Soon, Apple recently, it will enable doctors to monitor health data from their patients鈥� phones and watches between visits, part of the push into health care that Tim Cook, Apple鈥檚 CEO, has will constitute the company鈥檚 greatest contribution to mankind.
Since 2014, health systems around the country have partnered with Apple to tap into the mountains of data the company鈥檚 devices generate from patients. But most are still experimenting with these tools. While some doctors appreciate seeing records of home-monitored blood pressure, exercise and the like between visits, for others the data is more of a burden than an asset.
Over 100 types of data are available in Apple鈥檚 health app through iPhone, Apple Watch and third-party apps. In June, Apple said patients whose doctors work with one of the participating in the new feature will be able to send them tracked data like , .
Some see great promise in building 鈥減ipes鈥� between a patient鈥檚 phone and the health records viewed by their clinicians. Apple is 鈥渄emocratizing the flow of health data鈥� between doctors and patients, said Anil Sethi, a former Apple health director and current CEO of , a startup that manages health data for cancer patients.
But Apple鈥檚 announcement was shrouded in ambiguity and short on particulars. The company would not provide a complete list of the data patients can share with doctors and declined to comment for this article. Previous Apple moves to get more data into the hands of doctors have been announced with great fanfare, but questions remain as to how many health care providers are using the data and to what effect, and whether success stories are the norm or outliers. To date, rigorous studies showing clear health benefits from monitoring these types of data .
Although Apple has built pipes enabling patients to share growing amounts of data with medical professionals, it鈥檚 unclear how much data flows through them.
In 2014, Apple released HealthKit, a tool enabling health systems to pull in patients鈥� health data, with their permission, from their iPhones. At the time, then-Mayo Clinic CEO John Noseworthy this would 鈥渞evolutionize how the health industry interacts with people.鈥� But a Mayo spokesperson told KHN the system鈥檚 use of HealthKit is now limited.
Cedars-Sinai Medical Center in 2015 that, through HealthKit, more than 87,000 patients had been able to share their data, an arrangement Cook on a quarterly earnings call. A Cedars-Sinai spokesperson declined to comment on what became of this project.
Even Apple鈥檚 attempts to use its own employees鈥� app data to improve their medical care have yet to pan out. The that an Apple initiative testing a new primary care service for doctors to monitor Apple employees鈥� health through their devices had stalled. The company said many of the story鈥檚 assertions were inaccurate.
There have been a few reports of success. Ochsner Health in Louisiana reported that patients in a hypertension management program that provided health coaching while monitoring blood pressure data from mobile phones were more likely than a control group , . The health system now also has remote monitoring programs for diabetes, chronic obstructive pulmonary disease and expectant mothers, an Ochsner spokesperson said.
And Epic, the nation鈥檚 largest health records company, said that over 100 of its large health system clients are using Apple HealthKit to capture data from home monitoring devices like blood pressure cuffs.
But patient-generated data has not been widely adopted in health care, said Dr. Benjamin Rosner, an associate professor of medicine at the University of California-San Francisco. He and others point out major hurdles.
One, Rosner said, is that evidence is that monitoring such data improves health.
Another is that doctors generally aren鈥檛 reimbursed by health insurers for reviewing data that patients collect at home.
鈥淚n America, we generally pay doctors and health systems to see patients in front of them and do things to them when they show up,鈥� said Matthew Holt, a health technology startup adviser.
In instances in which doctors can be reimbursed for remotely monitoring patients, like those with certain chronic conditions, the payment is usually low, Rosner said.
And many doctors already feel inundated with patient health information and electronic health record tasks.
鈥淧rimary care doctors are overwhelmed by their inboxes,鈥� said Dr. Rebekah Gardner, an associate professor of medicine at Brown University. 鈥淏efore people start buying Apple Watches and sending all their sleep hours, let鈥檚 show that this improves health.鈥�
She said she wants to see more rigorous, independently funded studies showing that monitoring data from wearable devices makes people healthier or improves their care.
Liability concerns weigh on some doctors鈥� minds. Dr. Oguchi Nkwocha, a community health center physician-executive in Salinas, California, worries he could be held liable if he missed something in 鈥渁 diary of data,鈥� but said he might be more open to data that was analyzed and presented with predictive insights.
Apple isn鈥檛 the only tech company that has struggled to make health app data-sharing mainstream. Both and enabled patients to share their data in their personal health record products over a decade ago but shut down these businesses because of limited user adoption, Holt noted.
Optimists believe that, eventually, research will show that more forms of data monitoring lead to better health and that technology could help make the data more digestible for doctors. Then, Apple might succeed in making its apps part of medicine 鈥� assuming the payment system changes in a way that gives providers more incentives to identify problems early and intervene before people get critically ill, Holt said.
鈥淭his is exciting for the future of chronic care management,鈥� Dr. David Cho, a UCLA Health cardiologist, said of the new feature. With data at his fingertips on risk factors like exercise, diet and blood pressure, he believes he could help his patients manage chronic conditions more easily. That data, combined with virtual visits, could mean fewer office visits.
Apple鈥檚 announcement that it can integrate patient-generated data into the electronic medical record could be critical for doctors who want to see their patients鈥� self-collected information but don鈥檛 have time to hunt for it, said Dr. Seth Berkowitz, who leads a remote monitoring app pilot program at Beth Israel Deaconess Medical Center in Boston.
Some patients welcome a feature that would make it easy to share data with their doctors. Jen Horonjeff, a New York City-based autoimmune disorder patient and health care startup CEO, recently discovered by using an Apple Watch tracker that her heart rate, which doctors had described as irregular, registered as normal.
鈥淚 would absolutely send this to my physicians,鈥� Horonjeff said, noting that her data would give doctors an accurate baseline of her heart rate if she were hospitalized.
But Gary Wolf of Berkeley, California, co-founder of the Quantified Self, a movement of people who track their health and other personal data, said that finding a doctor trained to make decisions with 鈥渇ine-resolution data鈥� is impossible.
Without more evidence that getting health app data to doctors is clinically beneficial, it will be hard to assess whether Apple is succeeding, said Neil Sehgal, assistant professor of health policy at the University of Maryland.
鈥淩ight now, we don鈥檛 know if there are consequences if you don鈥檛 put your Apple Watch data into your electronic medical record,鈥� he said.
If evidence ultimately shows a benefit to sharing this information with doctors, he said, 鈥渢hat benefit will be concentrated among people who can buy the $1,000 phone and $400 watch.鈥�
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