Wouldn’t life be easier if you could view your full medical history with a few taps on your smartphone?

The consolidation of medical records may be on its way, as technology companies prod the health care industry to embrace an internet-based common standard for storing and sharing patient information. It’s known as FHIR and pronounced “fire” — a catchier way of saying Fast Healthcare Interoperability Resources.

Industry analysts say the rapidly growing demand for freer exchange of health care information is creating an electronic health record market estimated to reach . With numbers like that bandied about, it should come as no surprise that Silicon Valley tech giants Apple and Google are lining up for a slice of the pie — as are other technology behemoths, including Amazon and Microsoft. Those corporations, and many smaller companies and startups, offer FHIR-based apps and services to consumers and health industry professionals.

The idea behind FHIR is to share specific pieces of information, such as symptoms, procedures or diagnoses, without passing along entire documents. Each discrete chunk of data has a unique identifier, which makes it possible for patients, doctors and researchers to get the information they need on any device or browser, regardless of where the data is stored.

Proponents of the new standard say it should ensure that health care information can be exchanged seamlessly among providers across the industry — from a urine-testing laboratory in Los Angeles, for example, to a pediatrician in Redding, California.

When tech companies can agree to use an industry standard, the adoption of new technology accelerates: Think Bluetooth or USB. It’s a confusing tangle when that doesn’t happen: Think laptop power cords.

Adoption of the medical record-sharing standard may begin to accelerate with the rollout of this year requiring health care providers that receive payments from the U.S. government — Medicare and Medicaid — to use FHIR-compatible apps for patient data.

FHIR has met considerable resistance, however. Until recently, there were few business incentives and limited advocacy by health care providers to create the necessary demand for FHIR’s adoption, said Micky Tripathi, chairperson of the advisory council of , a not-for-profit developer of electronic health information standards that created FHIR.

“Change will come incrementally over time, not overnight,” Tripathi said. “The older standards, though inferior, have the advantage that they are in use today and the cost of ripping and replacing them is not worth the added benefit.”

Some hospitals and medical clinics put the brakes on the very concept of data sharing by engaging in “information blocking” in an effort to retain patients. In 2016, Congress enacted financial penalties to stop them from doing so, but their resistance has not been eliminated.

“There have been roadblocks that prevent innovations and data from being widely shared where it could benefit patients,” said Julia Adler-Milstein, director of the Center for Clinical Informatics and Improvement Research at the University of California-San Francisco.

Beyond its potential to revolutionize medical records requests, FHIR may also provide the first reliable gateway for patient-generated health information from millions of smartwatches, fitness trackers and blood pressure monitors to merge with clinical data in doctors’ offices, people in the industry say.

The need for a standard arose from of electronic health records at medical sites ranging from hospitals and doctors’ offices to urgent care clinics and nursing homes.

Digitizing health records was intended to clean up the chaos of paper-based medical histories, allowing information to be shared more readily. But many practitioners still , and among those who have made the digital switch, medical records often lie isolated in electronic silos.

In 2014, proposed leveraging how the internet works to break open the silos. FHIR evolved quickly, creating what its product director, Grahame Grieve, of international health information exchange.

At UCSF, FHIR is being used in a study to track the weight of newborns hour-by-hour. UCSF’s Healthy Start program integrates weight data with other information about each newborn to alert doctors when one of them may be struggling.

Established medical technology companies and a host of startups are salivating over FHIR, because eventually it could give them paths to lucrative uses of data, including for personalized medicine, population health and medical genetics as well as in emerging technologies such as machine learning and artificial intelligence.

“We want to have FHIR in our analytics and machine-learning tools,” Aashima Gupta, Google Cloud’s director of Global Healthcare Solutions, said at a conference in Orlando, Florida, in February.

Tech giants are already striving to benefit from the growing use of FHIR:

• Microsoft recently released , its data-on-demand offering, to attract health care clients to its cloud services.
• Google joined with the American Medical Association in an effort to improve coordination among health care systems with FHIR and develop methods of collecting and managing patient-generated health data.
• Apple’s Health Records app uses FHIR to let consumers download data from their health care providers.
• Amazon Comprehend Medical works through Amazon Web Services to offer guidance for health care data specialists using FHIR.

Six big tech companies — Microsoft, Google, Amazon, IBM, Oracle and Salesforce — have also joined to support FHIR and broader sharing of health care data through a government-endorsed project called , which is intended to make it easier for patients to view and download their health records.

