Wearable health technology in medical and consumer arenas
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Apple Computer Inc.'s widely telegraphed HealthKit announcement as part of iOS 8 and new partnership with Epic Systems Corp. appears to have gained more traction with the addition of IBM as a third partner.
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Apple had already made an incursion into healthcare with its initial 2010 alliance with Epic around the Haiku app, buttressing that move earlier this year with deals involving Fitbit and Withings and Epic's MyChart.
And now IBM has joined Apple in a deal that, with Epic, has spawned a triumvirate that intends to dominate enterprise mobility, and as a subset of that, the nascent market for pushing consumer health data toward providers. IBM's role is to provide secure messaging, analytics and mobile integration.
Along with similar healthcare initiatives by Google in the Android sphere and by wellness purveyors such as WebMD, the moves are putting mainstream healthcare IT players on notice that legacy tech giants are moving in on their turf.
Still, executives who are part of the Apple-Epic-IBM thrust are indicating that the companies see their effort as the forging of a new standard platform in the mHealth market, both across large health systems and for consumers.
"We will work with Apple and Epic to ensure the secure transfer of data. You need someone to be in the middle," Dan Pelino, IBM's general manager, public sector, told SearchHealthIT.
Pelino acknowledged that the historical rivalry between Apple and IBM is long over: "Apple has dominant mind share and unit share. Apple does a very good job of delivering elegant devices."
He also noted that IBM already has a relationship with Epic by way of its joint bid with the EHR market leader for a Department of Defense EHR contract for 9.7 million patients.
Pelino maintained that in the private healthcare market, what Apple, Epic and IBM envision goes beyond just building patient portals such as Epic's MyChart. They see their systems being used for true medical purposes such as checking glucose levels and performing ultrasounds, he said.
"The industry is going through a round of consolidation and aggregation, and it will be a catalyst for smaller companies to build applications," Pelino said. "It does signal a new era and a new level of cooperation and a new level of innovation, and the winner is the patient."
Not everyone convinced
Not so fast, say some who are working in the mHealth market.
Jeff Brandt, a longtime mHealth software developer and consultant and member of the Health Level 7 mHealth Task Force and co-chair of the mHIMSS work group, argued that whether the mobile device platform is Apple or Android is irrelevant.
"It's like the Ford or Chevy thing. For doctors, who have the money, they get Apple," he said. "We've seen that nurses use Android and [that] doctors use Apple."
As for the Apple-Epic match, "It's the same thing; they're both closed systems," Brandt said. "Putting IBM in the mix doesn't make sense. I don't make much of this. I think it will fall a little by the wayside.
"I don't think doctors want any more information than they've already got from patients," he continued. "Until an app proves its efficacy through trials, I don't think doctors will say this is real data."
Indeed, some doctors and CIOs look at the proliferation of wellness apps and devices and the chatter about them and their data streams migrating to doctors' offices as just so much hype.
For example, the Covidien's ZephyrLIFE wearable monitoring device -- a class 2 device subject to full FDA regulation, unlike the consumer mHealth apps and wearables such as Fitbit and Jawbone's UP bands -- drew a lot of interest at the mHealth + Telehealth World 2014 conference. The product and others like it are already being used in hospital settings and by elite athletes and offer many more advanced functions, including biometric monitoring, not routinely found on consumer apps.
"We should do mobility. There's no doubt we have to do it," said Khalid Moidu, M.D., CIO and CMIO of Family Physicians Group, an accountable care organization in Orlando. "But it certainly is expensive.
Moidu, like Brandt, questioned the core premise of the value of this kind of health information.
"This is self-health," he said of the popular wellness devices and apps. "Care coordinated by clinical professionals is different [from] self-care. This fitness information is of some value, but it adds to the physicians' work that they don't get paid for and they're clearly busy, so it's a challenge.
"These things are all oriented toward health, not illness," Moidu added. "We need to monitor for illness."
Apple's symbolic gesture
Despite some doubt, the market for consumer and patient wearables is booming, and with the recent draft guidance from the FDA -- which effectively deregulated the app market and came only a few weeks before Apple's HealthKit intro -- many big healthcare systems are getting into the act.
For Joseph Kvedar, M.D., director of the Center for Connected Health at Boston's Partners Healthcare, Apple's entry is promising and could spur rapid advances.
Kvedar's group is already piloting and using a host of mHealth and telehealth products and programs, from now-almost-traditional remote monitoring of patients with chronic illness, to integrating Fitbit wellness info into electronic health records.
"It's great for healthcare. It's these big brand names getting together," Kvedar said of the Apple gesture. "Things will happen now. They're leading the way. As for what was announced, not much was actually going on there. But symbolically it was a big deal."
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