Harvard Business Review: Apple’s Pact with 13 Health Care Systems Might Actually Disrupt the Industry

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An interesting Harvard Business Review article by David Blumenthal and Aneesh Chopra propels some common misconceptions about Apple’s focus.

mHealth Insights

“An announcement on January 24 didn’t get the large amount of attention it deserved: Apple and 13 prominent health systems, including prestigious centers like Johns Hopkins and the University of Pennsylvania, disclosed an agreement that would allow Apple to download onto its various devices the electronic health data of those systems’ patients — with patients’ permission, of course”

I was think the reason it “didn’t get the large amount of attention it deserved” is because the David and Aneesh are talking about the mainstream media. Anyone with any real interest in seeing Patients and Carers get documented care was talking about Apple’s news but why would be media brands be overly interested in something that’s going to disrupt the situation from which their major advertising partners are generating their profits? Hasn’t the media always been like this with radically innovative new approaches? eg. it’s not like there were photography magazines writing about Philippe Kahn and the soldering work he did while his wife was in the labour ward.

“It could herald truly disruptive change in the U.S. health care system. The reason: It could liberate health care data for game-changing new uses, including empowering patients as never before”

All signs show it is eg. Dr Ricky BloomField’s demo at HIMSS18 stole the show and he wasn’t even on a proper stage.

“Since electronic health records (EHRs) became widespread over the last decade, there has been growing frustration over the inability to make electronic data liquid — to have it follow the patient throughout the health system and to be available for more sophisticated analysis in support of improved patient care and research. Most efforts to liberate and exchange health data have focused on getting doctors and hospitals to share it with one another. Those efforts continue, but progress has been slow. Frustration has increased interest in a very different approach to data sharing: Give patients their data, and let them control its destiny. Let them share it with whomever they wish in the course of their own health care journey”

I think it’s clear that this problem existed even before records went electronic and Patients and caring Clinicians have been frustrated for decades eg. Prof Sam Lingam was at Great Ormond Street Hospital in London 30 years ago sharing medical records with the Parents of some of the sickest children in the world.

“Several technology companies — including Google and Microsoft — tried this in the early 2000s, but their efforts failed. There just wasn’t that much electronic health data available at the time, since only a tiny fraction of doctors and hospitals had electronic records. Health systems were reluctant to share what data existed, seeing it as a valuable proprietary asset. The technology for giving outside entities access to electronic records kept by hospitals and doctors was underdeveloped. And EHR vendors were uninterested in promoting such access because the demand was weak and data sharing could spur competition from other vendors”

I think this overlooks the fact that we hadn’t had the Nokia Decade and most people didn’t have a personal means of being reached 24×7 or connecting to the internet. Apple is the world’s largest and most profitable corporation because it seized the opportunity to leverage the newest mass media. It’s now time for Clinicians and Patients to seize the opportunities to advance how healthcare is accessed.

“Those obstacles have now mostly melted away. Electronic health records and digitized health data are now ubiquitous. Various federal incentives and regulations now require providers to share data with other providers and with patients or face significant financial penalties. The Argonaut Project, a voluntary private sector collaborative, has provided guidelines for an open source, standardized application programming interface (API) that provides ready access to data stored in providers’ electronic records. Think of APIs as gateways into electronic data warehouses that now populate the health care landscape. Of note, the federal government now requires all vendors of electronic records to include these open APIs in their products to be federally certified.”

I don’t think the obstacles have mostly melted away. EHRs’and digitalised health data is far from ubiquitous. There’s also a massive issue that arises because Electronic Health Records are all too often just billing records rather than clinical records and in most cases have never even be reviewed by the Patients they relate to.

“A world in which patients have ready access to their own electronic data with the help of facilitators like Apple creates almost unfathomable opportunities to improve health care and health. First, participating patients would no longer be dependent on the bureaucracies of big health systems or on understaffed physician offices to make their own data available for further care. This could improve the quality of services and reduce cost through avoiding duplicative and unnecessary testing”

I think it’s becoming obvious: healthcare is going to become a Mobile Experience, just another thing we do with our mobiles (2012).

