The advance of mobile medical applications are revolutionizing the healthcare industry in a number of exciting ways. We have previously reported on the reaction of the Food and Drug Administration, as well as the importance of crowd testing to ensure that patients and doctors are able to capitalize on the use of medical apps. But as is the case with any rapidly changing landscape, just as we get used to one technological advancement, another replaces it. Such is the case with Apple’s latest release, which has not only grabbed its usual headlines, but has sparked a national conversation about the future of mobile healthcare.
Our readers are probably aware of the wide variety of health and fitness mobile applications that have long been available on portable devices, from RunKeeper to Strava to MyFitnessPal. Earlier this summer, Apple introduced a new mobile application and platform that aims to consolidate the health data tracked by these various other health apps into one location. Apple’s product includes both the platform, called HealthKit, as well as a user-facing app called Health. The product will be bundled into Apple’s newest iOS8 software, which powers iPhones and iPads. The iOS8 software first became available last week.
But, like most of Apple’s epic releases, this month’s unveiling was years in the making. In 2012, Apple began collaborating with the world-renowned Mayo Clinic to design the Health app and the HealthKit application programming interface. For Apple, the Mayo Clinic offers legitimacy – and a powerful partner – as the tech company makes its first big push into the multi-trillion dollar healthcare industry. Mayo, on the other hand, stands to benefit from Apple’s technology to help streamline the process of connecting patients to clinical trials. In June of this year, Apple integrated Mayo Clinic’s database and electronic health records, or EHR, from Epic Systems into its HealthKit platform.
So how does Apple’s new product work? With the user’s permission, each app can use specific information from other apps to provide a more comprehensive way to manage the user’s health and fitness. According to Apple’s press release, healthcare providers will be able to monitor the data their patients choose to share through apps such as Mayo Clinic or Epic Systems’ MyChart app, which will be used by Duke University School of Medicine and Stanford University School of Medicine, among others.
For example, doctors at Duke University will be using Apple’s HealthKit in a pilot program to track vitals, such as blood pressure and weight, for patients with cancer or heart disease. The goal of the pilot is to improve doctors’ ability to monitor patients remotely. Meanwhile, doctors at Stanford will use the technology to monitor blood sugar levels for pediatric patients with diabetes. Participants in Stanford’s pilot will use an iPod touch to track their blood sugar levels remotely. The hope is that remote entry will eliminate the hassle of getting data from patients, and that the use of HealthKit will remove some of the error that inevitably occurs when patients manually enter their personal data.
In addition to its highly-publicized partnership with the Mayo Clinic, Apple has reportedly met with other hospitals as part of its strategy to establish HealthKit as a healthcare data hub, including Mount Sinai Hospital in New York, Johns Hopkins Hospital in Baltimore, and Cleveland Clinic.
Despite the obvious advantages of ever-evolving technology aimed at improving patient care, several concerns remain. One need only think of last month’s enormous breach of Apple’s system that resulted in sensitive photos of celebrities being leaked from their iCloud accounts. The potential for a similar compromise of private health information has, rightfully so, raised serious concerns about the privacy and security of patient data. As data is captured from more and more places and shared more widely, patients’ privacy is, at least in theory, at greater risk of being compromised. Some have questioned the feasibility of obtaining patient consent for information that is collected and shared on such a wide scale, while others question how Apple will be able to track and enforce app compliance with its health information guidelines. In light of these privacy concerns, Apple has said it is considering a certification process for third-party developers that would outline how user data is stored and, importantly, would bar the sale of data to advertisers.
A second, related concern is that healthcare facilities will need to upgrade their back-end systems in a major way in order to accommodate such a massive influx of data. Without the ability to properly organize and analyze the patient data that is imported, healthcare professionals run the risk of being unable to efficiently capitalize on the product’s technological advantages or, in the worse case, jeopardizing their patients’ care.
Another key consideration is how much Apple’s product depends on personal motivation and adoption. Individuals may not be convinced that there is a reason to store all of their health data on one platform, or they may not feel compelled to take ownership of their health data to begin with. Particularly in older populations – arguably the very populations that stand to benefit the most from advances in healthcare – there may be hesitation or reluctance in sharing sensitive health data in unfamiliar ways. Indeed, the people who take the most advantage of the Health app may be somewhat self-selecting, thereby further reinforcing population health disparity. In short: healthy people will use the system, unhealthy people will not.
Lastly, some may question whether the trend towards “remote” healthcare is in fact in the best interest of patients. While the streamlining of care and the expediting of data transfer that this technology promises to provide may in fact free up time and resources, such that healthcare providers can more accurately and thoroughly interface with patients, one could imagine scenarios where self-monitoring and remote care do not necessarily serve as “advances” in healthcare. At the very least, it seems inevitable that the developments in technology will result in a high number of users visiting their physicians less frequently, and there are arguably patients, conditions, and circumstances for which the traditional face-to-face visit has no adequate substitute. Just as eating an apple a day won’t actually keep the doctor away, it is unlikely that Apple will be replacing the good old-fashioned check-up anytime soon.