Epic Systems, the dominant EHR provider in hospitals and large medical groups, has been working with Apple on its HealthKit consumer health data initiative. But until now, the famously media-shy Epic and the famously secretive Apple have said very little about how the HealthKit ecosystem will work to the benefit of clinicians. But Epic has begun to talk.
Apple launched its new iOS 8 mobile operating system today, and a significant feature in that release is the Health app, which stores various types of our health data. You can think of HealthKit as a consumer health-information cloud data repository that connects to, and receives information from, a variety of consumer devices (connected scales, fitness trackers, smartwatches, etc.) and apps (food diaries, calorie counters, workout journals, and so on).
People in the health care industry hoped for more from Apple’s HealthKit platform than just amassing and sharing wearables data among app and device makers. They wanted HealthKit to make a difference. They wanted it to make people healthier.
A large platform collecting billions of data points about hundreds of aspects of our health on a daily basis might create a powerful information resource for health care providers and researchers. But in order for that to happen, the data will have to find a way into clinical systems, like the electronic health record (EHR).
“Apple’s HealthKit has tremendous potential to help close the gap between consumer collected data and data collected in traditional healthcare settings,” said Epic president Carl Dvorak in an email to VentureBeat. “The Epic customer community, which provides care to over 170 million patients a year, will be able to use HealthKit through Epic’s MyChart application—the most used patient portal in the U.S.”
The “customer community” Dvorak refers to is the hundreds of clinics and hospitals that use the Epic EHR. Patients use the Epic MyChart app to access elements of their own patient record from the Epic EHR. But note that the EHR accesses HealthKit data from the MyChart app, not via a direct integration with the HealthKit platform.
“While Apple will never mirror your Health data to iCloud (or allow another app to do that), once you provision access to another app, they may transport it elsewhere (e.g., to your provider’s EHR), but only if that particular endpoint allows access,” said Malay Gandhi of the accelerator Rock Health.
This may have been by design to avoid regulatory or privacy issues that might have arisen from Apple storing personal health data on its servers and then transmitting it past a health provider’s firewall and into clinical systems within. Here’s how Epic spokesman Brian Spranger describes the movement of data starting at the consumer device and ending at the Epic EHR.
“A consumer health app, like the Withings Scale, will notify HealthKit that it has a new weight and ask HealthKit to store that weight in the database on the iPhone,” he said.
Notice that the weight data that the scale collects doesn’t sit in the HealthKit cloud; it’s on the user’s phone.
“If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit “wakes up” the MyChart app and tells it there’s new data,” Spranger said.
So in this regard, HealthKit acts more like a traffic cop, connecting to devices and directing them to send or store data, all guided by privacy rules.
“The MyChart app on the phone then transmits that weight back to the EpicCare EHR system where it can be used appropriately as part of the patient’s medical care,” Spranger said.
Gandhi says that for the consumer, the Health app in iOS 8 is really the epicenter of Apple’s health ecosystem.
“Health is fundamentally a data aggregation and provisioning app disguised under very thin visualization,” he writes in a note to VentureBeat. “The consumer controls what data goes in, and what goes out, at a reasonably deep level (it would be like if when an app asked for access to your contacts, you specified access at the individual contact level).”
A year from now there may be many developers working with hospitals and their EHR vendors on HealthKit apps that present all kinds of consumer-generated information to physicians. The challenge, for now, is to boil down the mountains of information that will be gathered into the clinically meaningful and actionable bits.