Consumer advocates and cybersecurity experts warn that personal health information shared on the web could be compromised. They want to make sure the risk is minimized before any widespread rollout of FHIR products. Patients do not have a say in how their health providers store medical information, but patients can request their records be sent in the format they prefer, including paper.

Facilitating access to all that data for both patients and providers without first determining how to keep it secure may open a Pandora’s box that can never be shut, warned David Finn, executive vice president of strategic innovation for , a Mission Viejo, California, and Austin, Texas-based cybersecurity consulting firm.

“We have to change the way we think about data. It is our most valuable asset. But we have not adjusted our thinking about data to how the bad guys think of it,” Finn said. “Until we think about what you could do maliciously with that information, I’m afraid we will not catch up with them.”

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Amazon tiene grandes ambiciones para sus dispositivos. Piensan que el asistente virtual Alexa podría ayudar a los médicos a diagnosticar enfermedades mentales, autismo, contusiones, y la enfermedad de Parkinson. Hasta esperan que Alexa pueda detectar cuando uno está sufriendo un ataque cardíaco.

Actualmente, Alexa puede realizar algunas tareas relacionadas con el cuidado de la salud: “Ella” puede rastrear los niveles de glucosa en sangre, describir síntomas, acceder a instrucciones de atención posquirúrgica, monitorear las entregas de recetas médicas a domicilio y hacer citas el mismo día en el centro de atención de urgencia más cercano.

Amazon se ha asociado con numerosas compañías de atención médica, incluyendo varias en California, para permitir que los clientes y empleados usen Alexa para ayudarlos con la atención médica. Los empleados de Cigna Corp. pueden administrar sus objetivos para mejorar su salud y ganar incentivos de bienestar con Alexa. Y Alexa ayuda a las personas que usan el monitor de presión arterial de Omron Healthcare, HeartGuide, a monitorear sus mediciones.

Pero muchas nuevas oportunidades están surgiendo desde que Alexa obtuvo permiso para usar los bajo la ley de privacidad de los EE.UU., conocida como la ‘Ley de Responsabilidad y Transferibilidad de Seguros Médicos’ (HIPAA, por sus siglas en inglés).

Anteriormente, Alexa estaba limitada a proporcionar respuestas genéricas sobre afecciones médicas. Ahora que puede transmitir información privada del paciente, Amazon ha expandido su “Kit de Habilidades”, herramientas de desarrollo de software, para agregarle funciones a Alexa. Pronto, el asistente virtual podrá enviar y recibir registros de pacientes. Esto permitirá que las compañías de atención médica creen servicios que sus clientes podrán utilizar desde su propio hogar.

Los esfuerzos de Amazon en esta área son importantes porque, con sus 100 millones de dispositivos inteligentes a nivel internacional, podría cambiar radicalmente la forma en que los consumidores obtienen información de salud e incluso tratamiento, y no estaría limitado a los consumidores que son expertos en tecnología. Los analistas esperan que el inteligentes para 2022.

Algunas de las nuevas habilidades de Alexa son una novedad para estos dispositivos: escuchan cada sonido a su alrededor. Esto es necesario ya que están preparados para responder a cualquier solicitud, como “Alexa, ¿cuántas cucharadas en media taza?” O “Agrega zanahorias a la lista de compras”.

Recientemente, investigadores de la Universidad de Washington publicaron un en el que le enseñaron a Alexa, y a otros dos dispositivos -un iPhone 5s y un Samsung Galaxy S4-  a estar atentos a la respiración agónica, el distintivo  sonido de jadeo que es una advertencia temprana en aproximadamente la mitad de los paros cardíacos. Estos dispositivos identificaron correctamente la respiración agónica en el 97% de los casos, mientras que registraron un falso positivo solo el 0.2% de las veces.

Investigaciones previas habían demostrado que una máquina podía reconocer un paro cardíaco durante las llamadas de emergencia al 911 de manera más precisa y mucho más rápida que los operadores humanos.

Amazon, que no quiso hacer comentarios para este artículo, tiene una patente sobre una tecnología acústica que puede reconocer y actuar durante las interrupciones de audio significativas. En combinación con la tecnología patentada de la Universidad de Washington, que diferencia la tos y los estornudos de otros sonidos de fondo, Alexa, por ejemplo, podría discernir cuando alguien está enfermo, y sugerir soluciones.

Debido a que Amazon también posee patentes sobre el a través de una cámara habilitada para Alexa, su aplicación de inteligencia artificial podría enviar los signos vitales al consultorio de un médico antes de que el paciente llegue a su cita y puede continuar monitoreando su condición después de que regrese a su casa.

