I was saddened this week to see that CareSync, my personal PHR company, had gone into bankruptcy and shut down.

For those of you who hadn’t had the privilege of using their services, CareSync aggregated my records into a single patient folder that I was able to carry around on my smartphone. Both structured and unstructured data were supported, as well as medication reminders, concierge services for booking appointments, and a raft of other really useful tools. Yes, it was great, I loved it, and it was about ten years ahead of initiatives from companies such as Apple.

Fast forward to reading an article in HealthIT Analytics this week and a notable quote from secretary Azar – “To bring down costs and increase quality, we have to put patients in charge of their own data.”

While I agree with Secretary Azar as a matter of principle, I’m still perplexed by who pays for this. In the case of CareSync, the problem was pretty simple. Not enough patients who were willing to fork out the over one hundred dollars per year subscription charge. Yet, we seem so enamoured of the efforts of Apple and their ilk that we forget that somewhere, somebody, has to be picking up the cost.

Isn’t it all FHIR though? Isn’t that just a web service call to a RESTful API? Well sure, but think of how many patients are going to be calling that API at your average institution and then consider the implications of how large those servers are going to need to be, the privacy and security controls that will need to be in place, maintenance and software support, and the list goes on and on. There will be cost and it will be significant. There will also be a decline in the release of information charges which today are a major revenue stream for hospitals.

When TEFCA came out many respondents asked the “who pays” question, and I’ve seen nothing from ONC or in the original Cures act that really explains to me how this is going to be commercially viable. Reasonable costs are allowed, but nowhere is that defined, and I’m afraid that unless some margin is baked in somewhere that the whole thing is just going to fall flat on its face.

Don’t get me wrong, I love APIs and I think the attempts to reduce information blocking by presenting an open and relatively simple playing field for app makers are a great thing, but until we resolve the issue of who pays, it may be all for naught.

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