“Second, the liberation of patients’ data makes it possible for consumer-oriented third parties to use that data (with patients’ permission) to provide new and useful services that help patients manage their own health and make better health care choices. Such consumer-facing applications — if they are designed to be intuitive, useable, and accurate — have the potential to revolutionize patient-provider interactions and empower consumers in ways never before imagined in the history of medicine. Imagine Alexa- or Siri-style digital health advisors that can respond to consumer questions based on users’ unique health care data and informed by artificial intelligence. Health care could start to function much more like traditional economic markets”

It always amazes me how healthcare  industry professionals always seem to want to add the caveat that applications have to be “designed to be intuitive, useable, and accurate” in order to improve things. Maybe they don’t realise that unlike all the software that healthcare organisations waste $billions on every single bit of software that someone downloads to an iPhone comes with a universal rating system.

Related posts: “Majority of mHealth apps fail to engage patients”How Mobile First Clinical Trials & Ratings will transform the $100B Clinical Research Industry.

“Nevertheless, this vision of the future faces obstacles and uncertainties. First, large numbers of hospitals and doctors have to follow the lead of the 13 systems that have already jumped on board. There are encouraging signs that many more will join, but ultimately, there needs to be a clear business case for both providers and their IT allies to invest in this new partnership. Perhaps the most compelling would be widespread consumer demand for the service. For that demand to materialize, consumers have to receive something they value in return for giving third parties like Apple access to their data. This means that Apple and its future competitors will have to develop nifty consumer-facing apps that solve consumer health-related problems easily and cheaply. Those apps simply don’t exist at the moment”

This paragraph reminds of me of the age old definition of an expert: someone that can tell you exactly why you can’t do something. It’s interesting to note that the number of partner systems following the lead has already exceeded the authors expectations eg. the number of partners has already doubled.

“Second, the opportunities for fraud and abuse in this new world of data access are daunting. Most consumers will want to delegate to third parties the job of accessing, storing, managing, and analyzing their data. Making sure those third parties are trustworthy is critical, and unscrupulous actors will inevitably take advantage of unsophisticated patients. Health data is extremely valuable on illicit markets. And even honest but unsophisticated data stewards can create huge problems if they don’t adequately protect patient information. Federal and private sector organizations are trying to develop a voluntary but enforceable code of conduct to govern the behavior of private data stewards. This would be an important first step toward assuring that consumers are not victimized on the way to a brighter health care future”

I cannot see how we can be in a worse situation than that we have today where the Patient the data relates to isn’t even getting to access it.

“Third, once new companies start to develop consumer-facing health applications based on patients’ own health care data, the quality of those applications could become an important issue. If they offer advice, it needs to be reliable. If they promise a service, they need to deliver. Some applications may fall within the existing regulatory authorities of U.S. federal agencies like the Food and Drug Administration or the Federal Trade Commission. If not, the question of whether and how to assure that the advice furnished consumers is valid and reliable will certainly arise as a matter of public policy”

I cannot see how we can be in a worse situation than that we have today where the Patient information is being misused and Patients aren’t even getting to access it.

“These problems notwithstanding, the announcement of this collaboration between leading American providers of health and information technology services likely signals a new era in health and medicine. The partnership and its results will not solve all our health care problems. But they could really shake things up. And that is what the U.S. health system needs”

I remember the news said the Apple’s original iPhone “Could really shake things up” whereas Mobile industry gurus who understood the complexities of the industry (like Tomi Ahonen) straight out called it a new era and the ‘Jesus Phone’.

We’ve got the same happening with Apple’s push into healthcare except now they’re the  world’s most valuable corporation, have a $300Billion cash reserves, own the world’s most valuable brand and have had their senior management already tell the world that they are going all in on Healthcare and expect the revenues they generate by helping Patients to dwarf their existing business.

*** UPDATE 19 July 2018 ***

I shared an update to this on Linkedin and a couple of very highly respected medics made interesting comments:

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“If you define disruption as redistribution of HC resource$ to Apple, maybe.  If you define disruption as delivering improved value=outcomes/costs for patients and their physicians, absolutely not.  https://www.linkedin.com/pulse/connectivity-interoperability-our-lifetime-howard-green-md/

Howard Green, MD (Dermatology & Dermatology Apps)

Reply by David Doherty: Interesting that you don’t see enabling Patients to view and share health information as helpful. Does being able to look at your own financial transactions on your banks app or online statement harm your financial health Howard?

