For a nearly a decade, healthcare providers in the U.S. struggled to meet the demands of U.S. government requirements for electronic medical records. Those requirements were designed to get doctors, hospitals and other entities away from paper records – promising in return that the change would simplify healthcare workflows, allow disparate providers to exchange patient data, provide deeper understanding about patients as a result of more connected and searchable data, and empower users to take charge of their care by electronically accessing and sharing relevant information.
Summed up in a single word, what the government wanted is integration.
Despite comprehensive efforts by various agencies, a slew of new products for front-line healthcare workers and those overseeing them, and widespread adoption of electronic health records, most of these promises remain unfulfilled.
One of the biggest failures is the inability of systems to interoperate. Even with technical and meaningful use requirements in place, patients still don’t have easy access to their data or certainty that accurate and relevant information extends from doctor to doctor. In most situations, a patient ends up being the conduit for sharing information from one doctor’s office to the next (often without all the accurate details, which must then be collected by the provider – if at all).
Fixing this situation is part of the challenge Apple has set for itself with a host of healthcare initiatives, particularly in the upcoming iOS 12. And Apple just might be the one company that can pull it off and reinvent our medical records in the process.
Why current efforts missed the mark
Fifteen years ago, the majority of medical providers in the U.S. still used paper records. Unlike other industries, healthcare remained largely immune to the PC revolution. Thanks to powerful stakeholders and the costs of deploying electronic record-keeping, “this is the way we’ve always done things” and “don’t fix what’s broken” arguments led to inertia. Doctors, in particular, didn’t want to learn how to use PCs to manage workflows. It wasn’t part of their training and experience and many feared that computers in the exam room would slow them down and put a barrier between them and patients.
Faced with a medical industry grounded in the pre-digital world, Congress began passing laws and the federal bureaucracy began crafting regulations. In 2009, the HITECH act was signed into law and began the process of incentivizing the adoption of electronic medical records across the country. Provisions in the Affordable Care Act continued pushing hospitals, medical groups and other facilities to go digital.
Largely dictated by the desire by healthcare software companies to increase market share and revenue, a number of companies sought to be a sole provider wherever possible. They built excellent interoperability between their own products – records, electronic prescribing, billing, practice management, etc. – but focused less on making sure their products could interface with competitors.
This brings us to the current state of affairs. By and large, the industry has followed its government mandates to modernize. Requirements for patients to have access to their records electronically has become a reality and the healthcare stakeholders have, at times grudgingly, accepted and adopted workflows based around electronic tools – particularly mobile tools.
Even so, there isn’t the same incentive for records to be portable from one system or provider to another. Phone calls and faxes still dominate in many medical offices and users seeking to view or consolidate their records typically need to use a different patient portal at every doctor’s office or facility they visit.
Federal and state standards for information sharing, while still developing, are not altogether functional or trusted by those working in healthcare. Even now, medical information remains highly siloed.
Can one company manage everyone’s health data?
A lot of attention has focused on how regulations are spurring hospital and healthcare practice consolidations across the county. Though there are drawbacks, including potential anti-trust and price-fixing issues, one advantage of using providers in a consolidated system is that those providers generally work with a single set of tools across the board.
This is also one of the powerful functions of Kaiser Permanente, one of the nation’s largest health insurers (excluding government or veterans programs). Kaiser owns a range of hospitals and practices in different markets and uses a single set of tools or records across them, making it the largest civilian medical information system in the U.S. To some extent, Kaiser can be seen as a national model and the company and its members reap the benefits of this massive scale. That model is beginning to be tested and adopted by other integrated health systems in the U.S.
It’s worth noting that several other developed countries have a national health records system to ensure that a patient’s information travels with them, regardless of the provider they visit.
What’s this have to do with Apple?
Apple has been developing a presence in healthcare for years. The company has a wealth of industry experts on hand and has hired a number of luminaries from the medical technology industry, including some with experience handling mandates and requirements from government agencies.
Although Apple Watch tends to steal the show when it comes to health and fitness, Apple’s HealthKit, ResearchKit and CareKit are much more fundamental to the company’s apparent ambitions. Many software and hardware developers have created consumer products that tie into HealthKit – the framework underlying the iPhone Health app. ResearchKit is empowering more wide-scale medical studies than anything that came before it. And now Apple has built a solution around an open standard set of specifications and features to make it easy to exchange data with doctors.
