Report claims Apple expanding CareKit, working on iPhone health record repository feature

Posted:
in iPhone edited June 2017
Apple appears to be working on a digital medical record initiative to simplify getting all of a patient's information to every caretaker that needs it, and will take advantage of the iPhone's near-ubiquity in U.S. health care to do it, according to a new report.




In a report published Wednesday night by CNBC, Apple has "quietly" been building a team and consulting with hospitals and other industry groups in order to develop an in-depth tool for patients. This tool, should it come to fruition will collate a patient's clinical data including detailed lab reports, perscribed medications, and other data on a device and allow it to be shared easily with providers and insurance agencies.

If there is any veracity to the report, the effort would expand on Apple's HealthKit's and CareKit's records function which appears to be relatively limited compared to the described scope of the project.

Even with the advent of the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA), which includes provisions for secure transfer of digital records, patients must increasingly carry documentation from provider to provider. Systems between organizations required by HIPAA come from multiple vendors and don't always talk well to each other. Failing a patient-provided solution, information is often attached to email in a PDF, or still sent by fax machine and efficient distribution is at the mercy of often overworked staff.

Even enhanced by Apple's effort in the field, the medical record transfer issue may still be impacted by patient apathy, though.

"At any given time, only about 10 to 15 percent of patients care about this stuff," said President and CEO of the Massachusetts eHealth Collaborative. "If any company can figure out engagement, it's Apple."

Apple's Vice President of Software Technology Bud Tribble has been linked to The Carin Alliance by CNBC. The Carin Alliance is a health industry and developer group dealing with the so-called "interoperability crisis." The group declined comment on Tribble's association with the group.

In August 2016, Apple reportedly purchased personal health data startup Gliimpse, potentially setting the stage for enhancements to CareKit, HealthKit, and ResearchKit. The Gliimpse platform is intended to untangle "incomprehensible electronic medial records" and condense them into standardized coded elements for the patient or any provider to easily glean information and trends.

In May 2016, Apple was looking to hire an attorney with experience in HIPAA, and associated privacy issues. HIPAA has very specific rules on handling of patient records and data stored in a facility or on a device such as might be required for the implementation of Gliimpse's technology, or Apple's rumored new health care records initiative.

A possible simpler version of what Apple may be planning was released on Tuesday, in the Boston Children's Hospital Caremap app. That app produced in conjunction with Duke University uses Apple's CareKit to securely store vital medical information, and share it not only with a patient's regular physician cadre, but with other health professionals either as part of extended care, or during an emergency. Beyond just diagnoses, the app also tracks health metrics allowing for easier long-term trend analysis by observers.

Comments

  • Reply 1 of 17
    wonkothesanewonkothesane Posts: 1,378member
    This is what improving people's lives means. Not "bezel free designs" or curv d screens. Same with accessibility. 

    In other words: Apple is light years ahead of any competition due to their DNA, and usually amange to package such value-add in best in class user experience. 

    Tbis, exactly this is what sets them apart. And why I like them. 
    GeorgeBMacStrangeDaysrob53
  • Reply 2 of 17
    GeorgeBMacGeorgeBMac Posts: 4,949member
    This is what improving people's lives means. Not "bezel free designs" or curv d screens. Same with accessibility. 

    In other words: Apple is light years ahead of any competition due to their DNA, and usually amange to package such value-add in best in class user experience. 

    Tbis, exactly this is what sets them apart. And why I like them. 
    True,  but they face a mountain of obstacles, among them:
     Our healthcare system has implemented HIPAA to mean:  "We get to keep your records and share with anyone we desire -- except YOU.   You are only allowed to see the most superficial of the records and then only in fragmented form that is difficult to integrate or use in any meaningful way.  Because, don't forget who's in charge here!  (Hint -- it ain't you!).

    Our "healthcare system" is really just a "Disease Care system" driven by insurance reimbursement.   So most of the records it keeps have little to do with your health and everything to do with getting reimbursed by insurance -- including fake diagnosis codes for problems that are minor, irrelevant, obsolete, or may not even exist.

