Sunday, July 2, 2017

An Apple A Day

Part I: The Wonderful World of Healthcare IT

They say an apple a day will keep the doctor away, but this Apple will keep them even closer.

Welcome to Part I of a series covering Apple’s growing Healthcare ambitions.

Apple began cozying up to healthcare with the iOS Health app and Apple Watch. You can sign up to become an organ donor in the Health app, and most people know the Watch can do simple things like track your workout, record your heart rate, as well as the beginning of advanced tasks like remote patient monitoring. However, Apple is not not stopping there. There’s been a large amount of activity surrounding their healthcare efforts as of late, which I’ll highlight. They’re clearly building towards something big.

I have worked as an IT Consultant for a major healthcare organization going on ten years now. Let me walk you through where I think Apple can make the biggest difference.

Recent Activity

Over the past few years, Apple’s Health Team has been poaching a growing number of medical and healthcare professionals from major organizations and universities. Of note:

  • Just last week: Sumbul Desai from Stanford, where she was the Digital Health Executive Director.
  • Dr. Rajiv Kumar from Stanford, who used HealthKit to treat diabetes patients.
  • Dr. Ricky Bloomfield from Duke University, a HealthKit and ResearchKit pioneer.
  • Stephen Friend from Sage Bionetworks, where he was President.

As for other notable activities:

Red Tape and Cyber Security

Implementing new IT-related systems in healthcare is wrapped in three layers of red tape, and that’s if the company is on top of things. It’s widely known that healthcare systems as a whole are slow-moving, beaurocratic organizations, but they have to be. Making changes with reckless abandon can have serious risks to patients and staff.

As far as the tape goes, first you have countless government regulations like HIPAA1, SOX 2, and PCI Compliance3, to name a few. Then, you have the internal compliance, policies, procedures, standards, unions, and administration of the system and/or hospital itself. Last but not least, any healthcare company worth their salt will have a dedicated cyber security team to identify and correct risk.

As it goes, quite a few systems have insanely-low IT standards, most notably cyber security. Smaller systems are constantly plagued by malware, ransomeware, and viruses (not the one I work for, thankfully). It begs a question that is hard to answer, because we don’t have much choice—can we really trust healthcare companies to secure our most critical data?

The healthcare industry as a whole was coerced to adopt major technology when the American Recovery and Reinvestment Act passed in 2009. The act provided incentives for all healthcare systems to adopt an Electronic Medical Records (EMR) system by 2014 in order to maintain their existing Medicaid and Medicare reimbursements. Since then, coupled with a rapid increase of personal technology, there’s been an increase of innovation in healthcare in the forms of TeleHealth, virtual visits, remote monitoring, better websites, and more convenience for patients. Not to mention the ever growing number of healthcare-based tech startups.

The industry has been getting by largely without Apple software tailored for their purposes, but what if that was about to change?

Apple’s Presence in Healthcare

Quite a few healthcare systems already use Apple products. They mostly aren’t iMacs or MacBooks, though. That is to say, Apple is big in this space when it comes to iPhone and iPad. Why? Mobility, familiarity for the staff and patients, and exceptional hardware are big factors, but a lot of it has to do with iOS and its inherit sandboxing of apps. Sure, you can use Android for some use cases, but considering we’ve arrived at the iPhone’s tenth birthday and there has never been a major malware problem on iOS, using anything else would seem folly.

Healthcare trusts Apple because they’ve proved themselves to be exceptional stewards of customer data when it comes to their stance on privacy, which carries over with ease when it comes to Protected Health Information (PHI).4 I wrote this a couple weeks back, which ties in perfectly.

People themselves are becoming more open and accepting to sharing their medical data if the benefits outweigh the perceived risk. Tim Cook frequently says ‘only Apple can do this’, which is sometimes viewed as hyperbole, but this mantra will be so true in this space. Their stock as the ‘privacy and security’ company is going to pay off in this arena one day and it will be natural. Nobody will question giving their data to Apple, because of the strong grounding they’ve laid with respects to consumer data across the board.

