Apple is making a Health Records API available to developers and medical researchers in an effort to create an ecosystem of apps leveraging healthcare data designed to help consumers better manage their medications, nutrition plans, as well as diagnosed diseases.
The tech behemoth made the announcement on Monday at its 2018 Worldwide Developers Conference in San Jose.
“The Health Records feature allows patients of more than 500 hospitals and clinics to access medical information from various institutions organized into one view on their iPhone,” according to Apple. “For the first time, consumers will be able to share medical records from multiple hospitals with their favorite trusted apps, helping them improve their overall health.”
The news comes on the heels of the Cupertino, Calif.-based company’s initiative launched in April to enhance the Health Records section within its Health app, enabling patients to see medical data which is gathered from various healthcare institutions and presented in a single, aggregated view.
Apple is leveraging HL7’s Fast Healthcare Interoperability Resources (FHIR) standard for transferring electronic medical records and OAuth 2.0 security profiles for authentication to enable patients to securely access their health data on their iPhones.
The company noted in its announcement that Health Records data is encrypted on iPhones and is protected with the consumer’s iPhone passcode, while emphasizing that the data flows directly from Apple’s HealthKit to third-party apps and that it is not sent to the vendor’s servers.
“Medical information may be the most important personal information to a consumer, and offering access to Health Records was the first step in empowering them. Now, with the potential of Health Records information paired with HealthKit data, patients are on the path to receiving a holistic view of their health,” said Jeff Williams, Apple’s chief operating officer, in a written statement. “With the Health Records API open to our incredible community of developers and researchers, consumers can personalize their health needs with the apps they use every day.”
Reactions from healthcare IT thought leaders to Apple’s plans for the Health Records API were very positive.
“As these API tools become more widely available, smartphones will be an increasingly important ‘middleware’ component that enables patients to be stewards of their own data,” says John Halamka, MD, chief information officer at Boston’s Beth Israel Deaconess Medical Center.
Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, describes Apple’s initiative as exciting and pivotal given the fact that the company is supporting HL7 FHIR APIs.
“I think this announcement will lead to a lot of third party developers using FHIR and creating applications that will work against any hospital system that is supporting access via FHIR APIs,” Huff predicts. “If other big players follow Apple’s lead then I think we are watching the dawn of a whole new era of healthcare software development. It will be really significant if the developers move beyond simple tools to the creation of sophisticated clinical decision support programs. Sharing CDS applications based on HL7 FHIR APIs will lead to sharing knowledge as executable programs, and that could lead to very significant improvements in the quality of clinical care.”
Robert Wachter, MD, chair of the UCSF department of medicine and author of The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, contends that Apple’s announcement will help create a new healthcare ecosystem and that it is the most hopeful development yet in the movement to create a consumer-focused healthcare system.
“Patients have had a right to see their medical records for decades. But this promise wasn’t particularly useful until the record was digital,” according to Wachter. “Now that it is, the new challenge is to convert the data in the medical record—which is mostly indecipherable to non-experts—into tools that allow patients to understand their health and healthcare in important ways.”
“This is more exciting progress in what will become more and more common—consumer control of their data in the form of a longitudinal health record,” comments Karen DeSalvo, MD, former National Coordinator for Health IT and currently professor at the Dell Medical School. “We have been working towards this from a technology and policy standpoint and I hope that the healthcare world is taking this seriously because it could stand to significantly shift access to information and to consumers.”
Kenneth Mandl, MD, director of the Computational Health informatics Program at Boston Children’s Hospital, observes that Apple has taken the next logical step in creating a health apps economy.
“By connecting to hundreds of electronic health record systems using the open SMART on FHIR API standard, Apple has committed to and advanced the interoperability of health data across vendors and organizations,” adds Mandl. “With this announcement, they are opening up key health system data to their iOS developer community, who will soon have access to blood counts and medications for apps, just as they now have access to calendar, contacts, location and step count.”
The vision for SMART on FHIR is medical apps that integrate into diverse EHR systems at the point of care. The API is being adopted across major healthcare systems.
At the same time, Eric Topol, MD, director of the Scripps Translational Science Institute and author of The Patient Will See You Now: The Future of Medicine Is in Your Hands, is more measured in his enthusiasm about the Apple announcement.
“Apple’s continued efforts to get patient’s accessibility to their medical data are laudable,” says Topol. However, he adds that “we have a long way to go to get ‘holistic’ comprehensive data but this is a step in the right direction.”
Intermountain’s Huff, who has been a longtime advocate of standard clinical data models and terminologies, says his only concern is that there is a need to further standardize the models and terminology used in FHIR services so that the industry ends up with true semantic interoperability across the marketplace.
“It would be a shame if Apple’s implementation of FHIR was different from Microsoft’s which was different from Google, et cetera,” concludes Huff.
DeSalvo notes that as exciting as the Apple announcement is “we should also pay attention to the privacy and security concerns in this fast moving work.”
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