August 16, 2021

Apple wants to connect your iPhone to your doctor's office. But will that actually improve care?

Daily Briefing

    Apple says it wants to revolutionize health care by letting physicians monitor patients' health data through their phones and watches. But it's still unclear just how many doctors use such tools—and whether these technologies actually benefit patients, Sarah Kwon reports for Kaiser Health News.

    Telehealth primer: Wearables

    Background on Apple's personal health technologies

    Earlier this year, Apple announced it would introduce "secure sharing" tools to help doctors monitor health data from patients' phones and watches between visits. The effort is part of a broader push into health care that that Apple CEO Tim Cook has argued will be the company's "greatest contribution to mankind," Kwon reports.

    More than 100 types of data are supported through Apple's health app in the iPhone, Apple Watch, and third-party apps. In its June announcement, the company said that patients whose providers work with participating EHR companies will be able to send tracked data showing their heart rate, hours of sleep, amount of sleep, number of falls, and more.

    According to Kwon, some health industry observers have praised Apple's efforts to build "pipes" connecting data from patients' phones to health records used by their clinicians.

    For instance, Anil Sethi, a former health director at Apple and current CEO of Ciitizen, a health care start-up that manages data for cancer patients, said Apple is "democratizing the flow of health data" between patients and their doctors.

    However, according to Kwon, Apple's latest announcement was "shrouded in ambiguity and short on particulars." For instance, the company did not provide a complete list of what kinds of data patients could share with their doctors, and it still isn't clear how many health care providers are using Apple's data or what effect the data has had on patient care.

    How Apple's past efforts to share health data have stumbled

    In 2014, Apple released HealthKit, a tool that allowed health systems to collect patients' health data, with their permission, from their iPhones. Several health organizations around the country partnered with Apple to use the data collected, Kwon reports.

    For instance, Epic said more than 100 of its health system clients use HealthKit to collect data from home monitoring devices such as blood pressure cuffs. And Ochsner Health uses Apple's data for remote monitoring programs for hypertension, diabetes, chronic obstructive pulmonary disease, and prenatal care, according to a spokesperson for the organization.

    However, according to Kwon, most health systems that have partnered with Apple are still testing the tools or have not used them extensively.

    In one example, a Mayo Clinic spokesperson said the system's use of HealthKit is limited, even though its former CEO John Noseworthy said the tool would "revolutionize how the health industry interacts with people" when it was first released.

    And in general, patient-generated data is not widely used in health care, according to Benjamin Rosner, an associate professor of medicine at the University of California-San Francisco. This is in part because providers are usually not reimbursed for reviewing patient-generated data—and when they are, payment is usually low.

    Evidence of health benefits from Apple's technologies is currently limited

    According to Kwon, only a few studies show that monitoring this kind of health data can be beneficial for patients. Further, providers may struggle to keep up with patient-generated data amid all of their other data sources and EHR tasks. 

    "Primary care doctors are overwhelmed by their inboxes," Rebekah Gardner, an associate professor of medicine at Brown University, said. "Before people start buying Apple Watches and sending all their sleep hours, let's show that this improves health."

    Specifically, Gardner said she wants to see rigorous, independently funded studies that show monitoring health data from wearable devices leads to better care or healthier outcomes for patients.

    However, according to Kwon, some providers remain optimistic that user-generated data can lead to improved health or that technology could make the data easier for providers to parse through in the future.

    For instance, David Cho, a cardiologist at UCLA Health, said Apple's data is "exciting for the future of chronic care management." According to Cho, data on risk factors such as exercise, diet, and blood pressure could allow him to help his patients manage their chronic conditions more easily. And over time, using the data in combination with virtual visits could lead to fewer office visits.

    Still, more research is needed to determine whether there's any clinical benefit to transferring data from health apps to doctors, according to Neil Sehgal, an assistant professor of health policy at the University of Maryland.

    "Right now, we don't know if there are consequences if you don't put your Apple Watch data into your electronic medical record," he said.

    And Sehagal noted that, even if research does find that sharing this type of data with doctors is beneficial, any benefit "will be concentrated among people who can buy the $1,000 phone and $400 watch." (Kwon, Kaiser Health News, 8/12)

    Telehealth primer: Wearables

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