Can Apple Take Healthcare Beyond the Fax Machine?

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Despite spectacular advances in diagnostic imaging, non-invasive surgery, and gene editing, healthcare still faces a lackluster problem: many patients can only get health records from their doctor if the fax machine is working. Even when records are stored electronically, different chunks of every patient’s health information sit in the non-interoperable, inaccessible electronic record systems in different doctor’s offices.

Anyone who needs her medical files gets them either printed or faxed, or has to log on into separate portals for each doctor and hospital, and even then getting view-only access. View-only apps can’t access data to help patients share information with family and healthcare providers, make decisions, monitor disease, stay on course with medications, or just stay well.

On the positive side, this is changing, sort of. Using the iPhone Health app, patients will soon be able to download and view health records on their phones. On the one hand, don’t get too excited–it will initially only work for patients at a handful of institutions, Android users are still out in the cold, and the data available will be limited. And, some dismiss the impact of Apple’s move because of others’ failures to give patients control of their records.

However, Apple’s move is a decisive and consequential advance in patients’ struggle to get a copy of their own health data. Apple wisely chose to use open, non-proprietary approaches that will float all boats–even for Android users.

Every patient deserves a ‘bank account’ of her health data, under her control, with deposits made after every healthcare encounter. After my colleagues and I demonstrated an open, free version of a “bank account” to companies in 2006, Google and Microsoft launched similar personally controlled health records — GoogleHealth and Microsoft Healthvault. Walmart and other employers offered our version, Indivo, as an employee benefit. Unfortunately, even these industry giants couldn’t shake loose data from the proprietary computer systems in doctors’ offices, or make the case to patients that curating the data was worth the effort.

But 12 years later, Apple’s product enters healthcare under different circumstances.  A lot more patient data is electronic after a $48 billion federal investment in promoting the adoption of information technology to providers. But those products, mostly older software and purchased at enormous expense, still don’t promote record sharing with doctors or patients.

Recognizing this unacceptable limitation and having received a generous grant comprising a tiny fraction of that federal investment, our team created SMART on FHIR. SMART is an interface to make doctors’ electronic health records work like iPhones do. Apps can be added or deleted easily. The major electronic health record brands have built this interface into their products.

Apple uses SMART to connect the Health app to hospitals and doctors offices. The good news for patients, doctors, and innovators is that Apple chose a standardized, open connection over a proprietary, closed one. This approach lets any other app, whether running on the web,  iPhone, or Android, use that very same interface to connect.

So Apple will compete on value and customer satisfaction, rather than on an exclusive lock on the data. Does Apple’s approach help Americans trying to stay well or manage their conditions? Yes. But only with follow-through by Apple, health systems, technology companies, patient groups, policy makers, and government regulators. The emerging ecosystem’s nuances must be appreciated.

First of all, the floodgates for patient information are at least a crack open and will be very hard to close. As patients gain access to their data, they will recognize it is incomplete and feel frustrated it’s not available everywhere. But, patients in need will drive demand for data access in their role as health consumers.

Secondly, the government is effectively using law and regulations to compel an open interface. By selecting SMART on FHIR, Apple and its healthcare launch partners mark the importance of standardization. A uniform approach is critical for scale. Imagine if every electrical product required a differently shaped 120V outlet. Understanding this, Google, Quest Diagnostics, Eli Lily, Optum, and many other companies are using the same interface to plug into healthcare.

Thirdly, Apple’s first version of health records brings data onto the phone, but from there, like the portals many patients are already familiar with, the data are still “view-only.”  In 2009, I had the chance to meet with Apple’s rockstar Bud Tribble and talk about how the iPhone could serve healthcare. We concluded that crucial data–like the medication list–had to be as easy for iOS developers to use in their apps as contacts and location are now.  I would not be at all surprised if this is the next step in Apple’s journey–making the health records available to iPhone app developers. Here too is an opportunity to chose open interfaces, and to allow patients to export the data to another device.

Lastly, competition in healthcare IT is hot. Amazon, Google, Apple and Facebook all have healthcare divisions.  Apple’s extraordinary hardware, including sensors in the phone and watch, will monitor patients at home.  Google’s artificial intelligence will lead doctors and patients to diagnoses and decisions.  Amazon is rumored to be eying pharmacy management. Facebook has sifted through posts to detect and possibly intervene when users may be suicidal.

There are so many opportunities to compete. Locking up a patient’s data should never be one of them.

Why Apple’s Move On Medical Records Marks A Tectonic Shift

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Apple has just announced a major upgrade that will allow customers with iPhones and iPads access to their own health records.

This announcement actually amounts to far less than meets the eye, but it could well also mark a tectonic shift in the health care landscape.

It is less than meets the eye because the data enabled is a mere trickle compared to the torrent of health care data that we all generate during our medical visits.

It’s also only a uni-directional data flow from the health care institutions — the hospitals, the medical practices — to your personal health record. Data will not flow in the other direction. You cannot update an incorrect observation in your health record, nor can you add missing facts or missing medications to your “official” health record. At least, not yet.

It’s also not a magic switch that will allow everyone access to their health care records. It requires that hospitals agree to work with Apple to provide this data at a reasonably timely interval or on demand. Currently, only a small number of hospitals have agreed to do so.

So why might this announcement be earth-shaking? Because it represents the first time a mass consumer platform that is in the hands of tens of millions of consumers daily and for hours on end — the iOS operating system — will get officially sanctioned health care observations from the formal institutional health care system.

