Health

Apple's on-stage HealthKit goof proves it still has to earn the trust of the health community

shutterstock_181142714
Image Credit: Shutterstock

Monday at Apple’s Worldwide Developer Conference, an image flashed up on the screen behind VP of Software Engineering Craig Federighi. It was a screen shot from Apple’s new Health app (or a mockup thereof), showing a user’s blood glucose level.

But Apple biffed the measurement for blood glucose level, as Aaron Rowe of biochemical testing device maker Integrated Plasmonics pointed out. It’s measured in mg/dL. Apple’s slide said “mL/dL.”

Of course, this probably says nothing about the finished version of the Apple Health app we’ll see released with iOS 8 next fall. But it does raise an important issue for any company embarking on the new frontier of healthcare biosensing and informatics, no matter what form: To achieve the vision of a unified, consumer-driven health platform, they’re going to have to get the real, clinical healthcare stuff right.

It’s no secret that many in the healthcare community have serious doubts about the accuracy of the consumer health apps and gadgets available today. And a number of studies have reinforced those doubts. Consumer apps and devices are often inconsistent in their findings, reporting very different results in two tests of the exact same conditions. Clinicians are especially suspicious of apps that rely on the user to self-report key body metrics.

And that’s just the data collection part. The hard part is processing the data and taking meaning from it in a way that improves care. If developers don’t get this right, caregivers won’t use the consumer health data collected in their apps, devices, and platforms.

“It will be really important for companies to justify their interpretations of the information they provide to achieve physician buy in,” said Dr. Molly Maloof, a San Francisco Bay Area clinical physician focused on health optimization. “Otherwise, these consumer-focused devices will be written off as health toys rather than health tools.”

Knowing this, many digital health companies are trying to get their names associated with reputable healthcare names like the Mayo Clinic, the University of California at San Francisco Medical Center, and Partners Healthcare in Boston. But how exactly are they working together?

Dr. Maloof believes that doctors must work with developers in a clinical capacity. Apple is working with clinicians at the Mayo Clinic, and it has hired physicians with experience creating medical devices to work with its hardware and software engineers, Dr. Maloof points out. “What I wonder is how many physicians working with these developers are actually practicing medicine? At the end of the day, whatever they create should be designed to be interoperable with both the consumer world and clinical world.”

“I personally feel they should have an entire team of clinical researchers and medical doctors on their staff rather than just device experts because what they need is clinical validation that the tool is useful,” Dr. Maloof says.

Regardless of the level of doctor participation in development, healthcare is moving from doctor’s offices and hospital rooms out to the devices and apps in the pockets of consumers. More and more, healthcare providers are being paid based on how healthy their patient populations are: A recent poll of providers found that half of them believe that 50 percent of their income will come from these “risk-based” plans in three years.

So healthcare providers will be moved to care about the lifestyle choices their patients make between office visits. And digital health platforms and apps, if done well, could end up being physicians’ main connection to the daily health and habits of patients.

Apple, in one stroke, brought this idea into focus for a lot of people with its just-announced HealthKit offering. The company is in a unique position, with the help of doctors, to build its health ecosystem the right way.
“As a doctor, I’m excited, because if integrations like this help more patients measure their glucose, carbs, weight and steps, then that’s a great thing,” said Dr. Nate Gross, cofounder of health startup accelerator Rock Health.
“There will be glitches and hurdles along the way to patient empowerment, so hopefully Apple will be helped both in-house and among the community in medical expertise, platform integrations, and patient-centric design,” Gross said.