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9 February 2018

Apple nets large-scale hospital trials for iPhone-accessible health records

Apple has continued its mild-mannered incursion into the healthcare industry, announcing that 12 hospitals in the US had agreed to give patients access to their health records through their iPhones – inside the Health app on the beta version of iOS 11.3. This is a big step forward, assuming the feature makes it into the full release, and suggests that Apple has managed to assuage the industry’s fears that it could not be trusted to be the intermediary for such a sensitive piece of information.

For Apple, this is another way to add value to the iOS experience – a sales vehicle that helps lock customers into the ecosystem. As the current leader in this area, largely thanks to the security reputation of Apple’s platform compared to the often woeful Android ecosystem, Apple is hoping to push ahead – sewing up a market before a rival has a chance of competing. However, unlike a camera or battery capacity, it is quite hard to put a tangible value on such a feature – meaning that this is unlikely to begin popping up in marketing materials.

In time, Apple would like to expand that iOS experience to cover more and more devices. Its Apple Watch is the obvious next vehicle for collecting and harnessing health data, but the smart home is another avenue that Apple might look to exploit. Whether that’s through hardware sales or IP licensing (it’s hard to see Apple getting hardcore into medical equipment), Apple has spent a lot of resources to make sure it is a credible vendor in this space.

Apple COO Jeff Williams said “our goal is to help consumers live a better day. We’ve worked closely with the health community to create an experience that everyone has wanted for years, to view medical records easily and securely right on your iPhone. By empowering customers to see their overall health, we hope to help consumers better understand their health, and help them lead healthier lives.”

What this should do is present all the records within a single portal, in a format that is easy for them to understand. In terms of preventative care, this could be rather mutually beneficial for the patients and their care providers. Being able to see the current state of a condition might encourage the patient to be more proactive, which could help cut the number of treatments or hospital admissions needed to provide care.

For example, a diabetic patient might be able to realize that they could do a better job of managing their blood sugar levels if they are presented with a historic timeline that shows it is typically elevated. Similar results could be had with weight tracking, or blood-oxygen sensing – anything that could snap a patient out of complacency and into action could result in drastically improved outcomes, and a much lower cost of care.

Similarly, being able to dive into the data inside that single portal should provide a much better overall picture. Prior to this, if a patient was lucky enough, they might have been able to log into a single care center or provider’s website to see their data, but with this step, the goal is to unify all of a patient’s data in a single interface.

Apple has been active in this area for a while, but has gone quiet recently. Back in 2015 (when it was still selling the $17k Watch), it unveiled ResearchKit, an open source platform that was designed to let medical researchers collect biometric data for their research. ResearchKit also supported the iPhone 5 and up, and was the subject of a lot of rumors in Q1 2015 – with arguments raging over whether a scientific study could ever make actual use of data gathered through non-lab calibrated equipment.

Since then, ResearchKit has made headway, but there’s no concrete benchmark that Apple can swing around when it comes to measuring its impact on the medical world. Shortly after the ResearchKit announcement, Apple and IBM signed a partnership to expand their iOS application development from enterprise applications to healthcare. IBM has been pretty keen to develop its Watson AI platform as a tool for hospitals to use in both diagnoses and outbreak monitoring.

Later in 2015, Duke Medicine, Johns Hopkins, and Oregon Health & Science University announced that they were using ResearchKit to study autism, epilepsy, and melanoma – using an iPhone app to help better log patient data. One of the biggest problems that non-clinical medical research has faced is getting patients to log their behavior, and using an app could help prompt participants and patients to input data at better routine intervals.

The next progression was the launch of CareKit, a version for linking patients with their care providers (doctors and nurses). The first CareKit-based app was Parkinson mPower, developed by Sage Bionetworks and the University of Rochester, which was used by around 10,000 Parkinson’s sufferers – the largest such app usage, by some distance. More CareKit apps followed, including diabetes and depression treatments.

The next step was adding HL7, a healthcare data exchange language (also referred to as FHIR – Fast Healthcare Interoperability Resources), into iOS 10, followed by early partnerships with health insurers (Aetna, more Aetna, and Vitality), and increased competition from rivals like Fitbit through a partnership with Medtronic. There were rumors that Apple was developing optical sensors for measuring blood sugar levels too, which could eventually see such a feature added to the Apple Watch – which would be a huge leap forward.

Which brings us mostly to today. Darren Dworkin, CIO at Cedars-Sinai hospital said “putting the patient at the center of their care by enabling them to direct and control their own health records has been a focus for us at Cedars-Sinai for some time. We are thrilled to see Apple taking the lead in this space by enabling access for consumers to their medical information on their iPhones. Apple is uniquely positioned to help scale adoption because they have both a secure and trusted platform and have adopted the latest industry open standards at a time when the industry is well positioned to respond.”

The 12 hospitals taking part in the beta are: Johns Hopkins Medicine, Baltimore, Maryland; Cedars-Sinai, Los Angeles, California; Penn Medicine, Philadelphia, Pennsylvania; Geisinger Health System, Danville, Pennsylvania; UC San Diego Health, San Diego, California; UNC Health Care, Chapel Hill, North Carolina; Rush University Medical Center, Chicago, Illinois; Dignity Health, Arizona, California and Nevada; Ochsner Health System, Jefferson Parish, Louisiana; MedStar Health,  Washington, DC, Maryland and Virginia; OhioHealth, Columbus, Ohio; and Cerner Health Clinic, Kansas City, Missouri.