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My Wish List for Apple’s HealthKit Initiative

June 23, 2014


Apple has been making headlines again, which is not unusual for a company that sets trends and moves markets. A week or so ago they announced that iOS 8 would have a built-in app to collect all of your health info in one place. Then there was the announcement of the partnership with Mayo Clinic and Epic Systems. This generated even more headlines.  I saw all kinds of opinion pieces published, ranging from predictions that this will be the ‘game changer’ that mHealth has been waiting for, to those who said, “Not so fast. What is really novel here?”  I let the dust settle, processed all of this, and came up with the following reflections.

HealthKit

It’s impossible to give an educated opinion because all we’ve seen so far are some hints at what the software will do. We have no idea what the hardware play will be and we don’t yet know all of the planned software capabilities. However, there are some things I believe we can count on.

Apple has an amazing track record of creating superbly designed, intuitive software and beautiful, flawlessly integrated hardware.  By contrast, virtually all software created for health care users (providers, patients and administrators) is poorly designed.  If Apple offers some breathtaking software and very sexy hardware to help us stay healthier, it could make a difference, or at least point the way for others as the iPod and iPhone did.

Also, hats off to Epic and Mayo Clinic for showing us the way on the integration of patient-generated data into the electronic health record.  If the platform gets traction with Mayo clinicians and/or if they can show patient-generated data being used to improve health outcomes or lower cost, this could be a very big deal.

I can’t help but be optimistic.  But I also can’t resist playing armchair quarterback and offering some advice as the effort goes from screen shots to reality.  With so much opportunity to be transformative, I hope they take up that mantle seriously and don’t repeat the mistakes of recent connected health history.  Here is my wish list for Apple as they launch HealthKit.

  1.  Please don’t think that a health data repository on a mobile device will be transformative.  Google discontinued its health data repository and Microsoft’s has gotten very little use.  We (society, health care experts, providers) have not given consumers/patients enough of a reason to make the effort to store all of their health data on one platform.  People don’t feel compelled to take ownership of their health data.  The only compelling use case is the traveler who gets ill and that just isn’t enough.  Yes, HealthKit will make the collection of health data mobile and most likely passively captured. But overcoming these consumer barriers will not be enough to assure widespread adoption, I fear.
  1. Please don’t make it just about seeing your doctor’s notes/lab data, etc., on your mobile device.  This would be under-imagining the potential of this type of platform.  I’m assuming that with the wave of wearables and Apple’s interest in health tracking, we will see heavy integration of patient-generated data. But, assuming is dangerous, so this is my explicit plea to Apple to do lots with patient-generated data, both collected via a device and self-reported.
  2. Please do employ analytics on all of the data streams to feed insights to users in order to help us to improve our health.  This seems obvious, but I worry. At the Center for Connected Health, we have accumulated lots of evidence that personalized engagement messaging is what will make something like HealthKit sticky over the long run.  I don’t see evidence that Apple has done this.  

    Apple does OK at best, while companies like Google, Amazon, Netflix and Facebook live and die on their analytics ability.  Other than iTunes, can you think of a software application that Apple created that is superior?  Apple excels at many things, but any time they’ve been challenged to use analytics to target messaging and personalization, it has not gone so well. Just look at the example of Ping, Apple’s attempt at a social network, or how iTunes Radio stacks up to Pandora. We know there is no comparison to great machine learning as it pertains to keeping individuals engaged. I don’t see this as a core competency at Apple.

For me, it boils down to this:  Will easy-to-use, intuitive, engaging software and beautifully designed hardware be enough to bring people into an environment like HealthKit and keep them there? Or will it take a killer app with analytics to drive personalization to keep people engaged (a la Netflix recommendations, Pandora’s predicting songs for you or Google knowing exactly what your searching for after only three keystrokes).

If you are in the former camp, you predict Apple will be remembered for changing the game in connected health.  If you are in the latter camp, you may be seeing HealthKit go the way of Ping or Google’s health data repository.

What’s on your wish list for HealthKit?

26 Comments leave one →
  1. June 24, 2014 12:17 am

    Great insights. I read a Forbes article that made a great observation: “Google Health never took off because consumers actually don’t want to aggregate their data,” says Derek Newell, CEO of digital health care platform Jiff. “They haven’t wanted to. What they want is information. They want meaning, rewards and a feedback loop.” I’m hoping, based on Apple’s visits with the FDA and everything I’ve read, that Apple will provide us meaning and feedback.

    • June 24, 2014 6:05 am

      Derek is an insightful guy and an old friend. I have the same hope.

    • WaltFrench permalink
      June 25, 2014 7:40 pm

      Part of the challenge for Google is that they effectively sell information about their users. “Anonymously,” yes, but many people have concerns that the spirit of HIPAA just doesn’t go with Google.