Reply by Howard Green, MD: As a physician working where the rubber meets the road in the translational zone between tech and real life medicine I’m really into demonstrated large value for patients and physicians. Every physician knows that patients viewing and sharing health information on their devices beyond portals is a variable which hasn’t been fully examined regarding it’s effects on prevention, medical, surgical or palliative outcomes and costs unless standardized and interoperable. Carrying medical records is not bad, but simply holding your medical records on your device isn’t going to create massive innovative value in Healthcare which we need to deliver safe quality affordable innovative HC to all Americans. https://www.linkedin.com/pulse/empowered-patient-isnt-howard-green-md/

Interoperable standardized EHR’s would negate the need for Apples siloed product.  But as long as patient data remains proprietary and contributes to the EBITDA of the big 5 controlling industries of HC we’ll never see interoperability or value in our time. https://www.linkedin.com/pulse/connectivity-interoperability-our-lifetime-howard-green-md/

“Now to see if it actually improved pattient outcomes”

George Margelis (Medical Practitioner with a passion for improving healhcare)

Reply by David Doherty: I have a colleague who has been sharing Medical Records with Patients & Carers for decades (you can read a paper published on his work 32 years ago here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1778713/?page=1 ) and without a doubt it transforms the opportunity to improve Patient Outcomes. I have no doubt that it’s going to radically transform the capacity and opportunity for Patients and their Carers to understand and improve their own health. Until now the Medical Records were being used to help the financial health of hospitals/insurers/pharma/etc/etc so why aren’t you optimistic about the potential for Patients to see info about their healthcare? Step into a Carers shoes for a minute by watching Regina Holliday (one of those annoying “Mrs A-Type” personalities!) explain what it feels like to be excluded from being able to look at even the most basic documentation of a loved ones care: https://mhealthinsight.com/2013/01/09/of-all-the-horrible-things-that-happened-the-worse-was-the-lack-of-access-to-information/

Reply by Howard Green, MD (Dermatology & Dermatology Mobile Apps): Correct George, outcomes are the only products manufactured and produced in HC with patients. value=outcomes/costs. Let’s see the value! https://www.linkedin.com/pulse/health-care-marketing-emperor-has-clothes-howard-green-md/

understand and improve their own health? Took me 4 years of medical school, 8 years of post medical school graduate training and continuing education to just keep up with medicine and carrying a medical record on a device is going to innovate and disrupt healthcare? Why not free up physicians from the 100’s of thousands of hours every day they pay to input data into EHR’s just to be sold to ancillary industries for the profit of the EHR company to allow physicians to care for patients and innovate again. ???

Reply by David Doherty: Hi George & Howard,

Clearly this is a complex area. Why not join a debate on this specific topic (the impact of Apple Health) moderated by my good friend John Bennett MD at InternetMedicine.com.

Get a feel for the debate by watching a discussion we had recently when CNBC ran an article calling Telemedicine a bust because a few VC’s are losing their money on bets they’re laying on insurers paying for video consulting services:


or this group discussion of Mobile Health:


If you want to go ahead I’ll send an email to John and he’ll get it arranged for a time that suits all. I think it’ll be a very informative debate.

Reply by George Margelis (Medical Practitioner with a passion for improving healhcare):

Thanks David. I think it is important that we discuss this openly. In Australia we have a national shared health record which has great potential to transform care. We are working through how to get it to deliver benefit, and one of our challenges is clinician and consumer engagement. Just setting up the infrastructure is not enough. Developing clinically useful use cases and making them the standard modus operandi is the key. I applaud your work in demonstrating the possibilities, we now need to enable them at scale to get the benefit. Keep up the good work.

I know Regina well, as well as my old friend Daniel Z. Sands, MD, MPH who has been espousing this for decades. Personally I think Open Notes is the best solution, but clinicians need to be trained in writing better notes suitable for broad consumption. Each step in an incremental improvement, but we still have a long way to go.

About David Doherty

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