Tech Project Aims to Address Disparities in Who Can Access Health Records

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When President Barack Obama enacted the Affordable Care Act a nearly decade ago, the broad aim was to improve health care access. One of the pieces of that legislation: requiring doctors to use electronic health records.

Electronic health records, which include health histories, prescriptions and test results, are now commonplace—but not everyone has access to them.

Apple users are the only ones who can access their health records on their phones. CommonHealth, a new app for Android users, wants to change that and tackle health disparities in the process.

“Android users tend to earn lower incomes, so medical centers using the Apple app are cutting out (a large fraction of patients),” said Ida Sim, a professor of medicine at UC San Francisco, where she leads the team piloting the app. 

Sim and UCSF colleagues collaborated with Cornell Tech, the nonprofit Commons Project, and two other nonprofits to develop CommonHealth, which will be available to download for free in the coming months.

The app will allow patients with Android phones to safely store their health records on their devices and tell them how other apps are treating their stored health information. Experts also say it’s a step toward addressing the health-information access gap between Android and Apple users, because it will make medical records universally available—no matter the users’ smartphone brand.

Apple launched Apple Health Records two years ago, in January 2018, as part of the Apple Health app. The app allows users to access their immunization records, prescriptions, test results, documented allergies and other health information collected through their doctor’s patient portal.

The Office of the National Coordinator Health Information Technology reported that from January to May 2018, about 60 percent of the people who were offered access to online medical records viewed their records at least once on their smartphone or tablet.

Elaine Khoong, an associate professor at UCSF and primary care research fellow at Zuckerberg San Francisco General Hospital, said that most of her patients express interest in accessing their health information online. But she said that even with apps for both Apple and Android users, there will still be barriers in the way.

“Our patient population is overwhelmingly a lot of patients with limited health literacy, who are low-income insured on Medicaid, racial-ethnic minority groups, and there’s a certain number of limited English proficient patients as well,” she said.

Khoong, who is conducting patient interviews on usability, testing and perceptions about CommonHealth, said she is preparing to test the app with Spanish and Chinese speaking patients in the future.

Accessing test results requires some level of health knowledge to understand what their results mean, said Adrian Aguilera, associate professor at UC Berkeley’s School of Social Welfare who conducts research on mobile health technology. This can discourage “patients from looking at their electronic health records,” Aguilera said.

Studies have shown that the smartphone market is almost equally divided between Apple and Android, but iPhone users are more likely to earn higher incomes than Android users.

A 2013 Pew Research Center study showed that 40 percent of cellphone owners who earned $75,000 or more annually had an iPhone, while 31 percent had an Android. Only 13 percent of those who earned less than $30,000 owned an iPhone, compared with 28 percent at this income level who owned an Android.

Because Android phones are cheaper, they are the only brand available through the “Obama phone” or Lifeline Assistant program, which gives free smartphones to low-income Americans.

Moreover, while Hispanics and non-Hispanic whites were as likely to own an Android as an iPhone, 42 percent of African American cellphone owners said they had an Android.

Apple phones, said Khoong, serve “a really specific segment of the population.”

About 400 health care centers in the United States already use Apple Health Records—and the number keeps growing. Apple and the US Department of Veterans Affairs, the largest medical system in the country, which provides service to more than 9 million veterans throughout more than 1,000 facilities, announced last month that veterans can now access their health records on their iPhones. But those who have an Android will still have to wait for CommonHealth.

For some, apps that allow medical information to be stored on phones, whether Apple or Android, raise privacy and security concerns, especially whether the tech giants can see and use this medical information. Recent data breaches make those personal data even more vulnerable.

JP Pollack, co-founder of the Commons Project and a CommonHealth project collaborator, said that the CommonHealth app would ask third-party apps to disclose their policies. The app will evaluate and inform users about their safety to help them make their own decisions. CommonHealth will also use encryption to secure health records.

But “once the data goes to another application, you no longer have control over it,” Pollak said. “It could be sold anywhere.” 

That’s because the Health Insurance Portability and Accountability Act (HIPAA), which makes health care providers and insurers keep medical information private, doesn’t protect a patient’s information once it is stored on their phone.  

Pollak said that patients, privacy experts, researchers and developers would work together during a workshop in February to finalize the CommonHealth app and address final issues regarding data privacy and information sharing.

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