Car­bon Health’s epic plan for pa­tient data

Modern Healthcare - - INNOVATIONS - By Rachel Z. Arndt

Car­bon Health wants to put con­trol in the pa­tient’s hands.

The com­pany’s app, nes­tled in a pa­tient’s smart­phone, is an elec­tronic health record, a tele­health por­tal, a se­cure mes­sage plat­form, and a pay­ment and sched­ul­ing ser­vice. That is, it’s most of the mov­ing parts nec­es­sary for care to be­come more pa­tient-cen­tric and trans­par­ent, a tac­tic that would spell suc­cess for Car­bon Health in the age of health­care trans­for­ma­tion and the Triple Aim.

In­spired by the case stud­ies doc­tors present to one an­other, CEO Eren Bali set out to change the way pa­tients’ med­i­cal in­for­ma­tion is pre­sented. “Med­i­cal records should change in two ways,” he said. “They should be de­signed in a way that makes sense to pa­tients and doc­tors, and they should be or­ga­nized around pa­tients rather than the providers.”

Bali first had that idea a cou­ple of years ago, when he was still run­ning a com­pany he founded, on­line ed­u­ca­tion plat­form Udemy, and his mother fell ill with neu­rosar­coido­sis. She’s fine now, but she con­sulted with a lot of dif­fer­ent doc­tors, re­sult­ing in hun­dreds of pages of med­i­cal records. Bali’s sis­ter, who’s a doc­tor in Turkey, helped or­ga­nize ev­ery­thing. But Bali thought there had to be a bet­ter way, and he sketched an idea of what a com­pre­hen­sive med­i­cal record might look like.

Even­tu­ally, that idea be­came Car­bon Health, which is cen­tered on a mo­bile app. Within the app, a pa­tient’s med­i­cal in­for­ma­tion is or­ga­nized by con­di­tion, each with a time­line. Pa­tients can com­mu­ni­cate with providers in the app, in­clud­ing through telemedicine vis­its; fill out med­i­cal his­to­ries be­fore their ap­point­ments; and ac­cess their med­i­cal in­for­ma­tion, from imag­ing (the ac­tual im­ages them­selves) to doc­tors’ notes.

“Car­bon Health al­lows the pa­tient to be the hub,” said Dr. Linda Du­bins, a provider at Car­bon Health’s San Fran­cisco pri­mary-care clinic. “Providers can ac­cess, through the pa­tient, his or her med­i­cal in­for­ma­tion.”

Bali and his team opened the San Fran­cisco clinic to the pub­lic in Oc­to­ber 2016 to test and per­fect the Car­bon Health plat­form, which it’s us­ing in­stead of a tra­di­tional EHR like those from the two dom­i­nant ven­dors in the in­dus­try, Epic Sys­tems Corp. and Cerner Corp.

Later this year, the com­pany will ex­pand to other providers, who will re­place their ex­ist­ing EHRs with the plat­form, pay­ing for it not up­front but by hand­ing over a per­cent­age of billing.

The idea is to build a Car­bon Health net­work. Rather than a group of providers united by a hospi­tal, this group will be united by the plat­form it­self. In­ter­op­er­abil­ity will be built in. “It’s like a very large hospi­tal that does not own any build­ings,” Bali said. “It works and feels very dif­fer­ent from an EHR, but it does what an EHR does.”

Dr. Greg Bur­rell, Car­bon Health co-founder and di­rec­tor of medicine, ex­panded on the idea: “Both doc­tors and pa­tients are in this net­work to­gether, and the tech­nol­ogy con­nects them.”

That may not be enough to chal­lenge es­tab­lished ven­dors, though, said Dr. David Kibbe, CEO of Direc­tTrust, a not-for-profit or­ga­ni­za­tion that gov­erns the Di­rect frame­work. “Car­bon Health is not a model that will pose a threat for the mar­ket lead­ers.”

Now Car­bon Health in­cludes only the med­i­cal his­tory that comes from its providers. The app can’t pull or push ex­ter­nal data. But it will be able to even­tu­ally. “This is not as easy as it sounds,” Bali said, and there will al­ways be some prac­tices that don’t even use EHRs in the first place.

Even when prac­tices use EHRs, there are still prob­lems, Bali said. Be­cause he de­signed the app from scratch, he could fix some of those is­sues. The first prob­lem, he said, is the way med­i­cal records are stored. “Many ex­ist­ing ones are like glo­ri­fied note-tak­ing sys­tems built around a billing so­lu­tion,” he said. Car­bon Health, on the other hand, is built on the idea of struc­tured data. When lab re­sults come in, for in­stance, they’re not in a PDF but in dis­crete data el­e­ments. Symp­toms and pro­ce­dures are or­ga­nized by con­di­tions, and those con­di­tions are con­nected to each other by the pa­tient.

When pa­tients can view their in­for­ma­tion that way, they’re bet­ter able to stay healthy, Bur­rell said. “One of our goals is to make it so the pa­tient and provider can re­ally try to op­ti­mize their health,” he said. Giv­ing pa­tients ac­cess to all their in­for­ma­tion is a step to­ward achiev­ing that, along with more ef­fi­cient care.

“When you have a record over time that each care­giver can see and in­ter­pret, you can avoid du­pli­ca­tion of pro­ce­dures and treat­ments,” Du­bins said, and “pro­vide more con­ti­nu­ity of care.”

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