A doctor is skeptical about Apple’s HealthKit. Here’s why.

Apple recently previewed a new framework called HealthKit that will be included in their next mobile operating system called iOS 8.

Features mentioned in the video above:

One central app to integrate data from wearable technology like NikeFuel, the Withings blood pressure monitor, and Fitbit.

Working with the Mayo Clinic (for an app to launch in September) to integrate incoming and outgoing health information into HealthKit so that if there is a really high blood pressure, the Mayo Clinic will be notified, through the app, so that a medical professional can proactively contact the patient.  Here’s a quote from Mayo Clinic CEO, Dr. John Noseworthy: “We believe Apple’s HealthKit will revolutionize how the health industry interacts with people. We are proud to be at the forefront of this innovative technology with the Mayo Clinic app.”

Working with Epic, a huge player in the EMR market. The Epic EMR mainly administers to major hospital systems. From the video above, sounds like “the promise” is the integration of incoming and outgoing iPhone health information between Epic hospitals and the HealthKit app.

Emergency Card. The best part of this app, in my opinion, was brushed over very quickly. Within HealthKit is something called “Emergency Card,” and according to the Apple website, “You can create an emergency card with important information — for example, your blood type or allergies — that’s available right from your lock screen.” I like that!

A doctor is skeptical about Apples HealthKit.  Heres why.

I know that this is only a preview, and they were only able to scratch the surface at this point. But, to be honest, even though the tech press is very excited about this, I am not impressed. Why?

Has Apple solved the patient privacy problem? I’ve talked with many tech people about the challenges of making an app reach the standards of the strict HIPAA compliance. Not only does Apple want to hold health information on the phone, but also potentially have two way health information exchange with institutions like Mayo Clinic and Epic hospitals.

Patient comfort level with digital health information. When I talk to patients (especially the less tech adventurous patients), they are most sensitive to their health information. They are really going to be anxious about potentially transferring health information to Mayo Clinic or Epic hospitals. How is Apple going to assure patients and providers that health information is safe and secure?

Mayo Clinic false positives. In the presentation, it was stated that if something like a blood pressure was really high, that this information would be transmitted to Mayo Clinic and then a patient would be contacted by Mayo. I’d love to see the initial testing of this function. Blood pressure monitors have machine errors and user errors. How will they sort that out?

Epic integration. I won’t even rant about my hospital not having access to Epic because we’re too small of a hospital, which means my patients won’t have this HealthKit integration. I’ve seen the Epic system, and it is a lot of information even for a 13-15 inch laptop screen. Will typical patient portal information be available on HealthKit? Will patients be able to transmit health information from HealthKit to the Epic hospital system? Will patients even use HealthKit for this purpose?

Integration of the mythical iWatch. For months now, everyone from the tech press to the tech savvy medical providers have been saying that a wearable device like an iWatch is inevitable. Would an iWatch be helpful for health? An iWatch cannot take a blood sugar, a pulse, or a blood pressure. Yes, it can count your steps, but there are already a variety of devices that already do that.

Now, before everyone starts to come after me, let me say that, yes, I am impressed by the technology above. But unless I see more features and the patient privacy and integration issues answered, HealthKit may be as functional as the previously overhyped, but underutilized Passbook app. Remember that app?

Mike Sevilla is a family physician who blogs at his self-titled site, Dr. Mike Sevilla.

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  • Chiked

    Again, technology is where physicians are losing their relevance. It does not matter what the first Healthkit will look like. Because clearly the market (patients) are saying we want mobile health apps that communicate with our doctors. Physicians should spend more time learning how to or collaborating with software developers that can build such apps. Otherwise you will be forced to use a silly techie app that provides no functionality but lots of work for you. That is what happened with EHRs.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Is the “market” saying that though? Looks to me like all sorts of entities from tiny to huge are incessantly throwing out “mobile health apps” that nobody is using. The bait gets better and shinier every day, but the utility to patients seems all but absent.
      On the other hand, the utility to entities that want to extract more money from people, or just boldly and openly engage in discriminatory practices, seems to be increasing in direct proportion to the size and clout of the app vendor.
      These apps are not built to benefit individual patients.