    In short, Apple is diving into a muddy, stinky swamp of greed.
    But, if Apple is able to turn health records over from healthcare system centric to user centric where the user owns and controls their own data, they could revolutionize the system.   But, there will be mountains of self-interest and greed trying to block that effort.
  • Reply 3 of 17
    gatorguygatorguy Posts: 20,900member
    This is what improving people's lives means. Not "bezel free designs" or curv d screens. Same with accessibility. 

    In other words: Apple is light years ahead of any competition due to their DNA, and usually amange to package such value-add in best in class user experience. 

    Tbis, exactly this is what sets them apart. And why I like them. 
    True,  but they face a mountain of obstacles, among them:
     Our healthcare system has implemented HIPAA to mean:  "We get to keep your records and share with anyone we desire -- except YOU.   You are only allowed to see the most superficial of the records and then only in fragmented form that is difficult to integrate or use in any meaningful way.  Because, don't forget who's in charge here!  (Hint -- it ain't you!).
    And FWIW at the moment Apple's Cloud storage is not HIPAA-compliant (many other providers are). If they're working in this area and get serious about it I believe they'll buy a cloud provider rather than using their existing infrastructure. Buying up a big company in that realm is something I've expected for a few months now. 
    patchythepirate
  • Reply 4 of 17
    jdgazjdgaz Posts: 357member
    Me thinks there is some recurring services revenue in this area. Might even help sell a phone or watch as well.
  • Reply 5 of 17
    gatorguygatorguy Posts: 20,900member
    jdgaz said:
    Me thinks there is some recurring services revenue in this area. Might even help sell a phone or watch as well.
    Can't think of another reason Apple would spend money on developing it. They're not a Non-Profit :)
  • Reply 6 of 17
    zoetmbzoetmb Posts: 2,469member
    This is not my experience.  My doctors have offices at the largest hospital in the U.S.: New York Presbyterian Hospital (formerly Columbia-Presbyterian) and while they may personally own iOS devices, I've never seen them use one in the office (and many parts of that hospital don't even pick up a Verizon or AT&T signal anyway and there's no public WiFi).    One of my doctors still largely keeps hand-written notes and others do enter info into a computer system - but it's a PC-based enterprise system for the hospital.    And when I get lab work done, which due to my insurance company I have to do at a lab outside the hospital, they FAX over the results so that data doesn't even get entered into the system.  

    So I don't see any signs that Apple has "ubiquity" in the U.S. health care system if they don't have the largest and aside from getting a copy of my blood work report, I've never been able to get copies of my records, not that I need them.    I see no signs at this hospital that they're doing anything with Apple or anyone else that would get me my records, electronically or otherwise.    

    I think we've got a long way to go.   
    gatorguy
  • Reply 7 of 17
    stanthemanstantheman Posts: 319member
    Steve Jobs wanted Apple to get behind initiatives to promote health, and this is one more example. The reward will come longer-term.
    GeorgeBMac
  • Reply 8 of 17
    If Apple could pull this off it would be monumental. This epitomizes why I love Apple (and why I'm politically moderate). Rs and Ds keep ineffectually bickering over the best strategy to deliver health care, meanwhile the system is largely inefficient and corrupt,* which is the primary reason the cost is so high in the first place. Apple may be able to make some very meaningful progress that will save and improve lives, and improve costs as well (reduce evaluation redundancy, improve engagement in preventative care, provide reassurance and thus reduce number of visits, ...).

    The systems we have in place right now are beyond terrible. I'm a physician working in one of the largest medical centers in the US, and I can assure you, we have a long way to go:
    -There are some information portals (apps) that provide info to patients, but it's usually raw data with poor presentation and no context. They are also silo'd (system from system, and even hospital from hospital). There is typically little, if any, physician coordination with whatever info is provided.
    -On my (the physician) side of things, the EMR systems in place look like they were designed and built 15 years ago, are incredibly inefficient to use, and to evaluate information from. I'd say it's a safe bet that 99.9% of physicians are either too busy or too tech illiterate to complain about it.
    -Even though there are huge hospital institutions less than a block away from one another, the primary way to deliver patient records is: 1) get signed patient consent, 2) fax pt consent, 3) receive return fax of records (even if it's hundreds of pages, often with multiple duplicate info), 4) wait, 5) scan fax as a generically categorized 'history' file, 5) look at file in EMR. If you're "lucky," and you work at multiple institutions, you maybe able to access remote EMR data for review (if the pt consents, if you have privileges there, and if your crappy dell/it department can even do it), but there's no way to enter the info into the other system. I currently work with 3 completely separate EMR systems (they're not even the biggest system, which is EPIC), and I also use microsoft word and paper charts in two other smaller clinics.

