The following is a guest article by Mike Simmons, CEO and Founder at andros.
Sharing information across platforms has become so ubiquitous that many of us hardly notice it happening—interconnected technologies touch almost every area of our lives. Industries ranging from tourism to e-commerce have adopted data-sharing practices; greater access to information has proven, unsurprisingly, to lead to better experiences.
And yet, information-sharing innovations that would allow for streamlining and convenience are lagging in one of the most vital sectors: healthcare. If healthcare is going to join those sectors that are more advanced in both technology and consumer experience, it would do well to take a page from fintech—or more specifically, the open data paradigm known as open banking.
The goal of open banking is to lower barriers to entry across different financial services by making consumer financial data accessible and open through purpose-built APIs. This allows customers to choose the ideal financial product for them, be it easily opening a new credit card or adopting a new financial planning app.
In our increasingly digitized world, this kind of convenience, a result of open data, is often expected. By taking a cue from finance, healthcare can move beyond the slowdown of the initial ACA-incentivized telehealth boom over ten years ago to embrace newer technologies, and the possibilities of open data.
Current Innovations
The COVID-19 public health crisis brought the need for more, and better, telehealth services into stark relief, and the digital health industry has seen billions of dollars of growth in response.
The modified regulations surrounding digital health practice that allowed care to continue during the pandemic—like those governing insurance codes, practicing across state lines, and virtual HIPAA compliance—were introduced as temporary.
But many of these changes can continue to benefit all healthcare stakeholders in the long run—and many of them hinge on open data. Vitally, open data can streamline claims processing for payers, addressing concerns that the necessary rise of telehealth will be stunted by protracted reimbursement models.
Ultimately, increasing the accessibility and shareability of data will also make it easier for providers to make referrals necessary for patient care, and for patients to see the provider of their choice, regardless of location.
Addressing Inequity
Research shows that thus far, the boon of enhanced telehealth has been concentrated among those living in urban areas, with access to reliable internet connection and sufficient funds to pay for healthcare services.
Meanwhile, poor people and members of minority groups, especially those living in rural areas, have failed to see comparable benefits. This kind of inequity of vital services is intolerable, and we can and must do better.
A goal of digital transformation in healthcare via open data should be to close this gap by continually reducing barriers to care, and increasing access to resources. Recent legislation supporting an expansion of broadband infrastructure in rural areas demonstrates an understanding of the importance of making telehealth more accessible.
In a future where providers can easily obtain credentials, and patients can connect with any variety of assistance they need to facilitate care (from technical to financial), factors like income, identity, insurer, and location need not determine healthcare outcome.
What to Watch
For Medicare and Medicaid, open data is already arriving in a big way.
The ONC Cures Act Final Rule, which went into effect this summer after being delayed due to the pandemic, requires that CMS-regulated health plans make patient data available in accessible, mobile-friendly platforms.
The goal is for patients to be able to share this data with multiple providers, as well as third-party health apps. This requires the construction of new, easy-to-use APIs, and many companies are already taking on the challenge.
When open banking was initially introduced in the UK, the staunchest institutions initially strove merely for compliance, rather than innovation. Over time, however, it has become clear that this change is both industry-defining and for the better, as it expands financial access for many, especially elderly and vulnerable people. Today, the outlook on where it can take the U.S. financial sector is optimistic.
Healthcare can tend to be rather set in its ways, as well. Soon, though, those who refuse to move toward open data will likely be left behind. While some payers and providers may be reluctant to explore new methods, it’s clear from the increasing focus on healthcare consumerism that staying out of the game won’t be an option for long. The telehealth regulation changes of the COVID-19 era can be a jump-start to healthcare digital transformation.
Security is Essential
Whether it’s patient medical history or provider information, keeping healthcare data secure is absolutely paramount. Payers whose reputations are built on service and security know members rely on them. Privacy is an essential part of the trustworthiness of healthcare, at every step of the process.
That said, there’s a definite difference between data that’s being deliberately protected, and data that’s stuck in a silo simply because that’s the way things have always been done. Many payers find their hands tied when it comes to participating in changes that would help streamline the industry for all involved, and siloed data is a big part of the reason.
Open data in healthcare aims to fix similar problems to those addressed by open banking, and hopefully it has the same end result: more flexibility and convenience to help people connect with the care that’s best for them, increasing healthcare access for all. Information can flow freely, instead of being locked up in ways that throttle growth and stymie high-quality care.
Again, information related to health and treatment is extremely personal and often sensitive, and concern about how such data sharing will be handled is reasonable. Companies must ensure that the information flowing through their services is shielded by high-quality security measures.
And as for the government’s involvement, the passing of the ONC Cures Act Final Rule seems to indicate that it is at least beginning to address security concerns related to telehealth and digital healthcare, by putting structures into place to investigate healthcare fraud that encompass those sectors.
The National Rapid Response Strike Force, announced by the U.S. Department of Justice at the end of 2020, “investigate[s] and prosecute[s] fraud cases involving major health care providers that operate in multiple jurisdictions, including major regional health care providers.” This stated mission encompasses telehealth, as providers often practice medicine across state lines by way of telehealth.
Of course, more will need to be done to address security concerns around open healthcare data. As other technologies continue to be integrated into healthcare, such as artificial intelligence (recently commented on by the World Health Organization) and assorted third-party apps, it will be important to ensure that both internal security practices and external regulations are keeping pace.
The Ultimate Goal: Better Access, Better Health for All
Open healthcare may feel like an unexplored frontier to some, but the truth is that all signs have pointed in this direction for decades. Taking inspiration from sectors like finance where open data has already been thoroughly, securely, and effectively implemented, will help healthcare grow for the better.
By removing patient and provider data from the siloes where it has traditionally been housed, and allowing it to flow securely, we can focus on making healthcare more equitable and accessible for all.
About Mike Simmons
Mike Simmons is the CEO and founder of andros, whose mission is to make healthcare administration work better. andros offers a powerful software solution for building, expanding, and managing provider and payer networks. As a software developer dedicated to reimagining what’s possible in our healthcare system, Mike is passionate about encouraging others to do the same.
A unique, global upbringing in some of the poorest parts of the world gives him a distinct perspective and motivates him to do everything possible to advance the well-being of the world, regardless of how large and time-consuming the task might seem. At andros and beyond, his work is inspired by a forward-looking desire to foster connections that can be harnessed and built upon.