      • Chiked

        Yeah the field is fragmented right now which is probably why the market could care less. Once you bring all that data into one place, it starts to make sense.

        For instance, right now a routine visit to my doctor costs me $100. Factor in the half day of missed work and the hassles getting there, I am probably out $250. If an app will automatically upload my info to my doc so a virtual medical decision can be made without me being there, I am all for it.

        Which is why physicians should be a part of the development process so it is done right.

        • ErnieG

          This is idea is dangerous– managing individual patients without physically seeing them is a bad idea. I can’t tell you how many times one story on the phone sounds completely different than that same story at a face to face evaluation. Medicine is an art. I am not an old physician (early 40′s), but I know enough not to know that phone/app medicine is not a good way to practice.

          • Chiked

            I agree. But right now I can tell you that my insurance deductible for a simple routine visit is stupidly high. Someone or some company will exploit that opportunity with a mobile app. My point is that if physicians do not create a competing platform, slick marketing and corporate greed will force you to use these apps.

          • SteveCaley

            C’est magnifique, mais ce n’est pas la guerre: c’est de la folie (“It is magnificent, but it is not war: it is madness”). Pierre François Joseph Bosquet, on the charge of the Light Brigade.

            Having an app for something does not make it moral, or right or decent. Eichmann would have been a pretty efficient bureaucrat with the right apps.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          So how much are you willing to pay for the convenience of not being there when medical decisions are made?
          Other than the obvious peril with this scenario, you understand, I’m sure, that the technology that will enable this is not created by free capital (although labor is inching towards free), so what is the price you are willing to pay for convenience? Hint: It is not measured in dollars and cents units….

          • Chiked

            “So how much are you willing to pay for the convenience of not being there when medical decisions are made?”

            It will still be my doctor making the decision. I just don’t have to be physically present each time. With today’s 10 minute appointments, it is not worth the cost and hassle unless you are actually sick.

          • SteveCaley

            WHAT decision – the decision about WHAT? Our culture seems to be heartily discussing the mere wrappers and accoutrements of medicine, not the stuff of what we do in the clinic. Diagnose a stroke for you? or handle your cholesterol? Decide you need a family intervention for your drug abuse?
            There is a THING that goes on in the clinic, and it is complicated. I don’t think its something I can ‘phone it in,’ sorry. People talk about the practice of medicine as though it were some half-understood religious chore to which they show up, get blessed and leave.
            Those who believe that there is “nothing to the practice of medicine” may find it a self-fulfilling prophesy. There is much to Real Medicine – it is terribly hard to do sometimes, and often scary.
            What is a routine visit, anyway? I have seen patients for a “routine visit,” and zipped them down to the ER for emergency intervention. If there is no need for a visit, let’s skip it entirely! But in medicine, “routine” can turn into “horrible” before your eyes.
            To think otherwise is madness.

    • SteveCaley

      Sorry, I’ll call ‘nonsense.’ We see Again, technology is where physicians are losing their relevance, as though technology is some revolutionary entity of the last week that’s popped up and scared the dear old villagers; it’s a trope that never quits, but it’s rubbish. Technology…how were berry aneurisms o the Circle of Willis handled in 1960, ’70, ’80 until today? Each decade threw the old practices into extinction. I’ll bet in Ghana, they’re using techniques that were awesome here at home in the 1990′s.

      The “Market” is not the “Patient.” Look at the VA. The “market” was driven by the bureaucrats, not the patients. The “market” said that the VA is just fine, fine worthy of a bonus. So don’t read the slick glossies to see what the patient wants. They are clueless.