    What Apple is trying to do is not a simple task. Aside from the legal issues, there should be some selectivity in what gets shared. *A lot* of people (maybe even most of us?) are their own worst enemies, and if a physician is afraid to accurately document what is occurring (due to fear that the patient will get upset and: complain, sue, report, disengage from needed care), that can present problems (compromise treatment, legal liability, reduce the value of the information to other providers) (FYI: this is already an issue, and a lot of 'reading between the lines' is already par for the course). It seems like the best way to address this is to provide the raw info, but not the full text of the physician notes (although still available through formal records request, as it is currently), and instead provide a succinct visit summary and treatment plan (which can be facilitated by providing an AI-produced summary that the physician and or aide can edit where appropriate).

    *The pharmaceutical and medical device industries are the most prominent examples (e.g. an iPad is a more effective communication tool for an Autistic person than a $6k dedicated, single use case tablet).
    edited June 2017 jony0GeorgeBMac
  • Reply 9 of 17
    zoetmb said:
    This is not my experience.  My doctors have offices at the largest hospital in the U.S.: New York Presbyterian Hospital (formerly Columbia-Presbyterian) and while they may personally own iOS devices, I've never seen them use one in the office (and many parts of that hospital don't even pick up a Verizon or AT&T signal anyway and there's no public WiFi).    One of my doctors still largely keeps hand-written notes and others do enter info into a computer system - but it's a PC-based enterprise system for the hospital.    And when I get lab work done, which due to my insurance company I have to do at a lab outside the hospital, they FAX over the results so that data doesn't even get entered into the system.  

    So I don't see any signs that Apple has "ubiquity" in the U.S. health care system if they don't have the largest and aside from getting a copy of my blood work report, I've never been able to get copies of my records, not that I need them.    I see no signs at this hospital that they're doing anything with Apple or anyone else that would get me my records, electronically or otherwise.    

    I think we've got a long way to go.   
    Texas Medical Center in Houston, Texas is the largest Medical Center in the world. 
    patchythepirate
  • Reply 10 of 17
    sflocalsflocal Posts: 4,674member
    The cellular industry prior to the iPhone was a similar, bloated, bureaucracy.  Apple at the time had zero business being in it, but look how the iPhone changed the industry.

    If one company can do the same to the healthcare industry, it's Apple.  The next few years will be very exciting.  If they get it right, couple that with the Apple Watch and iPhone, and it will be a whole new era of information management for the healthcare industry and the Joe Consumer will have more control of their health.  

    Great time indeed. 
    lolliver
  • Reply 11 of 17
    rob53rob53 Posts: 2,074member
    This is what improving people's lives means. Not "bezel free designs" or curv d screens. Same with accessibility. 

    In other words: Apple is light years ahead of any competition due to their DNA, and usually amange to package such value-add in best in class user experience. 

    Tbis, exactly this is what sets them apart. And why I like them. 
    True,  but they face a mountain of obstacles, among them:
     Our healthcare system has implemented HIPAA to mean:  "We get to keep your records and share with anyone we desire -- except YOU.   You are only allowed to see the most superficial of the records and then only in fragmented form that is difficult to integrate or use in any meaningful way.  Because, don't forget who's in charge here!  (Hint -- it ain't you!).

    Our "healthcare system" is really just a "Disease Care system" driven by insurance reimbursement.   So most of the records it keeps have little to do with your health and everything to do with getting reimbursed by insurance -- including fake diagnosis codes for problems that are minor, irrelevant, obsolete, or may not even exist.

