“eHealth ecosystem” is a relatively new term, one that has assumed a range of meanings. We see it most often in accounts of large institutions trying to tame their disparate IT systems into some type of coherent whole.
However, an eHealth ecosystem can have more positive connotations and scope beyond a single institution. To my ear it evokes a connected and comprehensive information management environment that is mutually supportive, sustainable, adaptive and evolving, even if it’s also susceptible to pathogens like viruses, worms and misbehaving humans. The overall system works to organize patient information to improve healthcare quality and efficiency.
Where the term eHealth ecosystem gets confusing is when people use the word “ecosystem” to mean what it does in IT beyond healthcare. In that world, an ecosystem consists of a core platform created by an owner with supplemental applications (“apps”) made by separate entities. At present these include the platforms of the largest forces in IT: Apple, Facebook, Google/Android and Microsoft.
As it happens, the muddled terminology is accompanied by equally muddled thinking. If you follow eHealth news you’ll be regularly subjected to reports of how social media and new apps will transform healthcare. According to this narrative, patients will become more engaged, care will become more effective and everyone will be happier.
I don’t think so.
Let’s start with social media, which overwhelmingly means Facebook, a prime communication platform for many North Americans.
Social media exists to connect like-minded people. They may be real-world friends or have simply met online; regardless, they want to share photo, video and written information with one another. That makes social media an effective tool for communication between patients with chronic diseases or for healthcare providers/institutions to post information to a community of patients.
But we need to be clear: social media companies provide users with a free communications platform in return for the right to gather information on its users and exploit that information to sell advertising (using Google’s search engine strikes essentially the same bargain). As a result, it’s unsurprising that there is constant controversy about privacy on social media platforms: keeping things private negates their business model.
In addition, the health content available through social media blurs the distinction between true scientific evidence and unproven or even false claims that seek to influence our spending choices. How can we hope to empower patients if their information sources are accountable to business interests rather than the best knowledge available?
The answer is we can’t. And if social media’s content is suspect and its communication tools are by nature non-private then there is no role for it in the true eHealth ecosystem for managing patient information.
So what about apps?
Apps are by definition compact software programs that are narrowly focused on a single task or area of interest. That means that a typical individual will use several apps regularly and many more on an intermittent basis. As such, an app ecosystem is more fragmented than it is integrated; while the app library shares a common operating environment, each app is a silo of functionality and/or data storage.
But health information systems must be integrated to be effective and safe, which is why apps that simply store data – e.g. an immunization history or blood pressure readings – have poor prospects.
Instead, providers will most benefit from apps that can gather patient data or retrieve reference information with a portable device. While those are useful capabilities they’re certainly not transformative; the apps are simply providing portable versions of what’s readily available within well-developed EMRs that are at the core of the eHealth ecosystem.
Patients have a similar desire for data gathering: lists of the most frequently downloaded “health” apps are dominated by fitness monitoring with a sprinkling of nutrition and reproductive trackers. Virtuous but possibly obsessive. And without any evidence that people who closely follow their exercise, food intake and sleep are thereby influenced to change their behaviour.
In other words, medical and health apps are far less useful than their proponents claim (see this previous post on mHealth: Tool or toy?). And their destiny is likely extinction (a natural outcome within any ecosystem). That’s because current apps are similar to DOS utilities of the 1980s – screen savers, pop-up calculators etc. – all of which became obsolete when operating systems and larger applications coopted the utilities’ features.
Regardless of what social media and app enthusiasts say, the future of eHealth is a comprehensive, integrated EMR platform that meets all provider and patient needs, stringently protects privacy and is available through any connected device. While that connectivity will sometimes be via an EMR extension to a portable device, our forthcoming information management environment won’t employ mainstream social media, nor will it support an industry of app developers. In other words, expect our future eHealth ecosystem to be anti-social and un-appy.