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Carbon Health's epic plan for patient data

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.

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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 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.

Eren Bali Eren Bali

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.”

CARBON HEALTH

CEO AND CO-FOUNDER: Eren Bali

HEADQUARTERS: San Francisco

INNOVATION: Carbon Health's smartphone app is an electronic health record, a telehealth portal, a secure message platform, and a payment and scheduling service that could make care more patient-centric and transparent.

STATUS: The platform is being used at Carbon Health's San Francisco clinic. The company expects to expand to other providers later this year.

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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