    In short, Apple is diving into a muddy, stinky swamp of greed.
    But, if Apple is able to turn health records over from healthcare system centric to user centric where the user owns and controls their own data, they could revolutionize the system.   But, there will be mountains of self-interest and greed trying to block that effort.
    I think you needed to read what the rules state before making some of your comments. Check out https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

    "A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s protected heath information may be used or disclosed by covered entities. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing."

    This states that the covered entities you're talking about, the healthcare system, is not allowed to willy nilly pass around your information unless you give them that authorization in writing (or, probably, check a box on their website). I did a quick read through this website and didn't see anything about those same entities restricting access to your information. I get digital x-rays and CT scans from radiology departments without any problem.

    As for your last paragraph, I couldn't agree more. Just so you know, HIPAA has been a law since 1996 so it's not new, it's just not well implemented by the medical cartel or insurance companies, which we really could do without if we wanted to save some money. Talk about overhead.....
    lolliver
  • Reply 12 of 17
    Mike WuertheleMike Wuerthele Posts: 4,757administrator
    zoetmb said:
    This is not my experience.  My doctors have offices at the largest hospital in the U.S.: New York Presbyterian Hospital (formerly Columbia-Presbyterian) and while they may personally own iOS devices, I've never seen them use one in the office (and many parts of that hospital don't even pick up a Verizon or AT&T signal anyway and there's no public WiFi).    One of my doctors still largely keeps hand-written notes and others do enter info into a computer system - but it's a PC-based enterprise system for the hospital.    And when I get lab work done, which due to my insurance company I have to do at a lab outside the hospital, they FAX over the results so that data doesn't even get entered into the system.  

    So I don't see any signs that Apple has "ubiquity" in the U.S. health care system if they don't have the largest and aside from getting a copy of my blood work report, I've never been able to get copies of my records, not that I need them.    I see no signs at this hospital that they're doing anything with Apple or anyone else that would get me my records, electronically or otherwise.    

    I think we've got a long way to go.   
    Have you ever seen a doctor with a Samsung phone? We've got pretty heavy medical needs in this family, and I think I've ever seen one. In fact, my wife's OB interrupted a pregnancy-related appointment about a decade ago to talk about the iPhone with me.

    The point is, what company is better positioned to make such a move? Microsoft won't do it, and neither will Samsung.
    edited June 2017 lolliverGeorgeBMac
  • Reply 13 of 17
    badmonkbadmonk Posts: 819member
    I wrote Tim Cook an email last year on this very subject.  The revolution is healthcare records will occur when medical records are stored and controlled by the patient on their personal device (ie an iPhone with biometric protection) and not stored in a clinic, hospital or worse an insurance company.

    I suspect this stance is HIPAA conpliant. And in deference to GatorGuy, the iCloud and iOS is secure enough.



    Only Apple can do this.  Alphabet, Microsoft and Amazon are too tainted by their reputation for data mining.
    lolliver
  • Reply 14 of 17
    rob53rob53 Posts: 2,074member
    https://telehealth.org/blog/which-cloud-storage-services-are-hipaa-compliant/

    This article is dated (May 2014) but it talks about HIPAA compliance, and lack of it, saying as of 2014, there isn't even any "HIPAA "compliance certification" (exists) for backup applications, cloud storage, or disaster recovery services." Some of this has changed but I don't know how much. When I was working, I didn't have to worry about systems with HIPAA information on them so I didn't investigate how difficult it would be. The article goes on to say that "Apple refuses to sign a BAA (Business Associate’s Agreements), so your information is not protected or compliant with your requirement by HIPAA in iCloud." Just because Apple hasn't signed this agreement doesn't mean their iCloud servers aren't capable of protecting HIPAA or anyone's data, it just means they haven't gone through the extensive and many times nonsensical requirements to get a piece of paper. I had to deal with lots of these government regulations and put out tons of paper describing how systems operated and how they were protected. The crazy thing is a lot of this did not really protect anything, it simply covered people's back sides. 