  2. June 25, 2014 2:02 pm

    I notice that nothing mentions connectivity between Apple user/patients and their multiple providers, labs, pharmacies, images etc etc. The bias in Palo Alto has always been that mobile will eliminate the need for team care or even medical caregivers. The participation of Epic suggests there is potential to reverse this bias, but that last mile is what counts. An example would be if Labcorp and Quest begin sending all statin patients their lipid levels by default, and offers rewards, incentives and discounts. Apple assumes that this is the end of the episode, but most patients want to share this with a caregiver. That’s the market.

  3. June 25, 2014 2:22 pm

    Fair analysis regarding machine learning, but the reason this will be transformative, sooner than later, is the sheer volume of developers working to produce apps for the ecosystem.

  4. lawrencekerr permalink
    June 25, 2014 2:49 pm

    Dr Kvedar continues his leadership and sharing his unique understanding of technology and health. Addressing, specifically, his point most strongly made in #1, the data alone is without value or transformative. A delicious cake is only a cake after the ingredients ingredients have been mixed and baked. Then, it has been transformed into something to eat. Similarly, only when the ingredients of medical data are combined with judgement, interpretation and conversation is there value to the patient and the providers. We patients need to have our cake baked, not solely be sold the ingredients. We providers need collaboration to be happier, and to be more than we are alone.
    Lawrence P Kerr, MD FACS
    CEO, ClickCare

  5. June 25, 2014 2:57 pm

    I’m hoping the HealthKit initiative drives the cost of sensor technology so low that they can inexpensively be sent home with a discharged patient or follow them to a rehab or nursing facility. Then a simple internet connection can provide a simple video conference on demand while streaming various vitals which a healthcare professional can interpret. This interpretation can be logged and billed accordingly.

  6. June 25, 2014 4:11 pm

    Reblogged this on bonnieaylor and commented:
    The health app would be awesome if it tookt eh ehalth records over the years and then combined them with information like diets, exercise,activites and other things throughout the daily life. So when someone records that this day they had 1/2 pack of ciggarettes, a couple beers, some pizza and went to the downtown industrial center to see a safety and health exhibit,or went to the drag race championships, the app will pull up a stress alert and request some sort of anti-stress diet and activity and ask that you go the the doctor for a physical to ensure there are no signs of cancer, bringing up any data from the past that could compound that risk. Then users of the app could have to opportunity to click into links that would describe the different components of the risk and what makes them so risky.

    • WaltFrench permalink
      June 25, 2014 7:50 pm

      @bonnieaylor wrote, “So when someone records that this day they had 1/2 pack of ciggarettes[sic], a couple beers, some pizza…”

      I don’t think you have to worry about that scenario. All the trouble to input the data that you had 3½ slices of a 15″ Everything Cheezy® pizza, 3 beers, etc., will provide exactly zero information in return, in the foreseeable future. Nothing that your bathroom scale, plus a quick chat with anybody who knows anything about diet/nutrition, would give.

      I think the best we can hope for is that a health-monitoring app get regular weight and activity info (an easy combo of Apple’s motion-sensing tech and a Withings or similar scale), plus the results of your blood panels every 5 years and a physician’s evaluation, possibly computer-assisted, of what info might round out the picture, plus issues to track.

      Plus, the majority of the technophiles who would adopt this are already reasonably able to assess their overall health and what it’d take to improve on it. Maybe some human-factors experts could program in a tool to monitor your exercise schedule and remind you how to catch up if you miss a week for whatever reasons.

  7. June 25, 2014 4:46 pm

    Enjoyed this collection of advice and this plea for apple’s focus on participatory models &patient-centered customization to HealthKit. I hope sincere, useful and bi-directional EHR integration spawns quickly (in EPIC/Mayo and beyond) as many of us reside in the dream-state of health care online (where we share hopes/tactics/ideas for participatory, novel, intuitive and “just in time” health care” like this) and so few of us practice there…

    • June 25, 2014 7:24 pm

      thanks for your thoughtful comment

    • WaltFrench permalink
      June 25, 2014 7:52 pm

      Methinks you have the focus right. Apple, if they’re successful, will build a decent platform on which actual health-care-savvy organizations will make tools. Apple might provide a kiddie-car version, but as the author notes, it’s unlikely to come close to what would move the needle on health care.

  8. TSmall permalink
    June 25, 2014 4:54 pm

    I hope iWatch is a great success. have held off joining the fitness tracking bandwagon with the hopes that Apple may build a great all-in-one with iWatch….
    I wonder if Apple is aligning with the payers for reimbursement on iWatch as they did with the Telco’s to subsidize iPhones….tying usage into payers’ reimbursement or lower premiums could make Apple Health interesting.
    Without the physician feedback loop or incentives, I fear that Apple Health will be limited to a consumer-only solution serving the 10% of the market already using fitness trackers (i.e., Fitbit, Fuelband, etc.), and not the healthcare data sharing silver bullet many are hoping for. Unfortunately, most of our system’s costs are tied to the 90% of patients not currently using health tracking devices.
    A big point many are not mentioning: Android has >50% of smartphone operating system marketshare. How can Apple become the ubiquitous, de facto solution: Does anyone think that Mayo doctors will tell their patients on Android they have to switch phones or go take a hike? Will physicians use or recommend a system that maybe half their patients have access to?
    The winner in this space will likely not be Apple or Android/Google. It will be a device-agnostic software/app platform(s) that enables the feedback loop with the provider. Incentives will likely have to come from payers or employers to further drive adoption.