More significantly, Apple has the cooperation of the major players in the medical records and practice management spaces – the electronic tools the government pushed doctors and hospitals to use. Indeed, some hooks into HealthKit have been available for several years for these companies. Apple’s goal now is largely to extend that capability.
AppleWith iOS 12, the company is expanding and simplifying how users connect to these systems using the Health app. This means they’ll be able to view relevant information such as conditions, medications and lab results – and do so in one place and with a consistent user experience, regardless of where the data originated. (This info is in addition to the data that’s been part of the Health app since its introduction.)
The iPhone as a health hub
The ability to manage your own health and wellness is made easier with a fuller, more accurate picture of your health needs and how they’re being met by your medical providers; personal devices like fitness trackers; connected medical devices (such as blood glucose monitors and blood pressure cuffs); and symptom tracking and apps for managing acute or chronic conditions. With iOS 12, you’ll be able to aggregate your health data from all of these external sources.
Apple could move this whole effort forward relatively easily by allowing the Health app to share data into your medical records at multiple facilities. The result would be that your iPhone isn’t just a hub for you to see all your data but also the glue that links your data together across every provider you see.
Let’s say you break your leg and go to urgent care. At the urgent care center (or even on your way to it), you connect to the records in that care center. Doctors there can immediately see your overall health history. When you leave, you collect your data to your iPhone (which is exactly what is available in iOS 12). Before your follow-up appointment, you can ensure that the orthopedic practice has the clinical data from urgent care by simply sharing your information as you would to a consumer fitness app. Your iPhone acts as the conduit for moving the data between providers and does so based on your decisions about what and when to share.
Go for a physical? You can make sure your primary care doctor has your latest healthcare updates as well as other wellness metrics like how being off your feet has affected your physical activity and sleep patterns.
As I said, part of this is what iOS 12 will offer – the ability for your phone to be the hub of all your medical data. The biggest thing lacking is the ability to update your clinical records at each facility automatically. Even without that component, however, the ability to easily carry around your combined health data means it can be updated across the board with a high degree of accuracy – albeit in a more manual way as a staffer or nurse copies the relevant data from your phone.
This system could be useful to anyone. But it is particularly important for those with chronic and/or complex medical conditions or people that have multiple chronic and/or complex conditions, each requiring the services of a different specialist. It’s a major convenience for you as an individual and for providers, who can readily access your health information and deliver better care. It also saves money, since it can reduce testing and treatments for a variety of ailments.
The fact that our phones are almost always with us is important in another way: in an emergency, your data is available even if you’ve never been seen at the hospital you go to; healthcare providers can access crucial data using the Health app itself. In fact, the Health app has always allowed you to provide an emergency medical card that can be accessed from the home screen, even if you’re unconscious.
Can Apple pull this off?
The million-dollar (or perhaps billion-dollar) question is whether Apple can actually do this. Can consumers reallyexpect their iPhone to do something for them that governments, hospitals, medical groups, and healthcare IT companies haven’t been able to pull off?
The answer is yes. The ability to collect and consolidate your data exists. As to whether you can easily share data across all providers, I believe the answer is also yes (and it’ll happen sooner rather than later). Here’s why.
Health has been a major area of focus for Apple under CEO Tim Cook for years. With the resources and vision for using technology to improve our health and our lives, Apple can position itself as a major health resource company. (Its strong voice for tech privacy also helps.) Notably, Apple has also not ruled out getting into the connected device market, an extension of its experience from Apple Watch.
Major electronic records software vendors are already on board. Apple has had time to develop these relationships and these companies have announced they will be building support into their products, reducing a major barrier to adoption.
I expect to be driven mainly by consumers, just as the consumerization of IT and BYOD were driven first by workers bringing their devices into the office from home. If iPhone users can access their data, and do so easily, many will take the initiative to begin building a more complete picture of their health. And they’ll then push hospitals and providers to make use of the data sitting on their phones.
Much as any disruption in recent decades has been bottom-up, with consumers demanding solutions or simply finding/creating solutions on their own, many iPhone owners may well insist on making their iPhone a health hub. Clearly, that kind of motivation won’t come from government mandates or from those working in healthcare; it will come from users who want a simple solution.
If anyone doubts Apple can continue to disrupt heretofore entrenched industries, iOS 12 is a warning shot that change is on the way for healthcare – and that Apple aims to push change as few other companies can. It will, no doubt, face competition and it’s almost certain that other players in the mobile arena will want a piece of the action.
But by the time those options arrive, Apple will already have a leg (and torso) up on them.