Apple ups the ante with Health Records app
Another day and another tech firm announces they're set to revolutionise healthcare with their dinky new app, promising to bring untold insights from your personal health records to the palm of your hand and enable information sharing on an unimaginable scale. We hear this boast often enough and cast a thoroughly sceptical eye over every one, but when the app comes from Apple, we do admit to taking a little more notice than usual.
Gossip has abounded about Apple's interest in entering the personal health record market for some years and they've already got some runs on the board with their ResearchKit and HealthKit technology and the existing Health app. But while they've been hiring quite a few people with health technology experience over the last few years, speculation about Apple's likelihood of success in PHRs has always been tempered by the example of Google, which tried and failed with Google Health, and Microsoft, which still markets its HealthVault solution but which just this month closed down HealthVault Insights, an app that used machine learning to analyse health data.
There is also the problem that all app developers face when they enter this brave new field: healthcare's notorious information silos and the lack of interoperability between medical software solutions. The answer to this, of course, appears to be FHIR, the interoperability standard first devised by Melbourne lad Grahame Grieve that every big vendor worth their salt is now adopting with the support of HL7 International.
The difference between Apple's announcement to developers on Wednesday that it will have new Health Records functionality in the beta version of iOS 11.3 and all the others is that it will use FHIR, enabling it to link to 12 US hospital systems that use EMRs from Cerner, Epic and AthenaHealth, all three of which have been working to develop FHIR APIs through the Argonaut Project.
Apple says a number of other hospital groups in the US will soon join, and other big vendors such as Meditech and McKesson, now owned by Allscripts, are also involved in Argonaut. The huge US prescription exchange vendor, SureScripts, is also involved. Those information silos are about to come tumbling down, in acute care in the US at least.
The announcement immediately throws up many questions, of course. About 80 per cent of mobile phones sold these days run on Android compared to 20 per cent on iOS, so what about Android users? We suspect that with Apple showing how serious is it about health, a plethora of Android apps will be just around the corner. That's the beauty of FHIR.
Do people actually want a PHR on their phone? Apple thinks they might, and if any tech company can create a market where one did not exist before, it's Apple. What about security and privacy, when personal health data is kept on a device with just a passcode for protection? That choice is now very much the consumer's, who can weigh up the risks for themselves.
Is a personal PHR of any use on a phone rather than a secure website or patient portal? If it links to other apps which can use the data, then for some people yes. Having test results sent directly to your phone and a list of your medications will be valuable to many. But what about your other medical records, held by one or more GPs or other primary care practitioners? Can that data be extracted by the app? If the GP software is FHIR-enabled, then technically, yes.
Will it have an effect on national systems like the My Health Record? Absolutely. A FHIR-enabled app will one day be able to tap into the MyHR as well as hospital EMRs and general practice PMSs and other health data repositories, if that's what the consumer wants. Is it of any use for information exchange with your healthcare provider, or between clinicians? At the moment no – your doctor is not interested in your app or whatever dubious data it holds – but that may change.
And fundamentally, do consumers really want a copy of their medical record, on their phone or anywhere else for that matter? Plenty do, plenty couldn't care less. What this app means is the ability for consumers to make that choice is much easier than before.
The danger of course is that Health Records will turn out to be a bit of hype with few patients besides the fit and the well, just like the Fitbit and Apple's own Watch, which are dinky little devices and great for the active but have not really made inroads into the chronic disease sphere. It could all fall flat on its face, or turn out to be all hype and little help.
We'll see. In the meantime, the hospital EMR vendor with the biggest market share in Australia, Cerner, is bringing out a FHIR-enabled EMR interface this year. Local vendors like Orion Health and Telstra Health have been heavily involved in helping to develop FHIR and implementing it in their products, and there are also moves afoot to set up an Argonaut Australia project to help guide smaller vendors and healthcare organisations to implement FHIR.
We'll have more details about that next week, but in the meantime, we thought this would be food for thought for our poll this week: Is Apple onto a winner with its Health Records app?
To vote in our poll, sign up for our weekend edition or leave your comments below.
Our poll last week asked: Do you think shared care planning tools will ever achieve widespread adoption? This one was closer than usual: 56 per cent said yes, 44 per cent said no.