As Obamacare's growing pains continue, hospitals and clinics are racing to upgrade their paper files to electronic ones to reach a government deadline which specifies that providers must show "meaningful" implementation of electronic health records by 2015 or face monetary penalties.
But in choosing among hundreds of competing electronic health record systems, health care providers may be creating the same disorganization as the paper trails they set out to streamline.
"The foundations and the intent of the Affordable Care Act are laudable," said Dr. Patrick Soon-Shiong, a Los Angeles-based surgeon and drug inventor-turned-entrepreneur. "The way it's being implemented is a disaster."
On Monday, Soon-Shiong offered up his solution to the "disaster" with the launch of health IT company NantHealth, a subsidiary of his medical technology company NantWorks. He also unveiled NantHealth's intelligent Clinical Operating System (iCOS), which patients and caregivers can use to pull data from dozens of competing electronic medical record systems in order to create a single, easy-to-access profile of individual patients' medical history and current health regimen.
Soon-Shiong said the iCOS platform had the potential to transform electronic medical records in the U.S., adding that it could also deliver real-time vital statistics about patients based on the information medical devices can send up to the cloud that stores their medical data.
"Let's say that you live in Los Angeles but happen to be on a vacation in Florida when you get injured," Soon-Shiong said. A trip to the emergency room in Florida might leave you with an X-ray, he continued, and upon returning home and visiting your primary-care doctor, that X-ray would be available at all times using iCOS.
"It's there for you to see, even though the doctor in Los Angeles has no idea who the doctor in Florida is," he said. "The data is just available to you." Practitioners, for their part, would not be able to access such information without the patient's explicit permission.
iCOS interfaces with major health IT vendors, Soon-Shiong said, opening up lines of communication among doctors and practices that haven't been able to easily share information in the past. That means if even one of your doctors has iCOS, all of your caregivers across multiple health systems will be connected.
The platform also has a software component that gives physicians access to a database of 10,000 cancer clinical trials and more than 1,700 evidence-based cancer therapies to help them make appropriate treatment decisions.
Soon-Shiong hopes iCOS will play a major role in lowering the cost of the world's most expensive health care system. Health care in America is pricier than in other countries largely as a result of the fee-for-service model that pays physicians and hospitals for each treatment administered, as opposed to payment for the patient's overall health.
"The system is completely broken," Soon-Shiong said. "Nobody gets paid for keeping people healthy."
iCOS is designed to gather information about a patient's specific regimen and the costs of specific treatments. It can then continually update a patient's vital signs to give a comprehensive view of his/her health. And that, Soon-Shiong said, is the key to transforming health care from a fee-for-service model to value-based care, in which a physician or hospital is paid to keep a person healthy at the lowest possible cost.
Soon-Shiong built components of iCOS in clinics and hospitals across the country over the past 10 years. He personally invested $800 million in 60 companies and university research programs that worked on each aspect of the operating system, and Monday's announcement confirmed that iCOS is now available for purchase as a fully integrated system.
A spokesperson with the federal Health and Human Services Department's Office of the National Coordinator for Health IT (ONC) declined to comment specifically on iCOS but said the department is "always pleased" to learn about new tools that have the potential to ease the exchange of health information.
ONC said consumers would need to be assured of the privacy of any new tools that allow for the exchange of health information. Soon-Shiong described NantHealth's storage cloud as "HIPAA-secured," meaning that it complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which governs patient privacy and the security of personal medical information.
Soon-Shiong may soon face a competitive marketplace. But, for now, his product is the first of its kind in the field, said Stephen M. Shortell, Ph.D., professor of health policy and management at the University of California, Berkeley School of Public Health.
"He's certainly among the first to propose something this innovative," Shortell said. "There's likely to be competition in that space, and I do know there are others thinking along the same lines that just haven't made public announcements yet."
Catherine DesRoches, DrPH, a health IT researcher at New Jersey-based Mathematica Policy Research, agreed on the need for a tool like iCOS but added a note of caution.
"What [Soon-Shiong] is describing here seems to be out in front of where the market is, which is great," she said. "But the devil is in the details with these kinds of things. Let's see how they implement it."
DesRoches praised NantHealth's real-time, wireless biometrics stored in the cloud but noted that not all of the U.S. is connected with broadband internet. "I think [iCOS] will be implemented in places where they are already far ahead on the curve, and perhaps is not as useful for smaller, rural, limited access types of places where connectivity is still a real issue," she said.
Still, experts agree that NantHealth may be an important advance. Data integration and harmonization is "where everyone wants to go," said Jason Doctor, Ph.D., associate professor at the University of Southern California School of Pharmacy and the director of health informatics at the Schaefer Center for Health Policy and Economics.
"We've been doing electronic medical records for 40 years and we still can't get them to talk to each other," Doctor said. "If it works," he said in reference to iCOS, "the proof will be in the pudding."
CORRECTION: A previous version of this story incorrectly stated that electronic health record compliance were created by the Affordable Care Act, when it was actually created by the American Recovery and Revitalization Act of 2009. Beginning in 2015, health care providers will have Medicare payments withheld unless they demonstrate meaningful implementation. The ACA will reduce payment to health care providers if they don't hit certain targets, and electronic systems are crucial to delivering this data to government agencies. We apologize for the error.