Why Apple's HealthKit could transform health care in very short order

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Credit: MacWorld

Healthy disruption in healthcare.

As expected, Apple did announce a health and fitness app that will ship with iOS 8 during the WWDC keynote, although it was simply called Health rather than HealthBook.

The Health app will offer a broader range of functionality than most health and fitness trackers and is designed to aggregate health information from a range of sources including other iOS apps, wearables, and smart medical devices like Bluetooth-equipped blood pressure cuffs and glucose monitors.

Also as I speculated last month, Apple's Health app website notes that the app includes an emergency card feature that can be accessed from an iPhone's lock screen, though the site doesn't provide details on how such emergency access will function.

Although Apple’s Craig Federighi introduced the Health app and announced HealthKit -- the platform that allows iOS developers, the makers of fitness wearables, and connected medical device manufacturers, to exchange data to the Health apps -- the announcement was buried in the middle of the iOS 8 preview and demo section and was surprisingly brief given the potential of the HealthKit platform.

The brevity was particularly striking in comparison to Samsung's Voice of the Body event last week, during which Samsung announced its own mobile health platform -- including the wrist worn Simband that could integrate an array of sensors to deliver vital sign monitoring, integration with its various devices, and a cloud-based health and fitness aggregation and analysis platform. The scheduling of Samsung's event has been widely presumed to be an attempt to steal Apple's thunder regarding mobile health in advance of Apple's developer conference.

Given all the flash and hype surrounding Samsung's event and Apple's apparent downplaying of its Health app and HealthKit, it's very easy to make the case that Samsung succeeded in doing so. But things aren't always what they seem.

Although Apple was brief in discussing HealthKit, there were some key points that the company made and that illustrate Apple's health platform is a big deal -- in fact, it may very well end up being a bigger deal than Samsung's offering.

Like Samsung, Apple is building a platform rather than a complete health solution. Much as with its new home automation platform, Apple isn't trying to build an overarching Apple solution so much as its providing developers and hardware makers with a way for their new and existing products to exchange data. That exchange appears to function in both directions. Apps or devices designed to track metrics can feed data into the Health app and the HealthKit APIs also allow it to send data to other apps -- that means disparate tools can work in tandem.

A simple example of this would be a fitness tracker that identifies calories burned, which could enable a nutrition or diet app to respond with a suggested calorie intake or even recommend specific foods, potentially even foods from restaurant chains, or recipes.

What's particularly appealing about this two-way communication, however, is that it enables consumer-oriented tracking tools (and more medical-focused monitoring apps or devices) to provide data to clinical apps, which can then act on that information. Federighi highlighted this during the keynote, noting that the Mayo Clinic has already created an app that uses HealthKit to monitor specific vital signs or health metrics like blood pressure and alert a physician if the app detected readings outside an established range.

That's a pretty powerful use of HealthKit as a platform and it's worth pointing out that, in theory at least, it wouldn't matter how a user is tracking their blood pressure (or other chronic disease metric) -- it could be through a HealthKit-enabled Bluetooth cuff, a wearable device, or even a "dumb" blood pressure cuff that just displays a value to the user, who simply enters it into an app manually.

The Mayo Clinic gives Apple credibility in healthcare

That Apple is partnering with the Mayo Clinic is a big deal, as is the endorsement that Mayo's CEO Dr John H. Noseworthy gave HealthKit:

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.

The Mayo Clinic is one of the more respected healthcare organizations in the country. That endorsement carries a lot of weight in the health sector. When it comes to mobile health in particular, the Mayo Clinic has been a pioneer in integrating mobile technology, including consumer-focused technology, in ways that deliver incredible value to its patients, healthcare consumers in general, and to medical science.

Last summer, I highlighted the Mayo Clinic's patient app as one of the best uses of mobile apps for patient information, engagement, and care coordination. More recently, doctors at the Mayo Clinic were the first to explore the potential of wearable activity trackers in post-operative care for cardiac patients. They performed a study that showed consumer-oriented fitness trackers from Fitbit helped to predict recovery times for patients

Also launched earlier this year was a public Mayo's mobile health app/service called Better. Better itself is a free app that offers advice based on a user's health and needs. 

Put simply, Apple has garnered the endorsement of one of the biggest names and innovators in healthcare and that brings significant credibility to Apple to HealthKit as does its growing team of medical experts.

