemic is likely to have accelerated the move towards digital models of care.
“We’re seeing a real increase in telephone and video consultations and a real increase in hospitals using digital communication channels,” he says. “Our patient portal is right in the centre of that agenda. We recently won some large contracts with big local hospitals, including Royal Free London, and we are moving forwards with quite an aggressive agenda to work with entire regions as opposed to individual hospitals.”
Over the next 18-24 months, the company hopes to move towards a fully integrated virtual care platform, which will cover not just hospitals but also primary care, community care and mental health services. Concurrently, more patients than ever before are likely to have open access to their health records.
“I read somewhere recently that Google is launching a service fairly shortly, following in the footsteps of what Apple has done,” says Balmain. “This would mean the smartphone capability would work with Android as well as iOS.”
He thinks that as the technology progresses, and ideological resistance diminishes, access will become standard – particularly for anyone living with a chronic condition. What’s more, he thinks the shift towards digital models of healthcare delivery is here to stay, and that Covid-19 may have been an important catalyst.
“I think it’s a moral imperative to give people access – it’s something I personally feel very strongly about,” says Balmain. “I would hope that companies like Induction, and the other players in this space, will make great strides towards medical record access being really secure but also ubiquitous.”