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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

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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 :)

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