Reuters yesterday reported that Duke University and Stanford University will be piloting the integration of Apple’s HealthKit into clinical practice. We predicted this a few months ago when it was announced Apple was working on relationships with the largest hospital based electronic medical record company, Epic.
As a refresher, HealthKit is essentially a central place to store data collected by personal health devices. More importantly, the data will be stored in a standardized way – a blood pressure readings taken by a Withings, iHealth, or Qardio device will all be stored in the same way. That way, another app or software platform that wants to use that blood pressure data to help a patient implement a self-titration schedule doesn’t have to worry about compatibility with three different devices. All it has to do is integrate with HealthKit. For Android devices, Google Fit will provide a similar capability.
Pediatricians and endocrinologists at Stanford plan to integrate HealthKit to facilitate the transfer of blood glucose readings from smartphone-connected glucometers like those made by Dexcom into Epic’s MyChart application. Details are scant but it appears this will be done in the context of a pilot rather than a clinical trial. Efforts at Duke will reportedly focus on communication of health data in patients with cancer or cardiovascular disease.
As should be clear, details are pretty scant in the initial reports about efforts underway at Duke and Stanford. What we can take away is that the opportunities being created by HealthKit and Fit are being recognized by clinicians at major healthcare institutions in addition to software developers and entrepreneurs.
One opportunity is to facilitate the transfer of data into an EHR more simply by standardizing the data being collected. Certainly this could improve collaboration between individual patients and their physicians as well as other healthcare professionals, both at and in between clinic visits. Another is that it could also simplify the monitoring of select populations like heart failure patients with automated data transmission and triggered alerts if, say, a patient’s weight goes up by a five pounds in two days.
Even more interesting are the opportunities created independent of the healthcare system. By freeing developers from the hassle of trying to be compatible with dozens of personal health devices, we could see the rise of a more robust, competitive market of apps that effectively drive healthy lifestyle changes.
And given recent clinical trials demonstrating the efficacy and safety of self-titration schedules for patients to use in getting control of their blood pressure, we could see the development of apps to help facilitate that process. A study underway at Cedars-Sinai is evaluating a strategy much like that where patients following a self-titration schedule are monitored using iPhone-linked blood pressure cuffs; the data is transmitted automatically to their physicians who stop the dose escalation when the target is reached.
With this centralization of data in Fit and HealthKit, one natural concern is data security. With the recent hack of a large health system, exposing millions of patients’ health data, the security of personal health information has been front and center. A recent Symantec report also highlighted the vulnerabilities presented by a number of Bluetooth-enabled personal health devices. And then there’s the issue of what apps will do with the data they collect, an issue we recently discussed at length.
Apple recently announced updates to their developer agreement that indicates that they share these concerns. In particular, the developer agreements now specifies that:
- Apps may not use user data gathered from the HealthKit API for advertising or other use-based data mining purposes other than improving health, medical, and fitness management, or for the purpose of medical research
- Apps that share user data acquired via the HealthKit API with third parties without user consent will be rejected
It should be noted that this only addresses what apps and devices do with data acquired through HealthKit, not the data they themselves acquire.
The trend started by HealthKit and Fit will further drive the collection of health data by patients using mobile devices, data that can now not only find its way into the EHR but also be used far more easily by third-party apps. While privacy and data security issues that we will need to addressed, the opportunities being opened have the potential to change the way we deliver care. The pilots being undertaken by Duke and Stanford are just the beginning.
Ed Note: We’d love to hear what you think – are HealthKit and Fit the latest overhyped mobile health products or are they the key step we needed to realize the potential of mobile health?