      “Physicians should spend more time learning how to code or collaborating with software developers…” Rubbish. Physician input achieved nearly nothing in the bloated bureaucratic make-work Rube-Goldbergean monstrosity of the EMR. Competition for the gizmo market is hardly the reasonable goal of the physician.
      It becomes necessary to the cheerleaders of technopathy to insist that the physician is losing relevance – because if instead, the physician is being driven away so as to deprive people of individual care for the corporate saving of money, then it is a social atrocity.
      It is the burden of proof to the technopaths to prove that it is not. The cry from patients over the last twenty years has not been for more densely-integrated algorithmic-based software in medical care. It is the care of the patient.
      I do not tend to hold to the moral imperative in convincing people of this, the extinguishment of American healthcare. I hold to the evolutionary consequences. Societies which cannot care for themselves, die off. That cannot be disputed. Ours will likely do so, in the Great Plague that silences the last Tweet upon the last Tweeter’s demise.

      • Chiked

        I am sure you realize that never in the history of medicine has there been so much corporate interest. If you think this will be no different than other periods, you will be wrong. Hopefully this website will be up in 20 years so I can remind you.

        Bottom-line, technology is disrupting almost every industry imaginable. I never said it was good for the patient but it is here. To fight, physicians have to jump in not just complain from the sidelines. If you do so, you do it at your peril.

        • SteveCaley

          As a rabbit, I am not reassured by the fact that there are more coyotes than ever in history roaming about with great interest in my affairs. Getting their attention may not be what I desire. Like many of my colleagues, I try to stay immobile and inconspicuous when the corporate types trot by.
          It is not technology that is disrupting everything, it is a brownshirt mentality that insists that reform is to be accomplished with the club.
          The club is hardly a new form of technology; perhaps the TASER?
          To jump in, and do what, exactly? To lead the lemmings off the cliff? When medicine is thoroughly wrecked, do I want to bask in warm memories that I contributed to it? What is the peril? Trampling and smashing things has been a great part of our collective history already.
          Breaking things has never been the answer. All the chat and nonsense about “creative destruction” has been said and said, and said again over the many years, in the many languages of history. You cannot beat society and civilization into progress. “Creative smashing” is just smashing.

    • guest

      “clearly patients are saying we want mobile health apps that communicate with our doctors”

      I wouldn’t be so sure about that; why don’t you read the dozens of negative comments posted by readers (patients) at the end of this article about the newest cool medical technology.


      And as for mobile health apps that save you the trouble of going to see your doctor? Great idea, but how is your doctor going to keep his practice open doing virtual visits with patients when right now your insurance company doesn’t pay him for anything other than a face-to-face visit with you? If it’s not reimbursable, there’s very minimal incentive for anyone to develop it.

      • Chiked

        I don’t see how it is different from email. At Kaiser they encourage us to check our lab results and email our doctors with questions. So when I get a lab result, I email my doctor. He usually replies with a “don’t worry” or “come in”. That is all I would want from a health app.

        Again I am not saying it is how medicine should be, or that I even like it, what I am saying is that physicians or physician advocates should be at the forefront of the movement. I can’t imagine that if there were a move to change the way we bank, that you would not have a million and one bankers lined up ready for battle.

      • DeceasedMD1

        I saw that too on swallowing microchips to monitor your med compliance. No wonder big Pharma will be supporting this company. Quite lucrative for them to ensure you are compliant. Meanwhile you can be monitored by telemedicine and it’s likely the wrong diagnosis and treatment plan anyway but the technology is sure way cool. BTW how the h@ll did the FDA approve this? unreal.

  • Arby

    I’ve used Microsoft’s Health Vault in the past and I love it. I use it so my physicians can, hopefully, identify patterns and/or know that I don’t MSU [make stuff up]. In this new age of we won’t test you for anything because it is so expensive, getting your own data whether though a health app, a photograph or a video is a rational response.

    However, I do find the idea of transmitting it in real time to the doctor ludicrous. With the exception of a few cases, this level of monitoring is absurd. People should know how to monitor themselves or if think they are too ignorant, just set alarms into the system.

    Also, privacy is still an issue for me, but they are buying and selling me now without me knowing it, so it might as well be my decision in this case.

  • Steve

    As I think I have commented before on another post on this app-
    Great- another piece of technology that will send patients to the ED unnecessarily for their asymptomatic hypertension

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