Apple’s recently announced efforts to enhance the healthcare capabilities of its iPhone Health app represent a jump-start for efforts to advance the coordination of patient care through record sharing.
The push has direct implications for Apple’s designs to play a more significant role in enabling consumers to monitor and improve their health, while trying to advance providers’ IT efforts to share data with other organizations, as well as with consumers themselves.
The initiative’s success will hinge on the ability of an emerging standard to pull together patients’ medical information from a variety of records systems and present a unified view of that information to consumers.
To test the concept, Apple is collaborating with 12 technologically savvy healthcare organizations to participate in a pilot effort; they all use two major electronic health records systems developed by Kansas City, Mo.-based Cerner or Epic, headquartered in Verona, Wis.
The initiative will rely heavily on the Fast Healthcare Interoperability Resources (FHIR), developed over the past seven years by Health Level 7.
Initially, the upgrade will enable only a tiny percentage of patients of the 12 healthcare organizations to pull a portion of their medical records from their healthcare providers’ EHRs and store them on their iPhones. First, only 1 percent of all iPhone users have signed up with Apple to participate in its ongoing beta testing program to try out apps such as this. And there’s not a large number of patients now accessing their medical records through portals offered by the organizations, and patients that do use portals typically do so on a computer, not a smartphone.
A full public release of the upgraded Apple Health app is expected in March, according to one of the test participants.
Apple declined requests to be interviewed for the article.
Health IT leaders with several participating healthcare organizations and a health IT industry consultant say Apple expects the app will enhance the utility of its iPhone and better pair it with its Apple Watch health monitoring functions and its HealthKit data tracking platform for the iPhone.
“Five or 10 years into the future, there needs to be something that’s been built for individuals,” says Richard Milani, MD, chief clinical transformation officer, Ochsner Health System, Jefferson Parish, La. “It’s going to take a company like Apple to do something like this.” The technology company, he believes, has the influence, technology and commitment to healthcare to bring about change.
Patients of participating organizations already have access to their records through web-based patient portals, which provide more information and offer more services than what Apple will offer through the health app upgrade, says Peter Kilbridge, senior director of research with Advisory Board, a Washington-based consultancy. With the new Apple health app, patients can use it to log into their patient portals and then download some of their medical records, storing them on their iPhones.
Initially, those records will be limited to allergies, clinical vitals, conditions, immunizations, lab results, medications and procedures, Apple noted in its announcement.
The EHR patient portals, in contrast, allow patients to message their providers, a function unavailable in this initial, read-only Apple package, Kilbridge says.
“In many organizations, there may be more than one patient portal that patients have to use,” he said. “Many (provider organizations) have more than one medical record (system). They may have one in the hospital and several different ones in the outpatient clinics.”
The Apple app, if it’s adopted by other EHR vendors, could gather patient data on one device from multiple organizations and disparate IT systems, making the patient “an aggregator of their own data,” Kilbridge says.
Because patients will be using their own credentials to access their data, they’ll not face the record locator and record matching issues that hamstring other modes of health information exchange, notes Alistair Erskine, MD, chief informatics officer at Geisinger Health System, Danville, Pa. For example, if Geisinger has 10 patients named John Smith, each with access to their patient portals, the healthcare organization won’t need to use probalistic matching to try and identify which John Smith is making a record request using the Apple health app—matching will be handled when the patient logs in to the portal.
Apple was able to broker a deal between the two major EHR vendors to gain access to patient data stored on their systems, in part because of its market clout and also because of pressure from Congress, which required developers to publish and use APIs under the 21st Century Cures Act, passed in late 2016, he says.
The initiative not only involves nailing down syntactic interoperability—the accurate movement of data from one place to another—but also semantic interoperability, the ability, at least for Apple’s limited data set, to share data with agreement on what that data means, Erskine adds. Apple clout, and federal pressure, pushed the records system vendors to agree to enable semantic interoperability in the initial beta test, he notes.
“The ability of Apple to plug in through APIs means this technology could readily expand to other types of information,” such as images, says Brian Clay, MD, chief information officer at UC San Diego, which already has about 160,000 of its patients using Epic’s MyChart patient portal.
Meanwhile, by expanding the health components of its iPhone, Apple may lengthen its lead over its rivals using the competing Android operating system, according to Erskine. “It’s hard to deny the fact that Apple has found a competitive advantage in customer experience,” Erskine says. “They recognized that healthcare needed some of that magic.”
Apple’s data integration function could prove useful in the competitive San Diego healthcare market, Clay says. “Not all of the healthcare organizations in San Diego use Epic as their electronic medical record,” Clay said. “This would allow (patients) to transfer their information from one organization to another.”
The Apple initiative hinges on the maturity and ease of use of FHIR, says Charles Jaffe, MD, CEO of HL7, Ann Arbor, Mich. The interoperability protocols were publicly unveiled at the Interoperability Showcase at HIMSS convention in 2014.
“Today is just another validation that FHIR works,” says Jaffe. “I think in the coming months there are going to be more and more announcements” about real-world use of FHIR, such as in the Apple initiative.
At FHIR’s public launch, Cerner was one of the first developers to demonstrate a mobile app capable of drawing patient information from its EHR using the SMART on FHIR combination. SMART is an open, standards-based technology platform development project out of Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics.
Cerner has since branded its FHIR-based application programming interfaces. “Apple is just one more of those innovators that’s taking advantage of our Ignite APIs,” says Don Bisbee, senior vice president, clinical and business strategy at Cerner. Interoperability approaches have come and gone, but with FHIR, “I think this one’s got legs,” Bisbee adds.
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