Apple Health app pilot combines engagement and interoperability

Security and engagement through the app

 In January, patients at the pilot sites started integrating electronic health records (EHRs) into their iPhones via the Apple Health app. The records can be securely encrypted and protected on the phone.

Stephanie Reel

Stephanie Reel, CIO at Johns Hopkins Medicine in Baltimore, also a pilot site, said it's the right time to move forward in terms of technology, security, the Fast Healthcare Interoperability Resources (FHIR) protocol and consumer awareness. FHIR, developed by nonprofit HL7, is an interoperability standard that helps developers more quickly build applications to exchange health data.

The Health app features are "a way to make information available to patients where they are and where they live," she said, "[and] to empower them and engage them in their healthcare. But we will be respectful of patients and we will move cautiously."

The app's Health Records tab has seven types of documents: allergies, medications, lab results, conditions, procedures, vitals and immunizations. Using the FHIR interoperability standard, APIs and other technology, patients can see their records in one place, across time rather than in a single snapshot.

At every step, the patient decides whether to allow access to a provider or between providers involved in the Apple Health app pilot. At no point does Apple see the records; the download is direct from a hospital's server to the phone.

Apple gets a nod from pilot CIOs

Apple's sway could make a difference with this latest foray by a major tech player into electronic personal health records (PHRs) where the likes of Google, Microsoft, WebMD and others failed or continue to languish.

At Cedars-Sinai Medical Center in Los Angeles, another pilot facility, the choice to partner with Apple made sense for a consumer-facing initiative. "If Apple announced an effort for ERP or for doctors, I might look at it with a brow raised. Do they have the experience?" said CIO Darren Dworkin. "But they stayed right in their own swim lane with the ultimate consumer app for healthcare."

Darren Dworkin

Cedars-Sinai has its own app to access patient records and interact with clinicians. Patients can also go online to view their records, schedule visits or get prescriptions refilled. The Apple Health app is a bonus layer, Dworkin said -- a way for patients to own records from multiple healthcare settings.

"This has really whet the appetite for more data to be made available," he said, optimistic that diagnostic imaging and physician notes will join the data fields. He also expects apps that might, for example, review and customize medication plans.

Early adoption of the Apple app is expected among healthy patients and those who are tech-savvy, health officials agreed. Patients with acute and chronic illnesses are also likely to buy in, especially people with Type 1 diabetes who benefit from a long-term view of care or those people caring for an aging parent or ill child.

Reel's hope is that the technologies make a positive difference in the experience of healthcare and outcomes and reduce the cost of care over time. She'd also like people to stop using the buzzword interoperability and switch to terms like usability of systems and quality of data.

"If we can make systems much easier to use and find information that's needed, not just more information, we'll go a long way to returning joy to the processes of medicine," Reel said.

The business of interoperability creeps in

Michael Nissenbaum, president and CEO of Aprima Medical Software, which sells EHRs and practice management technology to physician practices, is not part of the pilot. But he has a friend with cancer who is forced to carry paper records between appointments because the facilities he visits use different EHR vendors and won't transfer his records. "He tells that tale in horror," Nissenbaum said.

At least Apple is "trying to establish some rationale for the interoperability and accessibility to medical information," he said. Still, to be effective, Nissenbaum and others said the app must easily transfer patient information from one system to another and one vendor to another.

At this point, only EHR vendors Epic and Cerner are involved in the Apple Health app pilot, but additional vendors and hospitals have said they are interested in joining the beta since its mid-January launch. Epic declined to comment for this story, and attempts to reach Cerner for comment were unsuccessful. The pilot stage could last several months. What happens next has yet to be determined.

Salil Verma

OhioHealth uses Epic at its main facility and plans to extend a single platform to its entire system. "But it would be foolish to say that's enough," Verma said. Hence, OhioHealth is looking broadly at the Apple pilot, plus engagement with Epic's MyChart, customization of its digital portals and work on voice-activated interactions through Amazon Alexa and Google Home.

Creating large enough data sets and artificial intelligence capability for Verma's future app will have to wait. Today, he said, "with everything we are doing, our desire is to create the burning platform, so customers want to engage with us."

Critics of lagging interoperability say the big EHR vendors have no desire to change their proprietary operating systems. Dworkin said there's validity to those charges, but the hurdles are legitimate.

"There are a lot of repositories of complicated information, and that's hard to normalize across platforms," he said. "But when Apple, the world's most valuable company, jumps into the fray and we see what they can do to help, it's hard to say it's not going to be additive."