Apple Health Records 2018
Early Participants Weigh In

One reason Apple’s entry into healthcare raises eyebrows is that the healthcare industry is notoriously complex and thus unfriendly to vendors without deep experience in patient care, health data, and government regulation—even well-funded giants like Google and Microsoft have stumbled. Apple’s early provider partners say Apple has a good chance of not repeating history and that the timing is right—EMR adoption has never been higher, and thus electronic records have never been as available; smartphones are more entrenched than ever; and interoperability standards (like FHIR) have never been as advanced. More importantly, healthcare now needs Apple’s creativity and proven success with consumers more than it needs entrenched healthcare perspectives. With historical attention to privacy and a business model that isn’t dependent on selling consumer data, Apple has earned consumer trust. Additionally, their Health Records solution sidesteps most HIPAA concerns because Apple never takes possession of patient data. Finally, Health Record participants say Apple has no need to rush development and has wisely adopted a strategy of starting small, then learning and evolving over time.

While participants say Health Records has visionary potential, most organizations’ formal plans for it are limited to its most immediate benefit—allowing patients to download their patient records, a benefit that requires relatively little time, effort, or cost from healthcare providers. Most participants view Health Records as an add-on for patient convenience that does little to alter their patient engagement strategy. Some even expect Apple to drive most patient adoption. Beyond data portability, most participants feel they lack the experience and expertise needed to pursue creative uses, such as consumer app development. Instead, they will let third-party developers from outside healthcare take the reins while they watch and learn from the sidelines.

Next Steps: Can Apple Scale?

Short term or long term, participants say that Health Records’ impact will depend on Apple’s ability to scale education, adoption, and data complexity. Both patients and clinicians need to figure out how Health Records compares to other patient engagement options that already exist. On March 29, Apple more than tripled the number of participating health systems (from 12 to 39), but there are over 2,000 hospital-based health systems in the US. In order to reach more than one-third of these, Apple will need to expand to EMR vendors beyond their current partners (athenahealth, Cerner, and Epic). In terms of capabilities, participants say that being able to upload data back into the EMR will be vital and that eventually Health Records’ data model will need to support more detailed data than the C-CDA data elements handled today. Eventually, if this general capability is going to benefit all patients in the US, it will need to expand beyond Apple to other smartphone vendors: "If an Android version becomes available," said one CIO, "that will be a home run for a lot of people."

5% of Hospitals Down, 95% to Go