    I don't believe Apple will end up building their own HIPAA-compliant (whatever that actually means) server, they will rely on IBM to provide and support that service. Apple doesn't build servers (even though we wish they would) so all they have to worry about is maintaining an approved level of security on the devices they actually control. Since most of their work has involved iOS devices and iOS devices are the most secure consumer mobile devices, they are a lot closer than any other manufacturer in obtaining any kind of government approval for securely and properly handling private medical information. The crazy thing is many companies continue to use faxes as approved methods for sending and receiving medical information when there's nothing really secure about this process. But rules are rules and if something was approved, then it must be secure (/s). 

    My hope is that Apple can find a really good way to handle medical information, get someone in Washington DC to take the time to evaluate it, and then get all those corrupt medical agencies/hospitals/etc. and insurance companies to actually use it instead of taking the Toyota approach and trying to build something that isn't given away by Apple.

    Food for thought: I just checked my insurance company, Anthem Blue Cross/Blue Shield, ANTM, and their market cap is $50B. "One in eight Americans receives coverage for their medical care through Anthem's affiliated plans." Quick math could put the value of medical insurance companies somewhere around $400B but I bet they're actually worth several times that amount.
    patchythepirateGeorgeBMac
  • Reply 15 of 17
    GeorgeBMacGeorgeBMac Posts: 4,949member
    zoetmb said:
    This is not my experience.  My doctors have offices at the largest hospital in the U.S.: New York Presbyterian Hospital (formerly Columbia-Presbyterian) and while they may personally own iOS devices, I've never seen them use one in the office (and many parts of that hospital don't even pick up a Verizon or AT&T signal anyway and there's no public WiFi).    One of my doctors still largely keeps hand-written notes and others do enter info into a computer system - but it's a PC-based enterprise system for the hospital.    And when I get lab work done, which due to my insurance company I have to do at a lab outside the hospital, they FAX over the results so that data doesn't even get entered into the system.  

    So I don't see any signs that Apple has "ubiquity" in the U.S. health care system if they don't have the largest and aside from getting a copy of my blood work report, I've never been able to get copies of my records, not that I need them.    I see no signs at this hospital that they're doing anything with Apple or anyone else that would get me my records, electronically or otherwise.    

    I think we've got a long way to go.   
    Apple aside:
    By law you are entitled to copies of your lab test results -- even though the lab and the physician sometimes try to block that access (but its getting better).  
    And, you owe it to yourself to get those copies and keep them in a historical record because:   your health status is not a single thing that can be captured in a snap-shot in time.  Instead it is a collection of past histories and, it is up to you to coordinate between any physicians and health care agencies you visit.   Nobody else will do that for you.  But, unless you have copies of your own records, you are unable to do that coordination.
  • Reply 16 of 17
    GeorgeBMacGeorgeBMac Posts: 4,949member
    If Apple could pull this off it would be monumental. This epitomizes why I love Apple (and why I'm politically moderate). Rs and Ds keep ineffectually bickering over the best strategy to deliver health care, meanwhile the system is largely inefficient and corrupt,* which is the primary reason the cost is so high in the first place. Apple may be able to make some very meaningful progress that will save and improve lives, and improve costs as well (reduce evaluation redundancy, improve engagement in preventative care, provide reassurance and thus reduce number of visits, ...).

    The systems we have in place right now are beyond terrible. I'm a physician working in one of the largest medical centers in the US, and I can assure you, we have a long way to go:
    -There are some information portals (apps) that provide info to patients, but it's usually raw data with poor presentation and no context. They are also silo'd (system from system, and even hospital from hospital). There is typically little, if any, physician coordination with whatever info is provided.
    -On my (the physician) side of things, the EMR systems in place look like they were designed and built 15 years ago, are incredibly inefficient to use, and to evaluate information from. I'd say it's a safe bet that 99.9% of physicians are either too busy or too tech illiterate to complain about it.
    -Even though there are huge hospital institutions less than a block away from one another, the primary way to deliver patient records is: 1) get signed patient consent, 2) fax pt consent, 3) receive return fax of records (even if it's hundreds of pages, often with multiple duplicate info), 4) wait, 5) scan fax as a generically categorized 'history' file, 5) look at file in EMR. If you're "lucky," and you work at multiple institutions, you maybe able to access remote EMR data for review (if the pt consents, if you have privileges there, and if your crappy dell/it department can even do it), but there's no way to enter the info into the other system. I currently work with 3 completely separate EMR systems (they're not even the biggest system, which is EPIC), and I also use microsoft word and paper charts in two other smaller clinics.

