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Healthkit

developer.apple.com

267 pointsvidyesh70 comments

This focus on health from Apple is a big move. It's a signal that, for now, the digital health/QS space is here to stay.

They're taking out a large chunk of general wellness apps. Apps like Fitbit, LoseIt, etc, will be rendered significantly less useful with Apple now controlling the experience for the majority of commonly captured health data (calories, sleep, nutrition, etc). Wearable and other health companies will have to find a way to differentiate their app offerings by including features well outside the scope of Health and HealthKit (think Strava and RunKeeper). Apple is also going after the PHR space, specifically Microsoft's HealthVault. The PHR space has historically struggled to catch on (e.g. Google Health), but I suspect both Google and Microsoft's products were ahead of their time. Although I have concerns about whether PHRs are actually useful, Apple with its marketshare might finally make them mainstream. I can see them extending their new Family Sharing features to family PHR management.

However, I'm struggling to think of how Apple may be able to crack the barriers to data access on the provider/EHR side, if they aim to.

I prototyped the personal health portal for a handful of our customers (hospitals). Circa 2008. Little different from Google Health or Microsoft HealthVault. Some deploys went live but most were still born.

The money people were motivated by increasing admissions, thru greater engagement, etc.

The doctors were completely uninterested. They would never trust patients self reporting.

I anticipate adoption will be driven by

#1 niche use cases, such as home blood glucose monitors, where the data gathering is automatic

#2 younger doctors more comfortable with the newer tech

#3 patients embracing the "quantified self" movement

I'm a doctor and I don't see these personal health portals being utilized by physicians. Unless they sync to the docs EMR and they don't have to do anything extra, then they won't be utilized. Doctors don't take/have time to sift through that kind of information for every patient. Too much volume. Too much detail. Docs make decisions based on parcels of data, not continuous streams. Most docs would be shocked by the hourly variance in a patient's pulse and bp and end of overprescribing.

The real use of phrs is for insurance and drug company data mining. Drug companies could perform mass retrospective trials very cheaply, and insurance companies could make huge quality/cost analyses, thereby "directing" healthcare cost and physician treatment.

As a doctor, I actually see these potentials as beneficial, though possibly restrictive for docs until medical education caught up.

Feel free to email me about this to. Kmitch00@yahoo.com

Do you see value in having longitudinal / long-term trend of the pulse, BP, etc? Intra-day variance may be very high, but wouldn't there be value of having an average of 100 measurements over a month, as compared to the 2 measurements that you do in the clinic?

Doesn't mean that the doctor needs to see the data as it goes in - you can review the average BP over 1 month when the patient comes for consultation, for example.

There's a big push right now to implement such systems. Hospitals now have a monetary incentive, due to the ACA, to not have patients return for anything more than a follow up for something like 30 days after an emergency room visit [1]. I'm not sure what Apple has to offer in regards to this kind of data storage, but it's going to have to be HIPAA compliant if they want any sort of acceptance.

Also, a lot of what is being done is automated monitoring. An algorithm can be developed to measure, for example, blood pressure, and if the patient deviates from acceptable ranges, the algorithm can trigger a contact to the patient, their healthcare provider, and family to begin an intervention to correct the bad blood pressure.

Adherance (doing it when you're supposed to) and validity (the measurements reported for Bob Smith are actually from Bob Smith) are big concerns, and there are also a lot of things done to ensure that the patient is doing their part correctly.

[1]: http://www.acep.org/Legislation-and-Advocacy/Practice-Manage...

> Too much volume. Too much detail.

Wouldn't the point be that this is electronic data that can be summarized and analyzed by computers?

The key with how Apple will succeed in this space is the partnerships (distribution) with Mayo Clinic, Epic et al. Mayo is a very forward thinking institute and has already partnered with many startups to expose their data in various forms to explore opportunities.

Many hospitals in the bay area run Epic so pushing data to your Epic EHR to help your GP with better decision making is a step in the right direction. The integration between PAMF hospitals that run Epic and how that data easily flows to my GP is already awesome. Sending additional data points should empower my GP to make smarter and better decisions related to my health.

Only last week my GP was wearing Google Glass. The adoption will happen fast. Now is the right time for this sort of tech adoption.

Wonder when Allscripts will come into the game.. hmm...

Nice move Apple! Now make the data flow the other way so it's a truly open EHR system and allow devs to build apps on top of it. Powerful!

I think the tricky thing about Allscripts is that it doesn't have a sole, dedicated patient portal like Epic does (which is where the healthkit integration is). Old Allscripts customers are using Medfusion, newer customers are using Jardogs software, and other places installed patient portals by companies like Medseek (Dignity Health comes to mind). Lots of integrations would need to be built to various portals for that to work.

