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I occasionally wonder if it would be the cheaper, sustainable approach to just give everyone an iOS device containing their full medical record in HealthKit and

I occasionally wonder if it would be the cheaper, sustainable approach to just give everyone an iOS device containing their full medical record in HealthKit and require that all data requests go through your device, where you have full control on who gets access and for how long. A simple back-of-the-envelope calculation results in $1 000 per iOS device x 300 000 000 = $300 000 000 000 (three hundred billion). To put that into perspective, the CDC says that $3 795 000 000 (three-thousand seven-hundred and nine-five billion) was spent on healthcare in 2019. https://www.cdc.gov/nchs/hus/topics/health-care-expenditures.htm https://www.cdc.gov/nchs/hus/topics/health-care-expenditures...

bpodgursky 4y ago
This just isn't realistic. No hospital EMR is going to act as a proxy for a thousand customer iOS devices hooked up to the WiFi or whatever. Just imagine the doctor trying to pull up your chart, and failing because you forgot to charge your phone. Yeah, no. Or, even better, you get admitted to the ER in critical condition and now nobody can pull up your blood type or even enter your medical records, because you don't have your phone on you. Not going to happen.
- 9wzYQbTYsAIc 4y ago
  Non-emergency intake procedures would be a great point in the workflow to get the authorization handshake out of the way. In emergency situations, getting medical records isn’t even a guarantee, today. If all a paramedic had to do was plug in a dead phone and wait 15 minutes to get access to medical records that would otherwise require potentially hours and fax machines, it might be a tic in the acceptability matrix, there. Using the device to manage your data, with whatver access controls you are allowed, doesn’t necessitate that the data be solely stored on the device. Using notifications and other operating system functions ought to cover a wide variety of workflow needs. The device would be able to take the place of any signature machines, on-premises, for example. Finally, as it is today, you can configure iOS and watchOS to display emergency medical information even while locked. Let alone any future enhancements that could really make a dent in the overall healthcare software ecosystem. edit: how environmentally sustainable it is to make 7+ billion iPhones, is a different topic though
  - mwint 4y ago
    There have been ~2B iPhones made. Doesn’t seem like a big deal. Not even an order of magnitude.
    - 9wzYQbTYsAIc 4y ago
      I’m not an economist, but I suspect that the supply curve would adjust pretty drastically to even just a doubling of demand, let alone a quadrupling. edit: there probably isn’t even enough readily available physical material for that many batteries. for example, consider the projected difficulties with supply side for the upcoming increase in demand for electric vehicle battery material
supertrope 4y ago
That solution assumes everyone has digital skills. The people who most heavily consume medical services are usually older, poorer, disabled, and on the wrong side of the digital divide. Many people lack health literacy or even literacy. How would this scheme even handle forgotten passcodes or device theft? Vendor lock in and giving a trillion dollar corporation the keys to your health record is a bad idea.
- 9wzYQbTYsAIc 4y ago
  True, part of what I ponder when the thought arises, is how the government would probably need to claim eminent domain over the whole thing, simultaneously build on the already great accessibility features, and then roll it out with a jobs programs in social services to accommodate everyone that needs accommodations.
- usr1106 4y ago
  In Finland we have online access the health data, tax, social benefits and what not for years. Banks close their branch offices and do their best not to serve customers in the few remaining ones. But there are about 10% (IIRC) of the adult population who don't even have credentials to any of those services (credentials are either provided by your bank or the SIM card of your phone). Or they don't have / cannot use any device to access online services. It's a significant problem of discrimination. But typically nobody mentions that, they are all proud how digital the country is.
csense 4y ago
For the "unconscious patient in the emergency room without a working phone" situations, put an RFID tag or a printed QR code in the hospital admission armband, then the doctor / nurse can scan it to enter records from their own device. Those records go onto the hospital's / practice's server, then when the patient wakes up / next of kin arrives and they find / charge their phone, they enroll by an app that generates a private key on the device, then shows the public key in QR code form. Nurse scans the QR code on their device and signs off on a dialog box that says "Yes I verified the person with this phone has the right to this patient's records," then the server lets the app authenticate and get the records. The API should be open source so if you want your records, you can hack some JSON, sign an API request with your private key and download it (maybe with jigdo or rsync or something if it's huge X-rays and 3D CAT scans and stuff?). A third party app can put it on your phone for you, but hopefully there will be regulatory stuff that tries to make barriers to consolidation to encourage the system to remain federated. I.e. regulations should try to make sure your medical history stays within the offices of primary physician / specialist / hospital where you're a patient, and your phone's local storage. But we really don't want some "too big to fail" medical data startup putting ten million people's medical records in one AWS bucket.
- 9wzYQbTYsAIc 4y ago
  Indeed, a government built open standard would be ideal, especially if the existing login.gov digital services team was involved in rolling out a hypothetical health.gov Login.gov seems to be on the right track, architecturally speaking.
encryptluks2 4y ago
IOS is the most closed and expensive platform for mobile devices. This sounds like corruption to me.
- 9wzYQbTYsAIc 4y ago
  It wouldn’t be corruption if the technology was claimed by the government under eminent domain or other mechanisms for taking over parts of industry