    What Apple is trying to do is not a simple task. Aside from the legal issues, there should be some selectivity in what gets shared. *A lot* of people (maybe even most of us?) are their own worst enemies, and if a physician is afraid to accurately document what is occurring (due to fear that the patient will get upset and: complain, sue, report, disengage from needed care), that can present problems (compromise treatment, legal liability, reduce the value of the information to other providers) (FYI: this is already an issue, and a lot of 'reading between the lines' is already par for the course). It seems like the best way to address this is to provide the raw info, but not the full text of the physician notes (although still available through formal records request, as it is currently), and instead provide a succinct visit summary and treatment plan (which can be facilitated by providing an AI-produced summary that the physician and or aide can edit where appropriate).

    *The pharmaceutical and medical device industries are the most prominent examples (e.g. an iPad is a more effective communication tool for an Autistic person than a $6k dedicated, single use case tablet).
    Very true...
    One of the dilemmas in sharing medical records is "Who owns the record?".   And, that is particularly true in medical notes (from any healthcare professional, not just physicians).   Because, the assessment done by the healthcare professional includes both their own observations and assessment as well as what is reported by the patient -- and often those two conflict. 

    In my own experience, that conflict most often occurs with pain assessment:  I ask a patient who is obviously calm, relaxed and comfortable "Rate your pain from 1 to 10 where 10 is the worst pain imaginable" and the patient says:  "It's a 10!"  and insists I record it that way.   My documentation will show both what the patient said as well as what I observed -- but I would not want the patient to see that record.

    Another area where sharing medical records is a problem is when a medical error is made:  the healthcare professional is instructed to not document the error in the patient record because that may be presented in court.  Instead, they are instructed to complete a separate "incident report" which nobody but the facility has access to...
    patchythepirate
  • Reply 17 of 17
    GeorgeBMacGeorgeBMac Posts: 4,949member
    rob53 said:
    This is what improving people's lives means. Not "bezel free designs" or curv d screens. Same with accessibility. 

    In other words: Apple is light years ahead of any competition due to their DNA, and usually amange to package such value-add in best in class user experience. 

    Tbis, exactly this is what sets them apart. And why I like them. 
    True,  but they face a mountain of obstacles, among them:
     Our healthcare system has implemented HIPAA to mean:  "We get to keep your records and share with anyone we desire -- except YOU.   You are only allowed to see the most superficial of the records and then only in fragmented form that is difficult to integrate or use in any meaningful way.  Because, don't forget who's in charge here!  (Hint -- it ain't you!).

    Our "healthcare system" is really just a "Disease Care system" driven by insurance reimbursement.   So most of the records it keeps have little to do with your health and everything to do with getting reimbursed by insurance -- including fake diagnosis codes for problems that are minor, irrelevant, obsolete, or may not even exist.

    In short, Apple is diving into a muddy, stinky swamp of greed.
    But, if Apple is able to turn health records over from healthcare system centric to user centric where the user owns and controls their own data, they could revolutionize the system.   But, there will be mountains of self-interest and greed trying to block that effort.
    I think you needed to read what the rules state before making some of your comments. Check out https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

    "A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s protected heath information may be used or disclosed by covered entities. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing."

    This states that the covered entities you're talking about, the healthcare system, is not allowed to willy nilly pass around your information unless you give them that authorization in writing (or, probably, check a box on their website). I did a quick read through this website and didn't see anything about those same entities restricting access to your information. I get digital x-rays and CT scans from radiology departments without any problem.

    As for your last paragraph, I couldn't agree more. Just so you know, HIPAA has been a law since 1996 so it's not new, it's just not well implemented by the medical cartel or insurance companies, which we really could do without if we wanted to save some money. Talk about overhead.....
    I am well aware of the theory you are describing.
    I am also well aware of the reality of how that theory is implemented in practice.
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