> Only last week my GP was wearing Google Glass.

That is not a good thing with current implementation of Glass.

I agree, but think it is even more niche. They hope that wearables will transform the "quantified self" from a niche to a mainstream, but as this iWatch parody says: http://mashable.com/2014/05/30/apple-iwatch-parody/?utm_cid=... "we take privacy seriously and will livestream <all your bodily functions and> your location to <not only> NSA.

I agree. My own cynical view is that PHRs, in terms of their role in healthcare, are only good for entertaining the average patient and satisfying their curiosity with hopes of leading to engagement. I don't see them useful to physicians or providers whose management decisions are becoming increasingly evidence-based.

How is evidence-based medicine practiced without evidence? PHRs provide evidence.

I'd love to talk to you about this, as I'm working in this field now, and would appreciate wisdom from someone who has been there. E-mail in my profile if you're up for it (I'd write to you, but no e-mail in your profile)

Feel free to email me too, I know a bit about this space :)

Epic/MyChart might cover the EHR side of things

"Epic Systems has developed an integration with HealthKit, suggesting a framework for getting information collected via HealthKit into patients’ MyChart app. "

Source: http://mobihealthnews.com/33728/apple-reveals-tracking-app-h...

I imagine that it's this (requires OpenID login):

http://open.epic.com/Clinical/PatientTrackingData

In case anybody else doesn't know what PHR stands for:

http://en.wikipedia.org/wiki/Personal_health_record

For those interested, also look into the CCR[1]. It's an XML file representing treatment history used for interchange between healthcare providers.

[1]: http://en.wikipedia.org/wiki/Continuity_of_Care_Record

I've spent the last 6 months worrying about today for my app business, as gps fitness tracking apps comprises a large part of it. (And actually just completely rewrote and released a version 2) Thankfully, I'm mostly relieved at the announcement. My apps are more along the lines of Strava and Runkeeper than Fitbit, and I think that is a niche that I don't think Apple's Health stuff is going to tread on. Might even offer an integration opportunity.

LoseIt already has many of the features that HealthKit promises. Integration with weight scales, fitness apps, etc.

There are quite a few solutions out there that do, but none of them have the consumer or vendor reach that Apple does.

True, and ideally everyone would integrate with Apple's solution, so you don't end up with the problems that you have today, like LoseIt supports two running platforms, but not the one I use, so I need to use a third-party service to sync thing up to Strava.

Yeah, that's what I mean. Apple will soon supplant apps like LoseIt because consumers will want the Apple experience and integration. And I suspect that eventually integration with HealthKit will be considered a requirement for apps by consumers, so if the data you're capturing is in parity with Health, there's no reason a user would use your app over Apple's.

I think the market will shift to favor health/fitness apps like RunKeeper and Strava that offer very specific feature-sets for a niche audience.

I feel like this is a small move for Apple. They are trying to carve out their niche in an application space that is immensely smaller than the iPod, iPad, and iPhone markets.

If I was an investor, I'd be worried about these new frameworks because its solving a problem people do not yet have.

A user’s health information is stored in a centralized and secure location and the user decides which data should be shared with your app.

Well, that 'centralized location' (accessable by Apple) would require my trust a bit too much.

I was under the impression the data was stored locally and not with Apple. I thought the 'centralised' place they were referring to was the Health app.

Centralized would then mean local, and that's almost never the case as far as I have seen such service advertisings.

Yes local, meaning on your device, centralised, meaning each app has access to some central repository instead of havint its own.

On the other side of the fence, users with extensive histories of health data (say, someone with high blood pressure with a year of hourly BP history from a wearable device) almost certainly don't want to lose their medically critical health data if their phone happens to take a bath. Backups are important, too.

Which in practice means all apps will ask for all info and we will blindly say yes to everything.

Heh. That app will want to access your health records in order to determine whether or not you are at risk of epilepsy, so it can adjust its flashy graphics.

Then, of course, they'll transmit the results of your last HIV test to every advertisement network on the planet.

The funny thing is that here in Germany, where consumers are heavily protected, people are sceptical. But in the US of A, where a piece of information about your health status can make you uninsurable, people are rather enthusiastic.

I'm not even entirely sure which approach will be more beneficial in the mid-term future. But for now I'll stick with my boring German ways.

Consumers are heavily protected here too... Look up HIPAA and the Affordable Care Act. It's illegal to deny health care coverage to a person based on health status and a long list of other reasons, and your medical records are highly regulated and private. The daily meme of USA lacking consumer protection gets really old after a while.

> A user’s health information is stored in a centralized and secure location and the user decides which data should be shared with your app.

