Do We Really Want Apple as a Health Data Hub?

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Apple is getting into healthcare! That’s the news this week after Apple announced its HealthKit and Health app at WWDC. Lt. Dan did a great job covering the announcement and its surprises — a Mayo collaboration and an Epic "partnership."

(I put partnership in quotes because I believe this deal was struck recently and I suspect the details haven’t been worked out. Epic employees learned about the partnership via email after Apple’s announcement.)

Apple is involved, however, so that means the announcement should be taken seriously. The company doesn’t always succeed, but it has had a good track record these last 10 years or so. Apple also has the resources to launch its health app with Mayo and Epic as partners.

It’s a good sign for the health tech sector that Apple takes it seriously. Whether they win or not, they could shake up healthcare as they did entertainment and education. Apple is also big enough to push vendors such as Epic around, which hasn’t been a typical situation. It will be interesting to see how that relationship plays out.

Aside from owning the mobile platform and having a ton of power in the market, Apple can help solve one other major problem for healthcare and health data — identity and authentication. Providing consumers access to their health data is challenging for a number of reasons, but one big one is being able to identify and confidently assert that an individual trying to access data is in fact that individual. If mistakes are made with identity, there is a significant risk of unauthorized disclosure of ePHI and the fines associated with that. Apple, because of the information it owns about its mobile users, may be able to help healthcare organizations and vendors solve this problem.

Despite all that, we should probably temper some of the game-changing excitement (at least if we think Apple Health is going to game-change our health system).

First, iOS is not the dominant mobile operating system. Its “game” doesn’t include a large percentage of the population, and that excluded population is has less education, less money, and a higher percentage of minorities. Those people should be included in the "game" that we are trying to change.

Second, I have reservations with Apple being the steward of my health information.

Let me frame my reasoning. I’m an Apple user. I use a Mac Book Pro and an iPhone. My company gives all employees Macs. I have an Apple TV at home. I buy and rent movies through Apple, though not music (I use Rdio for that). I have an a couple of different generation iPads, though I can’t figure out what to use them for other than letting my kids play DreamBox and kids’ programming games.

Despite giving Apple a lot of money and loving its products, I try not to use its software other than the operating systems. I rely mainly on Google services (instead of iCloud), Dropbox (instead of iCloud), MailBox (instead of Mail app), Sunrise (instead of Calendar), Chrome (instead of Safari), Google Maps (instead of Apple Maps), Evernote (not sure what Apple offers for this), Alfred (instead of Spotlight), and probably a few more I’m forgetting. My phone and Mac are filled with apps from other companies.

For me, Apple is still winning on hardware and OS, but not on software and services. They make my life easy because all my devices are Apple and their products are easier for my wife to use.

Making Apple an aggregator of health data should not be done lightly. Apple does not share well with others. It has a bad recent history of locking people into services they didn’t want or understand (you could say Apple makes it hard for people to leave those services if you don’t like the word “lock.”) Several of my friends had problems with iMessage and SMS when they moved from Apple to Android and Apple refused to help unless they paid a support fee, with the company’s reasoning being that they weren’t Apple customers.

We already have problems with data access in healthcare. We will spend millions or billions of dollars over the next 10 years to free up data from vendor silos. Hopefully some of that money will be spent to change contracts with vendors as well.

While Apple has potential as an aggregator of data from mobile apps and sensors, I have reservations about it being the steward, protector, and liquidator of data that healthcare needs. We should learn more about who owns HealthKit data and how users can access their information.

In the craziness of Apple’s announcement, it’s worth mentioning Samsung’s health announcement last week of its SAMI (Samsung Architecture Multimedia Interactions) platform, which sounds similar to Apple Health in that it aggregates data from multiple devices. UCSF is Samsung’s announced partner. Speculation is that Samsung rushed the announcement to beat Apple’s.

Samsung and Apple are moving aggressively into health. They are going beyond targeting only consumers and are working with large, traditional healthcare providers.

Do you trust Apple as a steward of patient-owned data? What did you think about the announcements?

TGphoto

Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • Tye Cook

    While Apple can now become an data aggregator, I believe this move is much more about aligning core competencies of some major players in order to efficiently expand into new arenas. Apple has been a great hardware and user experience company as you mention. That said, they’ve thrived in the personal space (i.e. music, design, telephony, etc…) as opposed to developing a stickiness in industry-wide settings, like business or healthcare, that would allow Apple to open up new (significant) avenues of growth. They’re firmly entrenched in hardware & UI that aligns with the individual and have been for some time.

