A shift toward patient-focused apps
At the core of the change, EHR vendors are opening up Application Programming Interfaces (APIs) that allow patients to connect to their medical records through third-party applications. This change is partly in fulfillment of requirements from the Promoting Interoperability mandate (formerly Meaningful Use Stage 3), but it's also part of a broader trend across most industries. Connecting patient apps to medical records lets applications quickly demonstrate value without tedious and error-prone data entry.
But freeing data from the walls of health systems doesn't directly translate into applications that patients will find valuable and engaging. To reach that standard, applications must meet a broader set of patient needs, including:
- Ease of use: For an application to win repeated use, it needs to be easy to use and quick to deliver value, meeting the expectations set by applications from the retail, travel, and entertainment industries;
- Trust: Health data can be deeply private, with irrevocable consequences for a patient if it is handled inappropriately. Technologies that handle health data outside the walls of the highly regulated provider environment need strong, comprehensible controls in place to build trust in their stewardship of sensitive data;
- Consolidation: Patients with complex health needs have multiple providers, and in many cases those providers still don't communicate clinical details consistently across care settings. Patients don't want five fragmented views of their medical history—they want one consolidated view;
- Personalization: Applications should implicitly tailor their behavior to the specifics of a patient's situation; and
- Interactivity: Patients have limited interest in simply downloading their medical record. They need to engage more actively by communicating with providers, setting goals, tracking progress, and receiving feedback.
Apple's mobile health ecosystem
Apple has been particularly active in building out its mobile health application ecosystem, and the company in June—at its World Wide Developers Conference—unveiled a key expansion of the HealthKit development ecosystem. With the next version of Apple's iOS mobile operating system (iOS 12), application developers will be able to ask for access to medical data managed under HealthKit.
Apple's health ecosystem is well positioned to support rich, engaging health applications that connect seamlessly to the health data that health systems must now provide. HealthKit builds on Apple's foundation as a trusted steward of personal information. The company has intentionally positioned mobile devices as secure guardians of sensitive data—no protected health information for the HealthKit platform flows through Apple's networks or data centers. HealthKit acts as a patient-controlled hub for information, combining records from multiple settings of care and letting patients determine what applications are allowed to access it.
Apple's approach helps mitigate the risk of inappropriate use, but it does not eliminate it. If a user permits a third-party application to access his or her health data, that application can potentially misuse it. Third-party vendors may illicitly share the data with other entities who could use it for everything from market research to direct-to-consumer pharmaceutical advertisements. While consumers are used to trusting Apple, they need to be warned about the hazards of opening their medical record data to use by unknown third parties. While Apple's straightforward, transparent approach to helping consumers manage their data is commendable, consumers in practice have shown limited interest or understanding of controlling their private data in other contexts, such as social media.
Centralizing the consolidation and control of health data does make it easier for patients to try out different apps and get a personalized, out-of-the-box experience. Want to get in shape and manage your diabetes? There are dozens of apps offering to help—and each one is just one tap of approval away seeing the same fitness, glucometer, and lab data under the HealthKit umbrella. Apple's CareKit and ResearchKit close the data loop, allowing patients to submit outcome and progress data, share data captured by their devices, and donate their data to research initiatives.
Mobile health is a crowded space, with a history of lofty ambitions that fell flat in practice, but improvements in data access and patient experience with mobile apps may make the difference. Health systems should develop a consumer mobile strategy in parallel with that development for their internal customers. The consumer strategy should include system-sponsored, pre-vetted apps and formal policies for apps that consumers bring to the table.