It was fascinating to read a CNBC article from June 14 on how Apple is looking to bring all of a patient’s health information together via its flagship product—the iPhone. The article, from tech reporter Christina Farr, has several layers to it that many in the health IT space would likely find captivating, but the core takeaway is that Apple is in talks with a multitude of healthcare stakeholders with eyes on turning your iPhone into a centralized bank for medical information.
Farr reported, “CNBC has learned that a secretive team within Apple's growing health unit has been in talks with developers, hospitals and other industry groups about bringing clinical data, such as detailed lab results and allergy lists, to the iPhone, according to a half-dozen people familiar with the team. And from there, users could choose to share it with third parties, like hospitals and health developers.”
Farr spoke with various health and technology experts for her piece, including Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, Farzad Mostashari, M.D., former National Coordinator for Health IT, and Aneesh Chopra, former U.S. CTO under Barack Obama and co-founder of Arlington, Va.-based NavHealth. These sources seemed to be in agreement that with Apple heading down the road of leveraging the iPhone as a one-stop-shop for a patient’s health information, a major industry development is upon us. Said Mostashari in the story, “"If Apple is serious about this, it would be a big f---ing deal."
Indeed, Apple does seem serious. As Farr reported, Apple has been in talks with health IT industry groups such as The Argonaut Project and The Carin Alliance, two organizations that want to promote interoperability. What’s more, the company has hired top developers involved with FHIR as well as having “made some notable hires from the medical sector of late, including a rising star of Stanford University's digital health efforts, Sumbul Desai,” the story stated.
For Apple, as Farr and others have noted, most of its previous efforts in this sector have been geared towards fitness and wellness. The company did launch HealthKit in 2014, a health platform aimed to connect personally-generated health data and clinical data. And then building off HealthKit, Apple launched ResearchKit, a platform designed to allow users to participate in clinical research trials. Then came CareKit, an open-source platform designed to help developers enable people to actively manage their own medical conditions.
However, pundits now are pointing to Apple’s 2016 acquisition of personal health data startup Gliimpse—a platform for data access, data sharing and data management that essentially collates users’ health data from different platforms and then enables consumers to collect, personalize and share their health data—as a sign that the company is all-in on its newest digital health endeavor.
What’s Different This Time Around?
A key angle to this development is that should it succeed, Apple could help solve some of healthcare’s age-old interoperability problems. While CNBC’s Farr noted that HealthKit has a feature, "health records," that includes the option to import documents that include summaries of care, it is “a limited snapshot of medical information.” But if the iPhone indeed becomes a centralized bank for our medical information, could that move the needle on health data exchange?
Shortly after the CNBC piece was published, I spoke with the above-mentioned Tripathi, one of the nation’s most well-respected thought leaders on healthcare interoperability. First and foremost, Tripathi feels that this development could signal a paradigm shift in how interoperability is thought of. Currently, most people think of interoperability as provider-centric, meaning patients are under the assumption that wherever they go for care, their provider will have access to their whole health history. But as Tripathi asks, is Apple keying in on the patient-centric angle instead?
He explains: “Patients are becoming at least a little bit more interested in the way they’re engaged and interacting in their care. This perhaps suggests a patient angle to interoperability; maybe they can be that lever rather than providers. So the idea would be: as a patient, I can’t count on my providers to share their information, so I take the control. And we see that now at times too, with people taking their CD and bringing it to the next site of care, because the imaging [reports] don’t get there otherwise.”
Tripathi notes that one of the big challenges to this patient-motivated side of health data exchange has been the lack of a real ecosystem that would allow it to happen. “So who’s the organization that can help mobilize patients and help give a scalable trust in a way so that patients can easily access their data from [two health systems], for example? And then do that in an easy way without having to get a username and password in each place, along with all sorts of other hurdles. The more work that is put on me [as a patient] makes me less likely to do it,” he says.
In that context, Tripathi continues, “Apple has a unique positioning where it is in customers’ minds with respect to people having already put their faith in Apple. You have your smartphone and your Apple ID, and you have it right there already with your most personal and deepest and darkest things already on your phone. So why not medical records, too?”
Indeed, it would be hard to argue that Apple has a certain stature in consumer consciousness that’s quite unique, with more than 1 billion iPhone users around the world. Only a few other companies have a similar standing, says Tripathi, bringing up Amazon as one example. “But even if you think about your personal relationship with Apple products vs. Amazon, it’s different. Amazon is more commercial; there is not really personal information with Amazon. So from that perspective, Apple does have a very unique lever at a time in the market when the moment is riper compared to Google Health trying it and then backing out,” he says.
One challenge that Tripathi brings up is that while there is an assumption that people are really engaged with wanting their health information on their iPhones in the same way they are engaged with Snapchat and GroupMe, the reality is that healthcare is very different. “That’s where the extension breaks down a little bit. If you’re a relatively healthy person, you don’t care about looking at your healthcare information every day. I look at mine once a year. Now, some people of course with diabetes and hypertension need daily monitoring, and my iPhone can do biometric monitoring and can manage my information, but that’s only [relevant] for a small part of the population,” he says.
Tripathi brings up the failure of Google Health six years ago, and many explanations were offered as to why it wasn’t successful, summed up nicely in articles by TechCrunch and InformationWeek from 2011. Both articles point to consumers not being interested in maintaining a digital file cabinet for their health records, something that Tripathi also notes as a challenge today. But there is a financial issue here, as well: the traditional fee-for-service healthcare model doesn’t go hand-in-hand with digital health innovation like the value-based care model does. Now that it’s six years later and the landscape is increasingly moving away from pay-for-volume, perhaps Apple can thrive in a way that Google Health wasn’t able to.
Going forward, there are tons of questions about if Apple can make this work. I haven’t even brought up privacy and security yet, though Apple has made that more of a focus in recent years. There have also been rumblings about Apple buying health IT vendor athenahealth, as recently recommended by a Citigroup analyst. While that is perhaps premature, several other pieces to the puzzle feel more real. In the end, when you consider the company’s unique market positioning, with all of the advantages Apple has that no other tech company can match, this certainly is not something I would bet against.
Thoughts or questions on this latest health IT development? Feel free to tweet at @RajivLeventhal or comment in the section below.