I'm glad the information is stored securely and the user has control over what is shared with targeted apps, but it says nothing about what is shared with Apple. Companies need to be clear about these things right up front.

In my opinion, this sort of data needs more than "we double promise we'll store it securely".

It's starting to remind me of the book 'The Circle" by Dave Eggers[1]. Where a company ("The Cirlce") eventually, essentially, takes over the control of all information in the world.

It wasn't my favorite book, although I very much respected my Mom for getting it for me. It's an easy read. And it makes you realize what could potentially happen I suppose. It's like 1984 written in 2010. And the ending...well I won't spoil it. Probably worth the read for the reminder. And it is very engaging. A lot of my complaints are almost metaphysical in nature. In that it is very hard to describe definitively what my issue was.

[1] http://www.amazon.com/The-Circle-Dave-Eggers/dp/0385351399

Well, at least in the US there are laws about health information storage, as well as compliance standards and companies who are VERY good at making sure you are in compliance.

Obviously there are failures of the system, but nobody in the field thinks of it as anything less than very serious business.

If the information is covered under HIPAA Apple will have to be compliant with US federal regulations regarding the security of personal health data. They can't just willy-nilly make the data available to whomever they want. I'm not sure what the equivalents are in other countries, but the US keeps ratcheting up the fines for people who don't comply. Also, all the hospitals whose logos were shown aren't going to allow themselves to be parties to violations of people's privacy.

I would assume everything is, just on general principle, unless Apple explicitly promised it is not, in writing in language that does not allow any ambiguity. "Centralized" means "not locally", and "secure" only means "it's not available publicly on the Internet, we promise", so I see no reason to assume Apple (and anybody who comes to Apple with a warrant or hacks them) has no access to it.

The data is shared with everyone Apple's wants to (or wants to sell to). Simple as that: "If you don't pay for it, then you're the product" :-). The quote of our time and the force that drives the internet's free services.

ps. They will have to have servers in the EU too, if they want European clients. EU law states that medical record data of an EU citizen can only be stored in the EU-located server.

I wonder what will happen to that EU servers law, because it has been made completely useless by a recent court decision in the US. Therein, the judge ruled that all data on servers of US companies in the EU can be accessed by the US legal system.

My prediction is that here in Germany, nobody will use cloud-based health services because of the risks. Not so sure about the rest of Europe, though.

Even if the US courts rule it legal, it's still illegal in the EU. Basically, this means that US companies with servers and data in EU will find themselves in an awkward position, with potentially no choice but to break either one law or the other.

Hm, do you have any link? Sounds like judge ruling out of his jurisdiction[1]. If the servers are in Germany, Switzerland or France good luck getting USA judge rulings implemented, especially if the other party (e.g. Germany/France) is not willing to cooperate. On the other hand, maybe there's some sort of agreement between the EU and the US we don't know about. Cloud services are becoming an increased pain, decentralized/encrypted data is the future apparently.

[1] Like when the US government wanted to indict Assange with charges of treason, regardless of the minor issue that he was not a 'USA' citizen, so... Treason according to whom?!

The case is "In The Matter of a Warrant to Search a Certain Email Account Controlled by Microsoft Corporation" [1,2]

In this case, it's about an e-mail account provided by Microsoft (an American company) but physically hosted in Ireland.

[1] http://www.reuters.com/article/2014/04/25/us-usa-tech-warran... [2] http://www.computing.co.uk/ctg/news/2341902/us-court-cloud-c...

I interested in how wearable companies use this. If they give up their data to Apple that removes a large barrier for users to adopt a different wearable company(or apples own product). On the other hand users might demand their current wearable product work with the health app.

Many health companies I have looked at have been quite liberal with their data (in the sense of allowing other apps to access it, not necessarily giving you direct access to it, e.g. the Fitbit app can access my Withings scale data despite Fitbit also selling a scale). Maybe that’s just the effect of a diverse market with no clear leaders and a natural benefit of that competition. I hope that will continue and I hope that integrating with Health Kit will be easy and straightforward.

I really like that Apple hasn’t stepped in to offer some definitive hardware solution. I like this diverse market and I don’t necessarily think Apple should try that on their own. They seem quite intent on letting the market figure that out and letting others integrate nicely. I also hope that Apple keeps steady with that, even if they start selling their own wearables (though I think that’s less likely now).

I mean, I assume this will be able to integrate with dedicated step counters, so the fact that newer iPhones have their own step counter built in didn’t lead Apple to prevent others from integrating – which is a somewhat promising sign.

I would be more inclined to use a product that interacts with it cleanly for specifically that reason. It just means that the quality of the hardware and software needs to be the differentiator, instead of it just being "Whoops, you're stuck in this silo now."

