AVIA’s Guide to Scaling Healthcare Innovation
Apple announced in late January that its new iOS release would allow users to access their medical records through the Health app – one of the most notable and potentially disruptive events of the last five years in health IT. Twelve US health systems signed on for the initial release, including AVIA Network members Rush University Medical Center, Dignity Health, and Geisinger.
In March, AVIA president Linda Finkel and I visited Apple headquarters in Sunnyvale, CA to discuss this phenomenon with Karthik Hariharan, a director at Apple. Hariharan had been the president, chief operating officer, and a co-founder of Gliimpse, which was acquired by Apple in 2016; Gliimpse built a personal health data platform that enabled consumers to collect, personalize, and share a picture of their health data.
Hariharan sat down to talk with us about Apple’s Health Records. To cover the technical aspects of the new release first, Health Records imports CDA-formatted data from participating health systems and other providers using the FHIR standard. It integrates new data into previous information sets, including those from other providers, and alerts users when their records are updated.
While consumers have been able to visit providers’ portals to view their health records for some time, in most cases, they are viewing only records of care from that practice or organization. “With the Apple integration, consumers will be able to see records from all of their previous care in one place,” said Hariharan, “and at some point in the future, they will be able to forward their records from one provider source to another,” making EHRs a much less effective means of locking patients into their current providers.
In releasing the Health Records app, Apple chief operating officer Jeff Williams spelled out the company’s objectives: “We’ve worked closely with the health community to create an experience everyone has wanted for years — to view medical records easily and securely right on your iPhone.” And health delivery systems signed on rapidly – participating health systems reached a total of 39 within the first six weeks after the announcement.
If consumers now own their data, will they be able to it sell it? For consumers with conditions of interest to pharma or biotech or device manufacturers, the sale of their data might become a potential source of income to offset the cost of their care. Will they be able to share their data with other services online? We imagined proliferating third-party apps, ready to ingest and analyze consumer data and to offer competing diagnostic and therapeutic solutions. When we asked Hariharan about consumer sharing of data for any of these purposes, his response was cautious; due to privacy and security concerns, it will be some time before Apple Health Records supports individual consumers’ release of medical record information to parties other than providers.
As a first step towards making patients truly the owners of their own health data and records, the Apple integration is welcome and valuable. While this move on Apple’s part may stir mixed feelings within our member health systems, it will be hard to ignore given Apple’s visibility and market presence (especially among the commercial population). Health systems joining now have decided that the opportunity to explore this new twist on health information exchange with their colleagues is preferable to the risk of being perceived less technology-forward than their competitors.
Apple’s reluctance to allow the release of consumer health records to third-party developers today is well advised, given heightened concerns about privacy and data access. Eventually, however, Apple will have to open the ecosystem so that consumers can do more with their data than simply view it in Apple’s own Health Records app.
For those contemplating the meaning of Apple’s moves for health care in the mid-range future, imagine this: a fairly healthy patient in your health system is managing her mild hypertension and pre-diabetes well with AI nurse coaching and your core population health management tools. She presents with a new complaint of tachycardia, and is worked up. As soon as her new diagnosis hits the EHR, she posts a request to the wide world of apps connected to the Apple integrated EHR: Who can help me with this condition? Mayo, Geisinger, Amazon Health, and a new Chinese or Indian service display their offerings… and her health plan throws in their advice and services. She is shopping for healthcare in an entirely new way.