Last year Katherine Kaiser graduated from Stanford University, incidentally meaning she also “graduated” from the Stanford health system. It was time to shop around for new doctors in her area, but that meant her medical records would potentially be scattered across different healthcare systems.
An analyst at a healthcare consulting firm, Kaiser is always tracking new tech. So she was interested when she heard about Apple's new Health Records feature, which lets users with records in dozens of health systems across the US transfer health data to their phone. She looked it up and saw Stanford was one of the participating medical centers. This prompted her to retrieve her records from Stanford and have all of them right on her phone.
“Having that on my phone is pretty cool. You can go through and look at trends like vitals and how has my weight fluctuated,” Kaiser told MobiHealthNews.
Last week Apple officially launched its Apple Health Records feature—just two months after deploying the beta version. The feature will aggregate existing patient-generated data in a user’s health app with data from their EHR—if the user is a patient at a participating hospital.
This launch opened up the feature to 39 health systems—including 12 from the original beta. Now any patients who has an iPhone and iOS version 11.3 will be able to download the patient-facing side of the feature by updating the health app in iOS.
Stanford Medicine, Scripps, NYU Langone Medical Center, Partners Health Care, Ochsner Health System in New Orleans, Vanderbilt University Medical Center, and Duke University Medical Center are among the hospitals that joined last week. Apple previously announced Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.
Andy Crowder, chief information officer at Scripps, said he doesn’t see the new feature interfering with physicians' workflow. At Scripps it will still be integrated with the Epic EHR. It is a tool for patients to become more engaged.
“If you are a patient that is a customer in a geographical area where you get part of your care at UCSD and another portion at Sharp and another at Scripp, they all have their own portal,” Crowder said. “The great part about this health record is once you link them up to those three sites it pushes all of that information into one single view. Having all of that data in one place will simplify the viewing information.”
From a physician's perspective, it gives patients a way to interact with information that usually only doctors can see.
Dr. Paul Testa, CMIO at NYU Langone Health, said that from the clinical side, he has access to extensive health records that he can see from offices across the health system. But the patient doesn’t get to see all of this background information. He said he hopes this will let patients have a broader view of their records and get patients more involved.
“It will absolutely drive patient engagement. Right now patients need to link that [data] together,” Testa said.
It also gives doctors access to information that they might not have had before. Patients can choose to share access to their smart tracking devices.
“There is information about those patients that aren’t in our EHRs today. It’s what they eat, what is the exercise that they do. It is a whole host of other wellness activities,” Crowder said.
The feature will use HL7’s FHIR (Fast Healthcare Interoperability Resource) specification. This will let users see their allergies, medications, conditions, and immunizations. It could also allow patients to check an EHR patient portal for information like lab results. The data will be encrypted, and users will need to enter a password to view it.
“Nothing should surprise me about Apple anymore. As I said, I’m a fan,” Tracy Mead, a patient using the Apple Health record feature, told MobiHealthnews. “But the way my health information was sorted and presented was pretty great. So much easier to understand than the patient gateway app and web site.”
However, it is important to note that not every patient is an iOS user. In fact, in the US Android users outnumber iOs users. According to Statista as of December 2017, 53 percent of smartphone subscribers were using Android devices, whereas only 45 percent used Apple devices. Currently the tool is only open to Apple users.
But for those who do have the Apple products, the set up was relatively easy. In general it takes the feature only a few minutes to retrieve the patients’ health records. It also uses GPS to locate providers in the area. Both Crowder and Testa have downloaded the feature as patients too.
For providers, the system was relatively easy to implement, Crowder said. He said that actually getting the EHR implemented in the health network was quicker and simpler than he expected. Before FHIR standards, he said, implementing a tool like this could have taken between six months to a year.
He said that from when Apple inked the deal with Scripps to implementation took about three weeks—and one of those weeks was paperwork.
Kaiser said that whether or not a provider is integrated with Apple Health Records could impact which provider she choses in the future. Right now in her area, Dignity Health is one of the big systems using the Apple EHR feature.
“Given all the factors lined up there is no reason not to prefer to go to Dignity vs another healthcare system which could be just as good but doesn’t have that function that they are integrating to Apple yet,” Kaiser said.
Providers say that despite what some people might assume, this smartphone-based feature is not just for the young. In fact, Crowder said recently Scripps Health System did a survey to gauge which demographic was using their mobile apps (different from Apple Health) currently to support their care. The results showed the number one population using the technology was people between 51 and 60, followed by people 61 to 70, and then 41 through 50.
“I think the older population, the ones who might have different co-morbidities, are going to be the ones who use it the most,” Crowder said.
Testa said that he has seen older adults often engage more with phone medical phone apps.
“I have older parents and I’m astounded…they are much stricter and more engaged with [technology] than the younger patients,” said Tester.
While many of the early adopters MobiHealthNews spoke with are positive about the technology, that doesn’t mean they are without questions, especially since the feature is so new.
Kaiser, who owns an apple iPhone but a PC laptop said she is concerned about interoperability between the two pieces of technology.
But perhaps one of the most pressing questions is one that Kaiser raised, and is something on both patient and physician minds: How will this new technology going to change the typical doctor’s visit?
“How are doctors going to react when I walk into a room and show them my phone?” Kaiser said.
Providers, at present, don’t have a concrete answer for that.
“I would say the dance that is going to get played out is going to happen in the exam room when [the patient] shows up and has the information on their phone,” Testa said.
Still only a week out of beta, it is difficult to say exactly how this new technolgoy could change a typical trip to the doctors. But when one of the biggest names in the tech world joins the EHR game, folks tend to take notice.