HealthKit and EPIC

The Mayo Clinic wasn't the only name that Apple dropped in relation to HealthKit. It also noted that it was working with EPIC, one of the top three electronic health record (EHR) companies in America. EPIC provides EHR and a complete range of other health information systems to a wide swath of hospitals, hospital chains, medical groups, and medical practices across the country.

EPIC's involvement with HealthKit does two critical things for Apple.

The first is pretty obvious: It gives Apple access to a massive installed base of clinical customers. That alone is a pretty major advantage for Apple. Working with EPIC not only puts Apple on the map of mainstream healthcare solutions used by doctors, nurses, hospital/practice administrators, and other healthcare professionals, it also shows that Apple understands what role HealthKit apps can play in clinical care.

The biggest advantage, however, may be that this gives Apple credibility with healthcare IT leaders and professionals. Many health CIOs and their teams may not know or trust Apple, but they know EPIC -- even if they work daily with solutions from its competitors -- and EPIC's involvement carries weight here since these are folks that can make or break HealthKit as a mainstream clinical solution.

EPIC's interest in HealthKit wasn't discussed in the keynote or any materials from Apple, but given the challenges facing health IT, it's likely that EPIC sees HealthKit as part of its strategy in three important ways: Handling patient generated data; demonstrating extended patient engagement; and delivering added patient-focused value.

Patient generated data, defined as information that is collected and tracked outside of a clinical setting like a doctor's office, is a major challenge in healthcare. Virtually all healthcare stakeholders seem to agree that the data from fitness trackers, wearable monitoring devices, medical devices like blood pressure and glucose monitors, and health/wellness apps can enable a much more accurate picture of an individual's health. That opens the door for personally tailored treatments like nothing else before in the history of medicine.

But there's no real consensus on how to capture, store, and analyze that data.

The sheer amount of data a single person can generate each day is staggering, and smart data solutions that identify and make sense of important information without getting snowed under by all the routine information are still in their infancy. EPIC could look at HealthKit as a way to attack that challenge.

The next issue is more well defined. The federal government's EHR program is divided into three stages, designed to ensure healthcare providers are using the systems effectively. 

The rules for the second meaningful use stage put an emphasis on patient engagement using electronic tools to offer the patient access to their health data and secure messaging between patient and provider, often via secure web portal. One of the key requirements is not only that providers offer these services, but that at least 10% of their patients actually use them.

EPIC already offers these types of features through the web as well as through an app for patients called MyChart that is available for iOS and Android. Building in support for HealthKit could help encourage patients to download and use the app regularly.

Building HealthKit integration into MyChart offers a lot of value to EPIC's customers -- the hospitals, practices, and clinicians that use its health IT systems -- and to their patients. A hospital or doctor offering a patient-facing apps with HealthKit and Apple Health app integration could be a selling point to patients. There's also the overall clinical value in engaging patients. EPIC could also be planning some clinical back-end functionality to offer doctors and other providers data and alerts from the app.

Other partners

The Mayo Clinic and EPIC are major partners that Apple needs in order for HealthKit to succeed. The company also has a range of other partners signed on including several health and fitness companies -- Nike, Fitbit, Wahoo Fitness, iHealth, and Withings. It seems almost certain that Apple has already been working with these companies and more on HealthKit implementation. Apple knows the importance of having an established ecosystem for any new mobile or app initiatives, and I'll wager we'll see a slew of announcements of day-one support from players in all kinds of health solutions when iOS 8 ships in the fall.

Apple really could transform healthcare as we know it

The scope of HealthKit is pretty incredible in and of itself. But with so many links to every part of the health, fitness, and medical industries in place, Apple truly has the ability to disrupt and transform how we understand our bodies, diseases, and chronic conditions, as well as how doctors treat and manage our healthcare needs.

That may be a good thing for the public, as well as for the healthcare industry. Thomas Stringham, Co-Founder & CEO Cientis Technologies and AmericanEHR Partners, included the following in a blog post Monday discussing Apple's health announcements:

I think that having Apple join the digital health space will provide a great push towards improved usability and interfaces, particularly in mobile. So many companies tend to “borrow” from Apple, and just having their products in the digital health space will provide a collective kick in the butt to the rest of the industry. This will also provide a great boost to interoperability as the iOS marketplace provides a great convergence point for multiple types of data from disparate platforms to connect.

The stakes are high for Apple and its HealthKit partners, but the payoff could tremendous for Apple, its partners, and the rest of us -- even non-iOS -- users if Apple's involvement pushes healthcare forward.

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