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Apple Health app update for health records: pros and cons

This analysis digs into the potential of the new PHR capability that is a result of the Apple Health app update and whether past consumer adoption snags will again come into play.

The Apple Health app update could be a big step toward the consumerization of healthcare, or the personal health record capabilities Apple has added could end up like many PHR systems of the past: commendable but largely unused.

The consumer tech giant announced this week that it updated iOS 11.3 beta to include a PHR function on the Health app. As part of the project, Apple is working with 12 major health systems, EHR vendors Epic and Cerner and the FHIR interoperability standard.

Epic, Cerner on board

The presence of the dominant EHR companies and prestigious healthcare providers lends much legitimacy to Apple's long-anticipated foray into the world of PHRs, which let individuals compile their own electronic, portable health records.

And use of FHIR (Fast Healthcare Interoperability Resources) appears to indicate that Apple sees interoperability -- probably health IT's biggest problem since digital health records became pervasive over the last decade -- as an impediment it has overcome.

Apple's stellar reputation for security and privacy also augurs well for protecting health data as it flows to and from healthcare systems via the Apple Health app.

Yet a slew of questions accompany the semi-blockbuster announcement from Apple.

Apple Health app
Apple Health app with personal health record categories, running on Apple iPhone X

Unclear if consumers want PHRs

The central issue, perhaps, is whether healthcare consumers really want to stitch together their own longitudinal health records into a PHR or even use a ready-made PHR vehicle.

A similar PHR, Microsoft's HealthVault, hasn't caught on since it was released in 2007. Same for other PHRs that have been on the market for some time, such as WebMD PHR, Patient Ally and Patient Fusion from web-based ambulatory EHR vendor Practice Fusion.

Google discontinued its Google Health PHR in 2011 after only three years on the market.

The big advantage of the Apple PHR is that patients can retrieve and assemble their health information from among different provider systems.

Going back a decade to the advent of PHRs, the American Health Information Management Association and federal health officials tried hard but achieved minimal success in promoting the PHR concept.

Also, Epic and Cerner both already have robust patient portals that function as PHRs for patients at many big and midsize health systems.

Usually available on mobile devices, the portals enable patients to view and retrieve updated information about medications, allergies, vital signs, procedures and lab results and make appointments with and ask questions of caregivers.

Easy to use and interoperable

The Apple Health app update with the health records functionality provides the same kind of access, though with a slicker and easier to use interface.

The big advantage of the Apple PHR is that patients can retrieve and assemble their health information from among different provider systems, giving the Apple Health app PHR more reach than conventional portals.

If this functions as advertised and the FHIR-based health data interfaces work quickly and seamlessly, it will mean that Apple has to a large extent conquered the interoperability monster, particularly for patients with doctors at disparate hospitals and healthcare systems.

But FHIR, despite rising adoption and great potential, is still a young standard. And while some in health IT see it as useful and faster than previous health data sharing protocols, it is still a bit clunky and unproven.

Also keep in mind that the Apple Health app update is still in beta and not available to the general public other than patients of the 12 provider systems that worked on the iPhone-based system with Apple.

Despite lavish praise for the project from those health systems' leaders, it's unclear whether patients are taking advantage of the Apple Health app update and are using the app with the PHR yet, and if so, if they like it.

Affordability could be obstacle

Of course, there's also the matter of affordability. IPhones are popular among doctors and middle-class and affluent healthcare consumers, but the devices are expensive.

However, Apple's version of the PHR does, indeed, seem more elegant than previous PHRs and Apple's marketing muscle and consumer-focused vision make it more likely to flourish where other PHR ventures have fizzled.

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How likely is your healthcare organization to join the Apple Health app PHR project?
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Although the concept is appealing, one of the biggest barriers to patients aggregating their data from all of their health care providers is that the FHIR API standard is not, in fact, standard.  Every EHR vendor has implemented their FHIR API differently, so that Apple or any other software developer who wants to access data from Epic, Cerner, AllScripts, eClinicalWorks, NextGen, and the myriad other EHRs in use will need to write a different interface to each of these systems.  Anyone accessing the EHR vendors' publicly available FHIR API specifications and testing sandboxes can readily see this.  Further, iun many cases, app developers will even need to be tweak their interfaces to accommodate variations in the FHIR implementations between one physician practice or hospital and another, even when the practices/hospitals are using the same EHR product. 

If Apple could exert its influence to actually get the EHR vendors (including the major partners its working with -- Epic and Cerner) to just support a single version of the FHIR API, that could pave the way to the PHR vision that is being proposed.  A good candidate would be the "Argonaut" implementation guide for FHIR, which many of the major vendors helped to define, but none of them are supporting faithfully in their actual implementations.  In the absence of that, I fear this effort will fall way short of its promise and potential, much like the PHR initiatives of the past. 
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All true. And FHIR, of course, is still only a standard for trial use, which means apparently that it is still technically a draft standard, though close to becoming a full, or normative, standard. Even FHIR's health IT standards organization parent, HL7 International, acknowledges that FHIR is not quite mature enough, or perhaps still somewhat too unstable, to be balloted as a full normative standard.

However, all of that considered, Apple is quite likely one of the few tech players that could pull off something like this. Its Health App has itself become the de facto standard for recording, using and, now, sharing, smartphone health data. Apple probably has enough development resources, which, if it deploys them with the full cooperation of Epic and Cerner, to make a truly interoperable, widely used mobile-based personal health record system a reality soon.
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This is a great step on the never ending road to interoperability. If Mayo and Cleveland Clinics not to mention Scripps and Sharp were all taking care of National Health (NHS) patients that were all being paid by that single payer there might be a chance that it would work, but alas they are all competitors and patients have not shown much interest in keeping their own records.
 
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Not seeing anything here or elsewhere that would allow me to scan and convert my 30 plus years of medical records into meaningful data so that I and my doctors can look for both positive and negative trends over time. So, there is nothing out there for the end user (me) that would allow me to take ownership of my health from a fact driven point of view over the long haul. I have hope that Apple will eventually figure this out but not holding my breath.
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