It just seems better to me, even for the market itself.

Oh you're still going to be stuck in a silo, it'll just be an Apple branded silo instead of a Runkeeper branded silo.

Switch to Android? Hope you aren't keeping your insulin / blood sugar records in there.

There's nothing stopping you, or the developer of your chosen application exporting/downloading/synchronising the information from HealthKit's APIs.

Aside for diabetics, I have found most people don't want or need to monitor their vital signs. Plus, it's a reminder of how unhealthy it is to sit in font of a electronic devise. Now, if the technology got great and could monitor lipid levels I might be interested. On the other hand, when my time is up I don't want Apple emailing me a Advanced Directive? "Good morning--did you sign your organ donor card? You have a 79% percent chance of a spinning wheel today, or window speak, you might have a blue screen today? Please, download our Pallitive care song app?" Would Jobs want to be reminded daily of his own mortality? No-- , I really miss that man. Lately, I have been thinking of making my MBP a Linux machine; That thought never would have entrpered my head If Jobs' was still around.

I don't think it is worth much to speculate about what an individual would have done. We can't predict the future or human actions that well. There are several internal forces at work with Apple that we do not know much of. It's not like Jobs never made bad decisions...

Apple could provide push for others to follow. This can be very big change in the way medical system works.

Well, I'm excited!

Interoperability, standards, security, governance, (PAS) integration, health professionals mindset change are all required too – however, if EHR/EMR/PHR [clinical/enterprise] innovation is ever going to happen, it's going to be driven by consumers. I'm sure all the integration/interface engine vendors will be working over time for the next few months.

I especially liked this line :P ...

“How are you?” now has a really accurate answer http://www.apple.com/ios/ios8/health/

Apple probably has to work on improving the accuracy of activity monitoring on its devices.

This paper from ACM Ubicomp 2013 concludes (as of ~2012), that iPhone (Moves App)performed worse than Nike+Fuelband, Nike+Sportsband, and Fitbit in tracking step-recording, with Fitbit performing the best.

https://www-old.comp.nus.edu.sg/~brown/pdf/pdm_workshop2013....

The iPhone 5s now has dedicated movement tracking hardware with the M7 chip.

It seems near impossible to create a service in this space that is both general purpose and also usable enough to get the kind of adoption that a company the size of Apple needs to justify its involvement.

So I'm really eager to see what Apple has come up with, and how it's going to be different from Microsoft HealthVault, Google Health, RunKeeper's HealthGraph, and Samsung's SAMI.

The healthStore is probably like the contacts database on the phone. Apps will need the user permission to access (read/write) to the store. Like contacts Apple might make the only sync option for the healthstore via iCloud. It is also likely that the structured data options on the healthstore will not satisfy all class of apps, except to what is supported by healthkit.

This is another step in the long long road to everyone being able to easily track their health electronically. This will not be the break-thru, but it will help.

If Apple successfully handles EHR integrations & HIPPA, it will create a significant opportunity for developers to improve our healthcare system.

Why would Apple bother with this? This is functionally them entering the "fitbit" space.

It's showing people neat graphs, which they'll rapidly get bored with because at the end of the day once you're even slightly away from reinforcing the feedback loop of "how much of a good person am I by proxy of my exercise/weight/calories?" no one cares and people specifically do not want to know.

Everything else about health is messy, full of legacy systems and liability, and completely facing away from the consumer.

I agree with you. Most people don't care about neat graphs and data.

Apparently, Apple is already integrating with Epic, one of the largest EHR systems out there. Preventive health is becoming a large opportunity and I think Apple is aspiring to become the main platform here.

haha.

Does anyone have a link to the actual API docs?

I would love to see what this is actually capable of. I suspect, at least for now, it's probably limited to not-so-useful counters like weight, height, age, calories, etc. I'd love to this turn into a full fledge PHR that people actually want to use, but I'm leary of that happening (see passbook).

I'm surprised by how minimal this is.

do we really need separate post for each of these?

There goes your health insurance premiums.

In the United States, insurers can no longer discriminate against members through the ACA in most ways (like healthkit):

(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

(1) Health status.

(2) Medical condition (including both physical and mental illnesses).

(3) Claims experience.

(4) Receipt of health care.

(5) Medical history.

(6) Genetic information.

(7) Evidence of insurability (including conditions arising out of acts of domestic violence).

(8) Disability.

(9) Any other health status-related factor determined appropriate by the Secretary.

They can still change the premium.

If they do (theoretically speaking) can you prove it?

This sort of explains Samsung's recent simband release. Samsung just wanted to throw something out of the door before apple.

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