What Apple’s Healthkit and Health app mean for physicians

What Apples Healthkit and Health app mean for physicians

I am writing this from the Apple Worldwide Developer Conference (WWDC) in San Francisco.  There were many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for health care.

If you remember the state of digital music, prior to the introduction of the iPod and iTunes music store, that is where I feel the current state of the health care app industry is at; there is no common infrastructure between any of the offerings, and consumers have been somewhat ambivalent towards them as everything is a data island; switching apps causes data loss and is not a pleasant experience for patients. Amazingly there are 40,000+ apps on the App store at Apple alone, showing huge demand from users, but probably a handful can talk to each other in a meaningful way; this is both on the consumer and professional side of health care.

Individual vendors such as Withings have made impressive strides towards data consolidation on the platform, but these are not baked into the OS, so they will always have a lower adoption rate. If we take the music industry example further, Apple entering a market with a full push of an ecosystem at their scale, legitimizes the technology in ways that other vendors simply can’t match. In their introduction, Apple introduced two health care specific items, the Health app and HealthKit framework.

The Health app is a central data repository on your phone that any HealthKit enabled app can deposit data into or read data from, under user control; it also serves as a display dashboard for the user of this data repository if they don’t want to use the source app. This will allow patients to aggregate their fitness and health data from a myriad of sensors (like FitBit) and sources (say, a PHR app) into a single place.

They showed using this as a gateway to broker between health goals, such as blood pressure control, set up by a physician on the Mayo Clinic’s EHR and then tying that back to the patient via the PHR app/Health app linkage. Since the patient can push data back once they grant permission to an app, you can imagine as a physician who is titrating blood pressure medications in the home, getting objective data from the patient electronically (the last mile problem). Engaging our patients is both our sworn duty as physicians and over time as we learn to use these tools effectively, will help us help our patients to be more self sufficient. As our mentor Warner Slack always says, “The least utilized resource in the health care system is the patient!”

HealthKit is to me in some ways more significant, as it allows a common platform internally for health apps allowing for common data formats, data exchange, storage and presentation to the patient; Apple again is establishing an ecosystem here. Having centralized support for health care data, makes applications more interoperable and useful. Several of the health care vendors, such as Epic (I was seated near their CTO who was pumped), who were near me were very excited about integrating this framework into their apps. This will raise all the health care apps to a new level, and greatly increase utility and innovation around these apps.

There is some very legitimate concern for providers; that this will enable an avalanche of data (on top of the tsunami we already are being washed by) from patients, and we will have to figure out how to cope with this. With easier access to sensor data, patients will have to be educated that not all changes are pathologic. A million years of evolution has allowed your body to control things like heart rate robustly, so we will need to be very specific in our education to patients about what they should and should not get concerned about. For patients undergoing fitness programs, this is a superb way to track fitness and can report objective improvement metrics to their health care provider or trainer.

Now for some non-health care specific technologies, that are very useful in health care.

Touch ID, the technology behind the fingerprint login on the iPhone, is now open to third-party applications. This means that instead of relentlessly typing a password (which of course gets longer and more complicated with each policy change) you could for instance sign orders or login to your EHR; I type my password well over 100 times per day into the EHRs that I use, which gets frustrating, and can probably be quantified in lost productivity over all the docs multiplied by all the time spent re-entering passwords as a serious sum of money.

A tiny change is that you can now respond to text messages and accept/decline appointments without leaving your current application. Why is this significant? While for many users this is a convenience, in health care this may prevent medical errors. John Halamka has previously cited a case of distracted computing occurring in the middle of creating orders for a patient, and leaving the task without signing orders, etc. Staying in context makes this error much harder to do.

Finally, I will talk about Swift. Apple has created a new object oriented language, called Swift, which as they phrased it, “took the C out of Objective-C.” This excited me as it reduces many common programming errors that are easy to create in C (for non-programmers, C is a language where you can do anything you gosh-darned please; and with great power comes great responsibility). They seemed to have stuck in some of the automagic of a language like Python with some of the strictness of Java, and then added modern power features, all in a very fast compiled language.

In summary, I think we will look back on the WWDC 2014 as a day when Apple really brought the health care app industry to a whole new level, especially on the consumer side, and also putting in a robust infrastructure for professional and consumer applications to exchange data. This is a 1.0 release, and undoubtedly it will grow over time, and we will see creative uses, which will inspire all of us to grow with it. Similar to digital music, we are at the beginning of a major shift, and we will have to see what develops out of this, but getting consumers excited about health care data, and getting vendors excited about sharing data with each other via the patient, has got to be a good thing.

Henry Feldman is a hospitalist and chief information architect, division of clinical informatics, Beth Israel Deaconess Medical Center, Boston, MA.  This article originally appeared on Life as a Healthcare CIO.

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  • DeceasedMD1

    “This excited me as it reduces many common programming errors that are easy to create in C (for non-programmers, C is a language where you can do anything you gosh-darned please; ”

    C is for chi ching ching….

  • guest

    How heartwarming to hear that EPIC is “pumped” to integrate Apple’s intraoperable ecosysyem for centralized health data support into their frameworks to broker between health goals.
    Any word on possible plans that they may have to improve their EHR user interface?
    Oh, I forgot…the actual clinicians in our healthcare system are not stakeholders in any of this, so our opinion is utterly irrelevant.

    • DeceasedMD1

      It is just jaw dropping, isn’t it? THe new sweethearts and success of the world is Apple and of course they know more about medicine than anyone else. Right? They can join the MIC (Medical Industrial Complex). Who needs to consult doctors when they seem to have all the answers.

  • Steve

    Great- an apple app that allows PCPs to send more patients to the ER for their asymptomatic hypertension! (Source: multiple EM physicians on twitter)

  • guest

    Physicians are absolutely the best prepared to build these apps. But when exactly do you think they would have time to develop them, since they need to see patients in order to repay their med school loans?

    • Chiked

      Building an app or getting someone to do it for you is actually not very difficult. You can build a basic iPhone app in two months at a fraction of the cost from just a few years ago. The real problem is that doctors are not being adequately prepared for the technological tsunami that is coming….or is already here.

      • guest

        I am sure you are right about apps, but we were actually talking about EMR systems, which is an entirely different type of product.

        • Chiked

          The current EMR systems to me are rather dumb. They are basically a digital version of my paper chart. I really have no idea why it seems so revolutionary.

          But as a patient how does all that data help me improve my health. I don’t care that I can log on to a website and look up my lab results. I want to know if I am jogging and my HR goes up to 120, should I be worried. I should have an app that stores all my accumulated data and warns me.

          Now I think that is where apple via its announcement is probably heading. But once again, it is being championed by techies. Where are the doctors in all of this? Why can’t doctors leapfrog everyone and bring it all together.

          • guest

            The doctors are too busy getting their a***s kicked by techies who are designing inefficient EMR products, regulators who demand data collection and entry, regulators who expect granular documentation, the ACGME who expects us to spoon-feed each and every resident, and our own certification agencies who expect us to jump through meaningless MOC hoops. Oh and add all that on top of patients who (shockingly enough) expect us to be current on an exponentially increasing body of knowledge regarding disease and how to treat it, and there is definitely no time for us to leapfrog anyone and organize a better healthcare system.

          • Chiked

            Unfortunately doctors let the foxes into the hen house many decades ago. But technology has a way of leveling the playing field. Doctors will need to embrace it to regain control.