Connecting the Digital Health Trail: One Person, One Record, One Plan

This post is the fourth in a series of guest blog posts by some of our sponsors from their perspective on Convergence.
Authors: Bharat Sutariya, MD, Vice President & CMO, Population Health, Cerner


As a practicing physician, I experience first-hand the challenges of trying to piece together a patient’s record across their many interactions with the health care delivery system. When individuals are seeking care, oftentimes convenience and proximity to their current location drive their care decisions. Practically, this means that an individual’s care spans multiple facilities and touch points – primary care providers, workplace health clinics, specialists, walk-in care clinics, emergency room visits and inpatient hospital encounters. When you layer in patient-generated health data from personal health records, fitness and nutrition apps, and wearables, you have a very complicated health information ecosystem that begs for aggregation and analysis to make it useful within a physician’s daily workflow.

We’re making progress in connecting this data thanks to the steady push for interoperability in health care over the last decade. Health information exchanges as well as industry initiatives such as CommonWell and Carequality are bringing together information from disparate electronic health records (EHRs). But we haven’t achieved ubiquitous interoperability yet – there are still big holes in the patient’s longitudinal health record – which means clinicians are still making decisions based on the narrow record available in the EHR. And although there’s much talk about empowering patients to be informed participants in their care, they struggle to do so with the narrow information available within traditional patient portals. For clinicians and patients, these narrow views result in duplication and waste of health care services, errors in medical decision making and limited consumer engagement.

We can fix this by creating a true longitudinal health record that reaches across the continuum of care and includes data points beyond the traditional “four walls” of the health care delivery system. To do so, we need to broaden our understanding of what the longitudinal record should include and how it is delivered.

Efficient management of care is most effective when we work together, treating every patient as a person who deserves one record and one plan. The more we align the care continuum around a person, the closer we’ll be towards achieving a lifetime longitudinal record.

Thanks to the broad adoption of EHRs, core demographic and clinical information about a person is readily available. As we go forward, many enhancements are necessary to paint a more complete picture of one’s personal health ecosystem. An effective longitudinal record includes overall health determinants – data about social, financial, behavioral and motivational factors, genetic information, an assessment of the individual’s health literacy, environmental factors and so on. To truly get to a comprehensive picture of one’s personal ecosystem, the record also needs to span a person’s lifetime including information from birth to end of life.

Most people see many clinicians across their community who use multiple EHR systems, making the aggregation of information across these EHRs a necessity in creating a longitudinal record. The record will need further augmentation of data from payers, pharmacies, connected devices that continue to proliferate in the Internet of Things, and many other data sources generated from a person’s digital trail of health information. This longitudinal record then needs to be made available so that it can be easily accessed by all care team members irrespective of the transaction system or EHR being used to manage the care. The presentation of this information needs to be contextually aware of both the user and the health care setting so that the right information is organized in an easy to consume manner, enabling appropriate review and decision making. Furthermore, there needs to be continual and proactive surveillance for new information generated in the individual’s digital health trail so that changes in health status and personal health goals update the longitudinal record and trigger a resulting update to the lifelong health maintenance objectives and chronic disease management road map for the individual.

The cloud will play a significant role in making the longitudinal record a reality. Advancements in cloud computing and big data capabilities have been the driving force of innovation and disruption in many industries, and in health care, we’re only starting to realize the cloud’s potential. To get to a sustainable model, the longitudinal record and plan will require many parallel experimentations and explorations by established tech companies and startups of many kinds.

This is more possible today than ever before as established tech companies, inclusive of Cerner, work to create an open development ecosystem to unleash the power of innovation in health care. This is further fueled by the sustained movement of emerging standards in the ability to access data using FHIR, and ability to create an interactive experience embedded in outside applications using SMART.

Medicine is both an art and a science. We may never know everything about the complexities of human physiology and psychology, but enabling clinicians to make intuitive, data-driven decisions can help us get closer to a more refined practice with less unnecessary variance. And we need to realize it’s not data alone that will get us there, but the study of insights garnered from the data and the actions we put in place because of them. This is what will get us to a much needed continuous learning-driven health care ecosystem. In this “new” ecosystem:

Providers and care teams work together to make contextually aware, personalized decisions for their patients

Payers can reduce friction-causing delays in reimbursement and improve their confidence in appropriateness of care decisions by receiving more comprehensive patient background information

Patients and consumers can become equal participants on their care team by gaining transparency to their health and care information within a single location and to reviewing and updating the data as needed

Efficient management of care is most effective when we work together, treating every patient as a person who deserves one record and one plan. The more we align the care continuum around a person, the closer we’ll be towards achieving a lifetime longitudinal record.

Hannah Ehnle

Author Hannah Ehnle

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