This immediately enables a number of productive, cost-saving, pain-saving and even life-saving scenarios.

• First, when you show up at a health care system other than the one you normally visit and see an unfamiliar doctor or nurse, this data will let you speed up and make much more accurate the getting-to-know-you phase of the visit. It will help you avoid repeated, unnecessary, expensive and painful testing.

• Now that our data is on this accessible platform, we’ve opened the gates to a world of innovators — some commercial, some nonprofit — to provide decision support, advice and recommendations based on these accurately and authoritatively transmitted health care data.

For example, genetic tests are mostly reported these days without the genetics company knowing your health care details or sometimes even your age. Now, with the clinical information that you can make available, you can give permission to these third-party applications or apps on your iPhone to access these crucial health data.

These companies will now be able to deliver interpretation of your results that are not generic but truly customized to your particular circumstance, just as has been promised to us under the rubric of precision medicine.

• Third-party telemedicine services such as Teladoc or AmericanWell currently allow you to speak to a licensed doctor, including a video connection, within minutes using your smartphone to get a clinical opinion. Now, they will not have to rely only upon the patients’ recounting of their signs and symptoms, or their recollection of laboratory tests or scraps of their record that they have available.

These will be able to be presented in an integrated fashion as part of the telemedicine encounter, which will thereby enable essentially the practice of medicine across state barriers in a way that has previously been artisanal at best.

The fundamental shift that is enabling this transition is the selected health care systems that have voluntarily agreed to transfer data in a well-formatted, accurate messaging that can be represented faithfully on the digital consumer platform.

This represents a major crack in the previously implicit understanding between electronic health record providers and health care systems that data about their patients would only travel in ways that would not increase the ability of patients to get health care elsewhere.

Companies have attempted multiple workarounds to attain this goal, but this represents a major step forward: Now, it’s the electronic health record systems themselves and the providers that are enabling this to happen. Of course, this was functionality that was mandated multiple times by U.S. legislation, but there always were apparently small details that limited the actual implementation.

So has the new era arrived yet? This announcement is the clarion call, but it may not be the new age yet.

It remains fragile in that health care systems can choose to participate or not to participate. The health care record vendors can choose to be more helpful or less helpful to this effort. New regulatory obstacles may be placed to limit the use and reuse of this data.

But the mere fact of this small beginning shows that it is technically and organizationally possible.

In this era when we expect access to information that is important to us in all parts of our lives — from the news, to our financial information, to our personalized weather — the shift to similarly fluid access to our medical data and the creation of a far larger ecosystem of interpretation and health care decision making will gain increasing support.

It will undoubtedly generate business plans and enterprises seeking to birth their unicorns into this $3 trillion sector of the economy representing one-sixth of our gross domestic product.

Furthermore, because the data-messaging standards that are used in this system were developed not by Apple but by a community of informaticians and data scientists working with various research entities such as the National Institutes of Health, these standards are open, so other consumer health platforms such as Google’s Android should have no particular problem in immediately following suit.

Full disclosure: I have a dog in this fight. I worked with colleagues at Harvard and Boston Children’s Hospital to develop automated consumer access to health-record data with funding from the NIH and the Office of the National Coordinator for National Projects such as the huge study All Of Us.

But I am also a doctor and a patient, and I can tell you what I’m planning to do with this new Apple capability: Develop an app to tell any patient with enough data on their iPhone what questions they should ask their doctor about their diagnosis.

Geisinger, Dignity Health among first hospitals to pilot Apple’s medical records system

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Danville, Pa.-based Geisinger Health System, San Francisco-based Dignity Health and Baltimore-based Johns Hopkins Medicine will be among the first 12 hospitals nationwide to pilot Apple’s medical records system, The San Diego Union-Tribune reports.

Here are six things to know about the pilot program.

1. Apple announced its intent Jan. 24 to integrate patient health records into its Health app to make it easier for consumers to review their medical data. IPhone users would need to download the 11.3 “beta” version of iOS to access the feature, according to The San Diego Union-Tribune.

2. While many hospitals and health systems already provide patient portals and other programs for patients to access their health information, Apple aims to embed patient data from multiple providers into the iPhone’s main system. This “deep integration” function could help improve smartphone users’ health by allowing patients to grant permission for other app developers to use the data to help provide the best deals on medications and connect patients taking the same medications, among other features, the report states.

3. Because the health records are stored on the patient’s device, users can send that information to any provider they choose — even those whose EHR systems are not directly compatible with the system the patient’s primary provider uses, according to Cheryl Pegus, MD, director of the division of general internal medicine and clinical innovation at the New York City-based NYU School of Medicine.

4. The challenge Apple and other tech companies with similar aspirations face, according to Dr. Pegus, is designing systems that do not inundate patients with irrelevant information.

“The key is to find a way to utilize this health data where someone puts in the right algorithms that really cause the most relevant data to bubble to the top so then you can message it how you want to. If that can happen, that’s going to be a great use,” Dr. Pegus said.

5. It is unclear if Apple’s medical records system will be able to synchronize physicians’ notes, the report states. The health records data will reside on Apple servers unless a patient’s phone automatically backs up the data to the company’s iCloud service.

6. Other hospitals involved in the pilot program include Chicago-based Rush University Medical Center; Los Angeles-based Cedars-Sinai Medical Center; and Philadelphia-based Penn Medicine.

To view the full list of participants, click here.