“Abre las posibilidades de brindar atención médica a distancia”, señaló el doctor Sandhya Pruthi, investigador principal de varios ensayos de prevención del cáncer de seno en la Clínica Mayo, y que ha estado en la primera línea del uso de asistentes de voz para la atención médica. “Piensa en las personas que viven en pueblos pequeños que no siempre tienen acceso a médicos y quieren saber si necesitan recibir atención médica. ¿Podría ser esta una oportunidad, si alguien tiene síntomas, para decir: `Es hora de que vea un médico’?, se preguntó.

Un número creciente de clínicas, hospitales, proveedores de atención médica a domicilio y aseguradoras han comenzado a experimentar con productos que usan Alexa:

• , una compañía startup con sede en Mountain View, California, enfocada en el manejo de enfermedades crónicas, vende un monitor de glucosa que se conecta a Alexa para ayudar a los pacientes con diabetes a rastrear su condición.
• El proveedor de atención médica domiciliaria ‘Libertana Home Health’, con sede en Sherman Oaks, California, creó una aplicación para Alexa que permite a los residentes mayores o en estado delicado comunicarse con sus cuidadores, crear notificaciones para los medicamentos, medir su peso y presión arterial, además de programar citas.
• El Centro Médico Cedars-Sinai en Los Ángeles colocó dispositivos de Amazon con un complemento llamado en más de 100 habitaciones para conectar a los pacientes con el personal y proporcionar controles de televisión de manos libres. A diferencia de un botón de llamada estático, el dispositivo controlado por voz también puede avisar a las enfermeras si un paciente requiere ayuda y puede decirle al paciente el estado de su solicitud.
• Boston Children’s Hospital, que ofreció el primer software de atención médica creado para Alexa, con una herramienta educativa llamada ‘Kids MD’, ahora usa la inteligencia artificial de Amazon para compartir datos de entre la casa del paciente y el hospital.

Muchas compañías de tecnología médica están tentadas por las posibilidades que ofrece Alexa y tecnologías similares para una población que envejece. Un dispositivo portátil podría transmitir información sobre caídas o si la persona no está caminando bien. Alexa podría combatir la soledad. Está aprendiendo cómo conversar.

“Alexa puede combinar una interacción práctica en torno a la atención médica con una interacción que puede involucrar al paciente, incluso entretenerlo”, dijo Laurie Orlov, defensora del cuidado de adultos mayores.

Alexa y otros asistentes de voz también podrían ayudar a brindar un poco de alivio a los médicos y otros p de que ingresar datos médicos en los registros lleva demasiado tiempo y resta interacciones importantes con los pacientes.

Esta tecnología podría funcionar en segundo plano para tomar apuntes durante las citas entre médico y paciente, incluso sugiriendo posibles tratamientos. Varias empresas nuevas están trabajando en este tipo de aplicación.

Una de esas empresas es , con sede en Redwood City, California, cuya publicidad es “Alexa para médicos”. Su software de inteligencia artificial escucha las interacciones entre médicos y pacientes para anotar la información automáticamente.

Los dispositivos de Amazon necesitarán sobresalir en la inteligencia artificial conversacional, tendrán que ser capaz de relacionar una frase anterior con una posterior, si es que quieren seguir siendo dominante en los hogares.

En una de 2018, en el blog corporativo de Amazon, Rohit Prasad, vicepresidente de la compañía y científico principal de Amazon Alexa, explicó la evolución anticipada de Alexa utilizando el “aprendizaje federado” que permite que los algoritmos se vuelvan más inteligentes al incorporar aportes de una amplia variedad de fuentes.

“Con estos avances, veremos que Alexa se volverá más consciente del contexto en la forma en que reconoce, comprende, y responde a las solicitudes de los usuarios”, concluyó Prasad.

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Amazon has big ambitions for its devices. It thinks Alexa, the virtual assistant inside them, could help doctors diagnose mental illness, autism, concussions and Parkinson’s disease. It even hopes Alexa will detect when you’re having a heart attack.

At present, Alexa can perform a handful of health care-related tasks: “She” can track blood glucose levels, describe symptoms, access post-surgical care instructions, monitor home prescription deliveries and make same-day appointments at the nearest urgent care center.

Amazon has partnered with numerous health care companies, including several in California, to let consumers and employees use Alexa for health care purposes. Workers at Cigna Corp. can manage their health improvement goals and earn wellness incentives with Alexa. And Alexa helps people who use Omron Healthcare’s blood pressure monitor, HeartGuide, track their readings.

