UCSF, UCSD study finds few patients downloading health records via smartphone apps

Federal healthcare policymakers are pushing to give patients easier access to their electronic health data via smartphone apps. The private sector also is playing a role in these efforts—Apple launched its health records feature in January 2018, and now more than 200 healthcare providers have joined the project. 

Are patients actually using these apps to get their health records? At this early stage, uptake has been modest, but the numbers are growing, according to an assessment looking at 12 early-adopter health systems published in JAMA Network Open.

Julia Adler-Milstein, Ph.D., an associate professor of medicine at the University of California (UC), San Francisco School of Medicine and Christopher Longhurst, M.D., chief information officer and associate chief medical officer at UC San Diego Health, evaluated the use of health record application programming interfaces (APIs) with the aim of creating baseline national measures of patient uptake against which to track future progress.

RELATED: HIMSS19: ONC, CMS officials outline the framework for interoperability, the use of APIs, FHIR

"It is anticipated that access to clinical data via Fast Healthcare Interoperability Resources (FHIR) APIs and use of this data by smartphone applications will allow individuals to better understand and control their health data, more easily ensure data accuracy, shop for high-value health care services, avoid the need to repeatedly supply data for entry into each new health care provider’s electronic health record (EHR), and increase their participation in clinical research," the researchers wrote.

The researchers looked at 12 health systems that provided patients the option of downloading their electronic health information using FHIR APIs. These health systems also used Epic EHRs.

From March to December 2018, a mean of 0.7% of patients who logged into their hospital's patient portal in a given month were also users of the API. But researchers did find growing numbers of patients accessing their information through APIs with a statistically significant increasing linear trend of 156 unique new users per month per health system, according to the report.

At some health systems, the number of unique API users grew to 3,000 during the 10-month period while other health systems had fewer than 500 users, according to the assessment. The average among the 12 health systems was about 1,500 new users by December.

RELATED: CMS launching pilot program to give providers direct access to claims data

There are two primary reasons patient uptake has been modest so far, Adler-Milstein told FierceHealthcare.

"First and most importantly there needs to be more apps that can take the data and turn it into something useful for patients. Right now, there are only a handful of apps that are available and the functionality isn't much beyond what patients have access to on a patient portal," she said.

Healthcare systems and health IT vendors need to do a better job of marketing this new capability to patients, the researchers said, as there are no clear incentives for patients to adopt it.

There also needs to be a broader awareness of this functionality and what it enables, the researchers noted. 

"It will also be helpful as a broader range of data is available through this functionality; right now it is not the full medical record," Adler-Milstein said.

Patients have been slow to adopt digital tools to obtain their health records, studies have shown. Data from the Office of the National Coordinator for Health IT (ONC) published in April indicated that more than 90% of hospitals now enable patients to view and download their records online, but most hospitals reported that fewer than 25% of their patients activated their access to their patient portal.

The Centers for Medicare & Medicaid Services (CMS) and ONC are focused on improving interoperability and giving patients easier access to their health data, with open APIs and FHIR as core components of these initiatives. CMS recently unveiled a pilot program to put claims data directly into the hands of healthcare providers and clinicians through APIs via the Medicare Blue Button program.  In interoperability regulations proposed earlier this year, CMS also is proposing to require health plans to share patient claims data through an API.