Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

HealthTap’s Integrated, Patient-Centered, Data-Rich Care

Posted on November 18, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health reformers dream of integrated health delivery systems that leap across the barriers between providers, employers, insurers, and various supporting groups such as pharmacies and test labs. People who have investigated this goal realize that it can be achieved only by putting data in the hands of the patients. HealthTap recently announced a “health operating system” that suggests what this much-anticipated integration will look like.

In this article I’ll look at some of the building blocks HealthTap put in place, and then delve a bit into features of the health care landscape that support their work.

HealthTap has built an integrated health delivery system over a five-year period. They started with an audacious enough goal in its own right: signing up doctors to answer questions from the public. A couple dozen other capabilities were tacked on over time, such as ratings, various personalization features, and then checklists and a recommendation system for apps.

Doctor-to-doctor interaction is also built into HealthTap, echoing proposals in a 2012 book called #SOCIALQI. Doctors can check how peers handle cases similar to theirs, do online consultations, and carry out literal reviews online. Founder and CEO Ron Gutman describes the combined process as “virtual grand rounds.” And in a glowing endorsement by the medical establishment, HealthTap has won the right to grant CME to doctors for conducting these routine activities on its system.

Now the integrated impact of all these initiatives can be seen. Health care delivered through HealthTap might look something like this.

  1. An individual creates a HealthTap account directly with HealthTap, or in a private system that her clinic, hospital, or employer creates based on HealthTap. This brings the patient into the system, where information and other forms of communication take place. The provision of private environments run by single hospital or clinic is a recent innovation by HealthTap.

  2. The individual optionally adds information about personal data such as age, and conditions she is suffering from. HealthTap uses this to direct educational content at her, and to answer her questions in a personalized manner that is more informative than a typical web search. For instance, the query “Is aspirin good or bad for me?” would trigger answers that take the patient’s particular health information into account. HealthTap’s Personal Health Record (PHR) becomes the key component that links together the entire continuum of care.

  3. The patient can sign up for a reasonably-priced concierge service that allows her to request an online consultation with a doctor whenever she needs one. The doctor writes a SOAP note at the end of the consultation. He can also create a checklist of things to do (take medication every day, go to the gym, make a follow-up appointment in three months) and HealthTap will remind the patient to do these things in a way chosen by the patient to be convenient. HealthTap offers apps for both doctors and patients on all major mobile devices, including Apple Watch and Android Wear. Communications are HIPAA-compliant and have received SOC 2 Type II security certification, the highest level.

  4. A doctor can also order a lab test electronically. The patient can take the test and get results delivered directly and securely through HealthTap.

  5. All this information is stored in a record available to the patient. Therefore, data that used to be available only to institutions serving the patient (hospitals, insurers, labs, pharmacies), and was used only for marketing or improving service delivery, is now available to the patient.

  6. All the information ranging from patients’ online queries to test results become input into anonymized, aggregated sets that HealthTap gives health care providers. They can view dashboards of information about their patients, about people throughout their geographic area, about people with related conditions and demographics around the country, etc. Savvy institutions can use this data for value-based care and improving their outreach to at-risk patients.

Thus, a plethora of features that health care reformers are asking for appear in HealthTap, ranging from targeted educational materials to messages that promote compliance with treatment plans and even analytics. The service strives to make the experience as comfortable as possible for the patients, who have access to all their data.

The achievement of Ron Gutman, to whom I talked this week on the phone, and his crew is impressive. But we should also be aware that the technical infrastructure and features put in place by the health care industry play a crucial role. These include:

  • ePrescribing systems such as Surescripts, and electronic ordering for lab tests, along with coding standards to ensure the different parties can exchange messages

  • Electronic health records, which have become widespread only during the past five to six years since the start of Meaningful Use payments from the US government

  • Devices capable of secure messaging

  • Public health information provided by a number of government and private institutions

  • Analytics offered by a huge number of firms to health care providers

Thus, the health care ecosystem has been evolving for some time to create the possibility for an advance like HealthTap. Much more is needed throughout the healthcare system for instant communications and smooth data exchange. For instance, HealthTap hasn’t yet integrated fitness devices into its ecosystem. But HealthTap has built a huge service on existing system elements, which many more institutions could do so if we had a health care system as open and rich as exists in e-commerce.

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.