That said, there are a lot of inherent problems with the red tape and EMR software used by each system that can extremely limit any hardware. The following quote from this recent Fast Company article says it well:

A major reason that hospitals across the United States have been notoriously slow to adopt mobile and consumer technologies relative to other sectors, like finance and retail, is that many are still tied to on-premises enterprise software. “Health care has been the last bastion for (apps with) design principles, mobility, and a clean, compelling consumer experience to infiltrate,” says Sterling Lanier, CEO of Tonic Health, an app that collects medical data.

This is very well said. You won’t find the latest design, UI, and UX sensibilities in EMR systems and healthcare software. Most still look like Windows 2000 (see below). Even updating these applications is an inherently risky task—you’re dealing with hospitals that are a 24/7 operation. One small mistake could result in an major outage and seriously affect patient care or worse.

Epic EMR

Epic EMR

Allscripts EMR

Allscripts EMR

How Apple Can Help

Here’s where I think Apple can make the biggest impacts, and I will be delving into more details as to how as the series progresses.

  • Cyber Security and Privacy
    • Privacy goes hand-in-hand with Apple and healthcare, while cyber security is Apple’s M.O. and most healthcare systems are lacking.
  • Medical Device Integration & Data Collection
    • In other words, seamless syncing and data collection of PHI from static, as well as worn devices. This ties in to the reported diabetes management they are working on.
  • Remote Patient Monitoring and TeleHealth
    • This is going to be huge, as less and less people will need to physically see a doctor down the line, with the advent of video visits. Apple’s FaceTime is not viewed as HIPAA-compliant for this purpose, but they could easily adapt it for healthcare.
  • Operational Efficiency
    • Using Apple products and their ecosystem to improve the efficiency of healthcare systems.
  • Patient Experience
    • This is where the ‘wow’ factor comes into play for patients. For example, imagine walking into your doctor’s office and already being checked in. Your iPhone or Watch notifies you of such, and also asks you to pay your co-pay via Apple Pay. No receptionists or lines to wait in. Just come in and have a seat.

Why Apple?

Apple has the mindset, growing talent, and means to address a lot of these above areas and more. Not to mention they care as an organization. They care about the planet, equal rights, and the overall well-being of the country.

Now, they are going to specifically and purposefully care about our health.

Is this a purely financial move? I don’t think think so. Sure, Apple will sell more devices as a result, but hardware and software is their product—not your data. Isn’t that better than another popular company whose product is you and your data? Again, trust is a major factor.

Is Apple going to write their own EMR system? It would be a daunting task, but I know the end result would be more intuitive and functional than the ones pictured above.

Conclusion (and the elephant in the room)

Healthcare in the United States is at a precipice, politically. It is unbelievable to see what goes on daily in Washington now. It’s unfathomable that 20 million plus people could soon lose their insurance just to line the pockets of Congress and big businesses even more. Look, Gaddgict isn’t a political site, and I will only touch on these things when necessary. That said, when you pull the crap Trump and the GOP does, don’t be surprised when politics seeps into everything. It’s incredibly saddening that the best country in the world does not have universal healthcare.

I, however, am an optimist. The good in America will prevail in the end. We will one day celebrate our exceptional health care and the amazing technology that saves lives as a result.

Thanks for reading! Keep an eye out for Part II coming soon.

  1. Health Insurance Portability and Accountability Act. A Federal law introduced in 1996 that restricts access to private medical information. 
  2. Sarbanes-Oxley Compliance. A Federal law introduced in 2002. It directs public companies to establish Internal controls and procedures for financial reporting to the reduce the possibility for corporate fraud. 
  3. Payment Card Industry compliance. A set of security standards designed to ensure that ALL companies that accept, process, store or transmit credit card information maintain a secure environment. 
  4. PHI: Any kind of information about health status or care that can be associated to an individual.