But a flood of new opportunities are emerging since Alexa won permission to controlled under the U.S. privacy law known as the Health Insurance Portability and Accountability Act (HIPAA).

Before, Alexa had been limited to providing generic responses about medical conditions. Now that it can transmit private patient information, Amazon has extended its Alexa Skills Kit, the software development tools used to add functions. Soon, the virtual assistant will be able to send and receive individualized patient records, allowing health care companies to create services for consumers to use at home.

Amazon’s efforts in this domain are important because, with its 100 million smart devices in use worldwide, it could radically change the way consumers get health information and even treatment — and not just tech-savvy consumers. Analysts expect will have smart speakers by 2022.

Some of Alexa’s new skills depend on a little-understood feature of the devices: They listen to every sound around them. They have to in order to be ready to respond to a request, like “Alexa, how many tablespoons in a half-pint?” or “Put carrots on the shopping list.”

University of Washington researchers recently published a in which they taught Alexa and two other devices — an iPhone 5s and a Samsung Galaxy S4 — to listen for so-called agonal breathing, the distinct gasping sounds that are an early warning sign in about half of all cardiac arrests. These devices correctly identified agonal breathing in 97% of instances, while registering a false positive only 0.2% of the time.

Earlier research had shown that a machine learning system could recognize cardiac arrest during 911 emergency calls more accurately and far faster than human dispatchers could.

Amazon, which declined to comment for this article, holds a patent on an acoustic technology that recognizes and could act on significant audio interruptions. Combined with patented technology from the University of Washington that differentiates coughs and sneezes from other background noises, for example, Alexa could discern when someone is ill and suggest solutions.

Because Amazon also holds through an Alexa-enabled camera, Alexa could send vitals to a doctor’s office before you head to your appointment and continue to monitor your condition after you get home.

“It opens possibilities to deliver care at a distance,” said Dr. Sandhya Pruthi, lead investigator for several breast cancer prevention trials at the Mayo Clinic, which has been on the front lines of using voice assistants in health care. “Think about people living in small towns who aren’t always getting access to care and knowing when to get health care,” she said. “Could this be an opportunity, if someone had symptoms, to say, ‘It’s time for this to get checked out’?”

A growing number of clinics, hospitals, home health care providers and insurers have begun experimenting with products using Alexa:

• , a Mountain View, Calif.-based startup focused on managing chronic diseases, sells an Alexa-connected blood glucose monitor that can help diabetes patients track their condition.
• Home health care provider Home Health, based in Sherman Oaks, Calif., created an Alexa skill that lets elderly or frail residents connect with caregivers, set up reminders about medications, report their weight and blood pressure, and schedule appointments.
• Cedars-Sinai Medical Center in Los Angeles put Amazon devices loaded with a plug-in called into more than 100 rooms to connect patients with staff and to provide hands-free television controls. Unlike a static call button, the voice-controlled device can tell nurses why a patient needs help and can then tell the patient the status of their request.
• Boston Children’s Hospital, which offered the first Alexa health care software with an educational tool called Kids MD, now uses Alexa to between a patient’s home and the hospital.

Many medical technology companies are tantalized by the possibilities offered by Alexa and similar technologies for an aging population. A wearable device could transmit information about falls or an uneven gait. Alexa could potentially combat loneliness. It is learning how to make conversation.

“Alexa can couple a practical interaction around health care with an interaction that can engage the patient, even delight the patient,” said elder care advocate Laurie Orlov.

It and other voice assistants might also help bring some relief to doctors and other medical practitioners who that entering medical information into electronic health records is too time-consuming and detracts from effective interactions with patients.

This technology could work in the background to take notes on doctor-patient meetings, even suggesting possible treatments. Several startup companies are working on such applications.

One such company is , based in Redwood City, Calif., which bills itself as “Alexa for doctors.” Its artificial intelligence software listens in on interactions between doctors and patients to write up medical notes automatically.

Amazon devices will need to excel at conversational artificial intelligence, capable of relating an earlier phrase to a subsequent one, if it is to remain dominant in homes.

In a 2018 on Amazon’s corporate blog, Rohit Prasad, a company vice president who is head scientist for Amazon Alexa, described Alexa’s anticipated evolution using “federated learning” that lets algorithms make themselves smarter by incorporating input from a wide variety of sources.

“With these advances, we will see Alexa become more contextually aware in how she recognizes, understands and responds to requests from users,” Prasad said.

This story was produced by , which publishes , an editorially independent service of the .

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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