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Apple’s Health Records App: A Ripple or a Roar?

January 29, 2018

To quote Yogi Berra, “It’s déjà vu all over again.” Or so it seems.

Apple’s Health Records App

Last week, Apple made a big announcement that headlines and excited many in our industry. They have enlisted two of the largest medical records companies, Epic Systems and Cerner, as well as Athenahealth, and a number of respected healthcare institutions, including Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine and UC San Diego Health. And, according to their press release, they have built their newly updated Health Records app based on FHIR (Fast Healthcare Interoperability Resources), which is the interoperability standard for transferring electronic medical records.

This is all good very good news. I might add that Apple has build an undeniable reputation on their ability to create beautifully designed and highly intuitive software and highly integrated hardware. I dare say, no one does it better.

But I can’t help but recall similar attempts to create health data repositories for patients on their mobile devices. In 2012, Google shut down Google Health after just three years due to “lack of widespread adoption.” Microsoft HealthVault has also seen its share of challenges since it launched in 2007. Of course, Apple entered the health market in 2014 with its Apple HealthKit which, to date, has not been the game-changer it was originally expected to be. A few weeks after the HealthKit launch, I actually catalogued my wish list for Apple HealthKit, and several themes from that 2014 post are still very relevant.

While I applaud Apple and their partners for this latest attempt to put personal health data into the hands of consumers, we should keep a few important caveats in mind. Why haven’t these tech giants — and others — been successful? Why won’t this latest announcement from Apple revolutionize healthcare? I have a few theories.

First, access to medical records is just not that compelling for the average consumer. Think about it. How many times do you wake up in the morning and feel the urge to check your medical records? Don’t get me wrong. It should be an imperative to have easy access to important personal health data, that you can simply and securely share with your healthcare providers, or access in an emergency. I have long been a vocal proponent to giving individuals access to their personal health data.

But that leads me to my second point. Access to personal health records will not magically improve clinical outcomes, or even motivate individuals to better manage their health and wellness. As we now know from our work at Partners Connected Health, it takes a sustained, highly personalized experience, seamlessly imbedded into our daily lives, in order to change behavior that can lead to better outcomes. Knowing my blood pressure results from my last doctor’s appointment six months ago will not motivate me to take a walk after dinner.  We must not think that access to health records will automatically lead  to improved health outcomes.

My third caveat is that, while this is a very worthwhile advance for Apple users, but what about those committed to devices that run on an Android operating system? According to data from Gartner, in QI 2017, 86% of smartphones sold worldwide ran on Android. If we are going to make personal health records available to consumers, we must make it device agnostic in order to create real change.

I suggest that we more closely examine how Apple’s new Health Records feature is actually different from past attempts.  It will likely be much easier to set up than Google Health or HealthVault and anything on a mobile platform is immediately more accessible. Apple also has their wonderful consumer design capabilities to bring to the party.  Undoubtedly, they will talk about those instances where an individual whose home is in Massachusetts breaks a leg skiing in the Rockies and is able to present her health record to folks in the Denver emergency room.  This is progress.  There are just so many other problems that providing access to medical records don’t solve.  Medical record data is not that compelling from a consumer perspective.   If they bring something to the table that inspires consumers to care (and Apple knows how to do this), that could be transformational.

Will history repeat itself? Will the promise of making personal health records just an app away fizzle or, at best, create a ripple rather than a roar? Time will tell.

What do you think? Is this déjà vu or do you think this will help to improve the quality of care?

 

12 Comments leave one →
  1. Praveen Timmashetty permalink
    January 29, 2018 6:38 pm

    At least a step in the right direction. Driving behavior change and the urge to check your weekly/daily health goals that leads to better clinical results in your next lab test will come. i would say a ripple going towards roar!

  2. Andrew D Oram permalink
    January 30, 2018 3:03 am

    Many observers said that Google Health and Microsoft HealthVault failed to take off because the clinicians and vendors did not cooperate and would not share their data. (FHIR makes it easier to do nowadays, but sharing could have been done then with the will to do so.) Thus, Google and Microsoft required patients to manually re-enter their health data, which was of course cumbersome. By this criterion, Apple does not “put personal health data into the hands of consumers” but gives into the clinicians and vendors, letting them keep control over the data. Through that compromise, and the convenience of FHIR, it is giving consumers a window onto data owned by others.

  3. January 30, 2018 5:34 am

    I had a similar initial reaction, is this PHR 2.0? However, given developments since the ill-timed PHR craze of 2007+ including Cloud, SAAS/PAAS, proliferation of apps, EHR adoption (HITECH), the march towards digital health and improved standardization/interoperability (FHIR etc.) this may be an idea whose time is right. Apple seems to have the right partners engaged for their initial developments. Will be fascinating to see how this unfolds….I’m predicting success.

  4. Brian Manning permalink
    January 30, 2018 3:43 pm

    In order for someone to choose to spend time on an app (when there are millions of them in the app store) the user needs to get something in return. And they need to get that return quickly. When I search for a restaurant on Foursquare I get a return (recommendations). When I use OpenTable I get a return (a dinner reservation). When I use WhatsApp I get a return (a conversation with a friend). When I use Spotify I get a return (music).

    But what does the consumer get when they upload a bunch of health data into the Apple health record? Nothing. At least not immediately. At least not until they’re sick. Which they hope they never are. There’s no clear return. This is the challenge with patient-driven health records.

    This is part of the brilliance of Zocdoc (disclaimer: I worked there for almost 4 years). They are able to compile important health information from the consumer. Lots and lots of it. Every single day. They’re able to do it because the user gets something in return immediately for engaging and sharing their health information (a doctor’s appointment).

    In my view, the companies that have failed on personal health records have failed because they didn’t fully appreciate the way consumers engage with their own healthcare and they ignored the core tenets of consumer behavior. People are busy and have been trained to ignore everything unless it makes them feel good or gives them some near instant utility. Unless Apple’s personal health record app can find a way to deliver utility back to the user (quickly) I fear that it may share the same fate as those that have tried and failed.

  5. January 30, 2018 4:48 pm

    very astute commentary

  6. February 8, 2018 10:51 am

    Excellent post and thoughtful commentary. Captures the conundrum around healthcare consumerism well, i.e., very few patients are eager to engage in either their care or wellness.

  7. February 14, 2018 4:57 pm

    For this system to work and be inspiring I would expect that the process of loading data to the app to be seamless, effortless, and invisible. We shouldn’t need to do much (if anything) to have our health data loaded. Like well connected IoHT devices, the data should just go there – from my scale, my watch, and now from my health institution(s). Apple’s “effortless solution” has so many opportunities for personal and meaningful consumer engagement, and I hope they get it right as it could become the benchmark. What if you could set up Siri to be more of a “coach” or at least a motivator that provides you with feedback on how your tracking on your health goals? Having your digital assistant talk to you without being prompted with “Hey Siri” may sound intrusive or odd – but it may be this kind of quirky behavior that could inspire consumers to care.

    • February 15, 2018 8:37 am

      this is spot on. I just did not see that vision in Apple’s announcement

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  1. Apple’s Health Records App: A Ripple or a Roar? | mHealth Insight

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