    On the other side of the agreement is Epic. They’ve thrived on the software side of healthcare and been consistent in sticking to that target. The next wave of data gathering is now moving into wearables & other devices to enable the individual patient to take a more active role in managing their healthcare outside of clinic & hospital visits. Epic would have to expand from its core, spend an inordinate amount of resources, and compete with established giants in an effort to drive standards for how data is transmitted from the individual patient into its database. That would be a tough nut to crack.

    To me Apple wins because they get into healthcare around a core strength. Epic wins because they get to work with Apple to develop standards for data transfer from devices into their database. Ultimately this allows them to scale quickly across their customer base and provides leverage when they turn to Samsung & Google to extend the offering to more patients. Mayo is a nice Alpha site. They happened to be in the market for a new EMR and this is a pretty nice way for them to make waves to catch up with the Kaiser, Geisinger, and Stanfords of the world that are a bit in front of them when it comes to analytics.

    As far as data aggregation goes, I think Apple will ultimately get into this area, but initially the broad changes required are going to come much more in top-down fashion as opposed to bottom up. Due to that dynamic, the big health systems and Epic will probably benefit more data aggregation in the short term than Apple, particularly since healthcare is a new industry for Apple coming with an inherent learning curve. In the long term, the data aggregation as it impacts overall lifestyle choices is where Apple is positioned to reign supreme.

  • prl99

    Travis, your degree combination is an interesting one and one that worries me more than your obvious under-informed comments about Apple. iOS is the dominant mobile platform, not Android. Android is a fragmented OS that rarely gets updated except when people buy new phones. There’s only one implementation of Android that passes any kind of federal computer security and hardly anyone uses it. You’re a doctor (or at least have an MD) so you have to know about HIPPA and should know about FIPS 140-2 certification (used within HIPPA). iOS has the latter certification, which means they have been tested by an independent technical laboratory to operate in a very secure manner. There’s nothing secure about Android or Samsung. Your comment about iMessage and SMS shows you listen to too much of the anti-Apple analysts and bloggers. Apple is fixing this and the problem happened because people didn’t properly disable their Contacts information about people who left iOS devices. This is the same and people not changing a person’s email address in their Contacts list and wondering why the email bounced. Take some responsibility for understanding what you’re using.

    Do I trust Apple with my data? Absolutely. Do I trust anything related to Google or Samsung with my data? Absolutely NOT! Would I rather see doctors offices running Apple products instead of PC? Absolutely. Microsoft can say they’re secure all they want but I know better after spending 33 years working for a government sub-contractor, having to patch and monitor Windows PCs, which were always ripe for malware. Look at all the medical sites that have been hacked. Were any based on Apple hardware/software? No. Look at the percentage of iPads vs non-iPads going into government installations. It’s almost all iPads because they can be secured and managed. Forget about Android devices with 99+% of all mobile malware.

    When you give the typical comment about Apple products only being for people with money you again show your lack of understanding about how people use mobile devices and how many mobile devices could actually be used for medical data storage and access. The majority of Android devices being sold in the US are disposable phones that lack the capability to run the types of software Apple is working on. They are used for SMS, photos, and (sometimes) actual phone calls. Look at the statistics about web access and you’ll see who actually uses their mobile devices (hint: iOS devices).

    My daughter has to put up with the Epic system where she works and it sucks (sorry for my technical explanation). Epic could care less about it’s users, they only care about cornering the medical market. iPads supposedly work through a third-party app but it doesn’t do everything. Macs only work when using a remote desktop client instead of a native connection. If Apple is able to get Epic to change, this will be a major event but I’m sure Epic will find a way to charge an excessive client license no matter what happens.

  • melci

    Considering the disastrous lack of os updates, dreadful security, poor privacy and malware hellhole that is Android, many people would indeed rather trust Apple.

    The fact of the matter is that with closing on 1 billion iOS devices and active credit-card enabled accounts, Apple is indeed in a prime position to act as the gatekeeper and hub for mobile health for a sizeable proportion of the US population.

  • viacavour

    I lol’ed when you suggested SAMI. I shall file this article as a placement by Samsung, plain and simple. None of the claims in the article is credible.

  • Not the answer

    The winner in this space will likely not be Apple or Android/Google. It will be a device-agnostic software/app platform.
    Apple HealthKit is a solution for consumers, not providers, despite what the press releases say. Does anyone really think that Mayo is going to tell its Droid patients to go take a hike? Are physicians going to use a system that only half their patients have access to?

    Not to mention there is no financial incentive for patients to participate….This is geared to the 10% still using activity trackers who want to see it all in one place, not those who are most costly to our health system.

  • Mobile Man

    Love the comments! Wow… More activity than in most previous posts… I think that says a lot in and of itself.

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