    • June 25, 2014 7:24 pm

      I don’t imagine anyone will insist that a patient change phones. I have less high hopes for iwatch.

  9. Michael permalink
    June 25, 2014 6:50 pm

    Hopefully Apple will seamlessly integrate the app with existing data repositories of chronic disease durable medical equipment such as insulin pumps and blood glucose meters to take advantage of accurate, real time disease management data.

    • WaltFrench permalink
      July 1, 2014 5:54 pm

      Actually, those activities are SO FAR from Apple’s competencies (and somewhat-related activities, such as their Ping music recommendations, have been such complete busts), that you should instead hope for Apple to make it easy for experts to do the same.

  10. June 26, 2014 11:05 pm

    Thanks Joe for sharing your insightful thoughts!
    A few thoughts of my own…
    1-I would like Apple(and other key health/wellness related data gatherers) to think of themselves not as data collectors/repositories but as data exchange networks that increase data velocity, reach & liquidity… The true power of Health data will be unleashed when it ‘magically’ appears as actionable insight at the point of decision across all stakeholders. An ubiquitous friction free healthcare insight nexus!

    2-The digitization of life is well underway… The possibilities to improve health & wellness are boundless! All of the data has a place in the health puzzle that needs to be assembled…

    3-Agreed that Apple is not an analytics powerhouse but they are masters at creating and managing a developer community that are zealots! The open platform & developer community will build the much needed analytics & algorithm layer that will supercharge the data as it flows through the pipes…

    4-Apple will need to think of themselves as not just a design & consumer product company but a healthcare services & experience corp. To that end their pricing models may need to become aligned with the shift from FFS to outcomes. They may need to consider making money when their products and solutions improve health. Only then will healthcare providers & consumers view them as partners…

    • June 27, 2014 5:30 am

      Very well stated. Good point about the developers.

    • June 28, 2014 9:33 am

      Joe/Paulo – Your comments hit the mark. I’ll chime in with a couple additional thoughts. If you look at the last few decades of healthIT, it’s interesting to observe when the large, successful horizontal technology companies put their focus on healthcare. IBM, DEC, HP, MSFT, & Google each did deep dives with healthcare specific software efforts and end up pulling back. Why? They achieved far greater success when they remained focused on enabling their ISV partners to dive deep into the vertical market (healthcare, in this example but true of other markets). Thus, I predict there’ll be an enabling layer but the healthcare-specific services & experiences that touch providers will be completed by their partners. One example I heard from a good source from one of the companies listed above demonstrates what may inform the thinking going forward. The horizontal tech company made $2B per year from sales of their tech via their partners in healthcare alone. In contrast, they lost well over a half a billion in their healthcare-specific efforts. It’s not hard to imagine how the CEO/CFO of those companies evaluated one approach versus the other.

      You may be interested in this article (http://mashable.com/2014/06/16/webmd-health-hub/) as it speaks to Paulo’s point about insights. It no time, connectivity for data to be aggregated will be assumed. The insights and analytics that come next is where things will get interesting. The aforelinked app was in development for the past year. More to come…

  11. June 27, 2014 3:32 pm

    Nice commentary. My sense of HealthKit is that it will facilitate heath data capture in ways that are starting to catch on. It’s great to see devices like FtiBits and the WiThings scales as ways to capture fitness oriented data, but it doesn’t really have anywhere to go right now except to be held for personal use. Facilitating capture of blood pressure and glucose measurements could be a real boon and a way to get more engagement of patients in their own health. Smart devices could make the typically laborious process of documenting these measurements substantially easier.

    Aside from capturing device data, however, I’m not sure I see an obvious new capability (admittedly with little known at this point). If there’s enough integration with systems like Epic, pulling data the other way and standardizing patient portal like behaviors is another potential avenue, though one that is more challenging to standardize.

  12. July 1, 2014 1:54 am

    This discussion (and the visible part of Apple’s strategy) is focused on the consumer side. This side is perplexing; I would have thought that Google Health would be a winner but it fizzled. Will Apple succeed where Google, Microsoft, and others didn’t? Another question regards the provider side. Most of the doctors and nurses (I am one) that I know use iOS not Android (but this is anecdotal only… no flames, please!) What I’d like to know is, what are Apple’s plans for this audience? I have worked on it, gambling on iOS as the platform of choice, and have produced NurseMind, an iOS-based checklist app for nurses. It is a standalone but would benefit from integration into the larger ecosystem (Epic, Cerner, GE, et al). My prediction? They’re already working on it.

    • July 1, 2014 7:17 pm

      no one answer to your well asked question. I can only say that EMR integration in and of itself is not the magic bullet. more complex.

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