This week Apple revealed a mix of health features that at first glance seem a bit all over the place. It added a new way to measure mobility health and announced that iOS 15, due this fall, will let users of its Health app send a summary of their data to doctors that is viewable inside their electronic health record. Patients will also be able to share their Health app data with friends and family.
All these updates may seem minor, but they’re representative of a larger story: Apple increasingly wants to serve as an interface between patients and their doctors. While Apple has not always succeeded in creating health products, the industry is still likely to welcome it. Healthcare providers want more ways to engage with patients outside their offices and regulators want patients to have easier access to their own health data.
Apple’s Health app can already pull in patient health data from a vast and growing list of healthcare providers in the U.S., but the new version of the Health app will be able to send a summary of daily health data back to doctors. This update could put the Health app at the center of patients’ ongoing conversations with their doctors. Patients will be able to easily send information about their eating and exercise habits over to their physicians—where it can be viewed inside their electronic health record, making it easily readable by their doctors—as well as to friends and family. To preserve some privacy, and to make it more digestible, it will appear as part of a summary of trends and health events, rather than individual health entries.
This new doctor-sharing capability is being supported by several electronic health record companies, including Cerner, the second-largest such company in the U.S. Notably absent from the list is Epic, the biggest health record company in the country and the one most wary of Apple’s ascendance in healthcare.
Epic has its own health app for collecting and sharing patient data called MyChart. The app is part of the company’s expansion outside of the hospital and into the hands of patients. MyChart already integrates with some Apple products: For instance, it can read data from the Apple Health app and Watch. But it’s not yet clear the company is willing to share patient data back to Apple.
Epic has been fighting the market and regulatory forces making patient data more accessible across a widening spectrum of apps. Last year, as the Office of the National Coordinator for Health Information Technology (ONC) was finalizing the minutiae surrounding the 2016 Cures Act—which says patients should be able access, exchange, and use their own health data “without special effort” through digital means—Epic cajoled 60 hospital systems into signing a letter opposing the new rules. The concern laid out in the letter is that patient data privacy may be at risk under the new rules.
In response, Seema Verma, then the administrator of the Center for Medicare and Medicaid Services, called out the signees for trying to hold onto lucrative patient data under the guise of protecting patient privacy. “The disingenuous efforts by certain private actors to use privacy as a pretext for holding patient data hostage is an embarrassment to the industry,” she said at the Centers for Consumer Information and Insurance Oversight’s Industry Day.
While the Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects patient medical records, there has been concern that health information inside of mobile apps falls into a legal grey area. But ONC has been responsive to this issue, creating guidelines on how mobile apps can and need to be HIPAA compliant. Ultimately, it implemented the new rules, paving the way for health data to more easily flow to a bevy of new health apps.
Doctors, patients, and apps
In this increasingly open landscape, the opportunity to own the relationship between patients and doctors is immense. Doctors have realized that they lose the ability to help patients as soon as the patient leaves their offices. Patients suffering from chronic conditions such as diabetes, obstructive pulmonary disease, or obesity, need to follow fairly regimented health plans involving medication, exercise, and nutrition regiments. To reach patients outside of the clinic, doctors are looking to apps, wearables, and other digital tools.
Apple has leaned into this arena by providing developer kits—ResearchKit, HealthKit, and CareKit—that help doctors and others to develop apps to this end. While Apple may have its own consumer health data repository, it’s also enabling third-party apps that have the potential to have a big impact on the healthcare landscape. It’s also using these various frameworks to market itself as a facilitator of data sharing, rather than a company that’s perceived to be keeping health data boxed into a single platform. Given the new rules, all companies in healthcare have to make data accessible. But Apple’s positioning as a company that wants to help open up health data may ingratiate it with developers and doctors designing the next wave of health apps.
At Apple’s Worldwide Developers Conference (WWDC) on Monday, Apple showcased one of the apps built on its APIs: Corrie. Developed by doctors at Johns Hopkins Medical Center, Corrie gives patients who have experienced a heart attack a set of daily tasks to complete in order to stay healthy after they’ve left the hospital. It reminds them to take medications, outlines trackable exercise targets, and offers nutritional advice. It also integrates with the Apple Watch, so patients can log their steps and other exercise.
Corrie also provides a patient’s doctor with access to their data. Seth Martin, chief medical officer of Corrie and a cardiologist at Johns Hopkins, says that this makes patients want to do better because they know someone is watching (a phenomenon known as the Hawthorne Effect). Before Johns Hopkins developed this app, he says, cardiologists would send patients home with a stack of papers outlining post-hospital care. “Papers can be super confusing and—even if they’re initially understood—where do they end up? The truck of your car?” says Martin. In contrast, an app gives patients a way to follow a doctor’s instruction that is trackable and shareable.
Notably, Corrie’s functionality could have been built for MyChart, but Martin thought that using Apple’s APIs would make it more accessible to a broader number of patients, especially those whose health records are not in Epic’s system.
The app, which has been around since 2016, has seen success among its users. Martin says that patients who use Corrie have a 52% lower risk of being readmitted to a hospital 30 days after their last hospital discharge. In creating the app, he says he and his team were sensitive not to overload patients with too many tasks and data tracking. “The hope is to inspire them,” says Martin. He says for this reason he’s also excited about Apple’s new fitness programs, which he thinks could supplement a medical app like Corrie.
In addition to developer APIs, the Health app, and the Apple Watch, Apple has also been supporting research that may inform the future of healthcare. During WWDC, Apple announced the iPhone can now determine how “steady” a person is while walking. The steadiness feature determines a person’s propensity for taking a hard fall based on an existing risk assessment test called STEADI. This work builds on its mobility features, introduced last year, which assess the length of steps and asymmetry. This latest feature was developed through Apple’s mobility study. It’s another example of how Apple is trying to shape care and the patient experience.
Apple has not always gotten its health products right. Doctors complain, for instance, that the Apple Watch heart arrhythmia detection feature is too prone to false positives. But the Apple Watch and Apple Health can still give doctors insight into aggregate patient behavior data in a way that may be useful for tracking their overall health progress—and ultimately shaping it. If Apple can bring its sleek user experiences to patient-level health apps in a way that doctors appreciate, then it will be a formidable player in the health tech industry. And with the new ONC rules in effect, Apple may have few obstacles keeping it from getting ahead.