How Apple's Health Records could reshape patient engagement
As a longtime collaborator with Apple – since before it even beta-tested its Health Records project, live now at 39 hospitals – San Francisco-based Dignity Health is in sync with the iPhone developer's vision, said Shez Partovi, MD.
"We had been working with Apple prior to their initial announcement for some time," said Partovi, chief digital officer and senior vice president of digital transformation at Dignity Health. "We'd been working with them for a while because we're aligned in our philosophies of empowering patients by giving them their data."
As part of the Health Records launch, Dignity will leverage HL7's FHIR standard to securely move patients' health data from own electronic health record system to the iPhones of patients using iOS 11.3 – enabling them manage meds, labs, allergies, conditions and more, and notifying them when the health system makes changes to their health information.
"When you think of personalized medicine, you can think about caring for yourself in two dimensions," said Partovi. "There's care management, where a health system or physician or team is managing your care, and there's self-management."
For those patients managing an illness or a chronic condition, "a big part of your life is self-managing that condition," he said.
Luckily, nowadays there are "more and more tools out there that will be enhanced if they have your data." A tool like Apple's Health Records, that puts valuable EHR data right onto a person's smartphone, can only be a boon.
"That, for us, has always been the philosophy," said Partovi. "We recognize that a lot of care happens outside the four walls of a health system. And we believe that for healthy populations we need to give patients their data."
Picking up where Google left off
The idea of personal health record is nothing new, of course. Most providers offer at least a basic patient portal that can be accessed via computer or smartphone, although utilization of them remains underwhelming.
And large consumer-facing companies such as Microsoft and Google tried their own versions of the PHR – HealthVault and Google Health, respectively – both of which struggled to gain traction with the public.
But Partovi says he thinks the new iPhone Health Records initiative will be different.
"There are three reasons why Apple is uniquely positioned," he said. "One is the way they approached this whole story, which is by actually moving the data directly from the health system to the device. That's different from what Microsoft and Google tried in the past. It's the data itself. They give the patient their data, not just store it in yet another cloud."
Second, "Once the data is on your device, you have the strength of the App Store. All of the different potential apps will come forward to be able to use your own personal data, to personalize self-management,” he said.
“It's just a click-through to gain access to your data,” Partovi continued. “In the past, the data would be stored somewhere else and you'd need all kinds of HIPAA privacy consents. Here, you can develop a whole new generation of health apps."
Third, he said, is the simple ubiquity and popularity of iPhones, the intuitive nature of iOS software: "Apple's view of the world has always been individual-centric, trying to create a positive experience," he said.
"Those three things make Apple different from everyone else," said Partovi. "They give you your data. They have the strength of the app store to enable third parties to make use of your data to do great things for you. And their philosophy on privacy and individuality is going to make this very different."
Positive results in action
It's early yet, but some anecdotal experience suggests the project might catch on, he said. As soon as the public preview went live, he got a text from a friend who helped care for his mother, who has a chronic condition.
She gets care both at Dignity Health, and also another health system that's taking part in the Apple project. Her son was easily able to download her EHR information from both health systems, directly to her phone.
"He texted me to say it was a jaw-dropping experience for him to look at her phone and see all her records in one location," said Partovi.
Asked what he hopes to accomplish, either in terms of uptake or outcomes, from Dignity Health's participation in this initiative.
"For us, there are things we as a health system want to do, and there are things I hope Apple does," he said. "We're focused on a few patient journeys – patients with asthma, with diabetes, with cardiac conditions – and we will be focusing on those cases, people who we think will benefit immensely from having their data on their own devices."
As for Apple, Partovi is hoping eventually to see the data moving bi-directionally.
"As the patient moves between health systems and changes doctors, we would like to see the ability for the data to go back out," he said.
"The ideal scenario is that you walk into a clinic, your Wallet wakes up, and you swipe it and it says the clinic would like to get the following information – immunization, labs, medication – and you click, OK, OK, OK and click submit," Partovi added. "That is a transformative experience for the patient, but also for our care system from a workflow perspective."