bpodgursky 4y ago

This just isn't realistic. No hospital EMR is going to act as a proxy for a thousand customer iOS devices hooked up to the WiFi or whatever. Just imagine the doctor trying to pull up your chart, and failing because you forgot to charge your phone. Yeah, no. Or, even better, you get admitted to the ER in critical condition and now nobody can pull up your blood type or even enter your medical records, because you don't have your phone on you. Not going to happen.

9wzYQbTYsAIc 4y ago
Non-emergency intake procedures would be a great point in the workflow to get the authorization handshake out of the way. In emergency situations, getting medical records isn’t even a guarantee, today. If all a paramedic had to do was plug in a dead phone and wait 15 minutes to get access to medical records that would otherwise require potentially hours and fax machines, it might be a tic in the acceptability matrix, there. Using the device to manage your data, with whatver access controls you are allowed, doesn’t necessitate that the data be solely stored on the device. Using notifications and other operating system functions ought to cover a wide variety of workflow needs. The device would be able to take the place of any signature machines, on-premises, for example. Finally, as it is today, you can configure iOS and watchOS to display emergency medical information even while locked. Let alone any future enhancements that could really make a dent in the overall healthcare software ecosystem. edit: how environmentally sustainable it is to make 7+ billion iPhones, is a different topic though
- mwint 4y ago
  There have been ~2B iPhones made. Doesn’t seem like a big deal. Not even an order of magnitude.
  - 9wzYQbTYsAIc 4y ago
    I’m not an economist, but I suspect that the supply curve would adjust pretty drastically to even just a doubling of demand, let alone a quadrupling. edit: there probably isn’t even enough readily available physical material for that many batteries. for example, consider the projected difficulties with supply side for the upcoming increase in demand for electric vehicle battery material

supertrope 4y ago

That solution assumes everyone has digital skills. The people who most heavily consume medical services are usually older, poorer, disabled, and on the wrong side of the digital divide. Many people lack health literacy or even literacy. How would this scheme even handle forgotten passcodes or device theft? Vendor lock in and giving a trillion dollar corporation the keys to your health record is a bad idea.

9wzYQbTYsAIc 4y ago
True, part of what I ponder when the thought arises, is how the government would probably need to claim eminent domain over the whole thing, simultaneously build on the already great accessibility features, and then roll it out with a jobs programs in social services to accommodate everyone that needs accommodations.
usr1106 4y ago
In Finland we have online access the health data, tax, social benefits and what not for years. Banks close their branch offices and do their best not to serve customers in the few remaining ones. But there are about 10% (IIRC) of the adult population who don't even have credentials to any of those services (credentials are either provided by your bank or the SIM card of your phone). Or they don't have / cannot use any device to access online services. It's a significant problem of discrimination. But typically nobody mentions that, they are all proud how digital the country is.

csense 4y ago

For the "unconscious patient in the emergency room without a working phone" situations, put an RFID tag or a printed QR code in the hospital admission armband, then the doctor / nurse can scan it to enter records from their own device. Those records go onto the hospital's / practice's server, then when the patient wakes up / next of kin arrives and they find / charge their phone, they enroll by an app that generates a private key on the device, then shows the public key in QR code form. Nurse scans the QR code on their device and signs off on a dialog box that says "Yes I verified the person with this phone has the right to this patient's records," then the server lets the app authenticate and get the records. The API should be open source so if you want your records, you can hack some JSON, sign an API request with your private key and download it (maybe with jigdo or rsync or something if it's huge X-rays and 3D CAT scans and stuff?). A third party app can put it on your phone for you, but hopefully there will be regulatory stuff that tries to make barriers to consolidation to encourage the system to remain federated. I.e. regulations should try to make sure your medical history stays within the offices of primary physician / specialist / hospital where you're a patient, and your phone's local storage. But we really don't want some "too big to fail" medical data startup putting ten million people's medical records in one AWS bucket.

9wzYQbTYsAIc 4y ago
Indeed, a government built open standard would be ideal, especially if the existing login.gov digital services team was involved in rolling out a hypothetical health.gov Login.gov seems to be on the right track, architecturally speaking.

encryptluks2 4y ago

IOS is the most closed and expensive platform for mobile devices. This sounds like corruption to me.

9wzYQbTYsAIc 4y ago
It wouldn’t be corruption if the technology was claimed by the government under eminent domain or other mechanisms for taking over parts of industry