In January, Apple announced the launch of Apple Health Records, a new iPhone feature for downloading, aggregating, and viewing patient medical records. At that time, 12 major health systems signed up to be digital health partners as beta testers of the health records feature. In March, Apple tripled the number of health systems participating, from 12 to 39, and announced that the new capability was available to all iPhone users with the latest iOS 11.3 update.
A new report from Orem, Utah-based KLAS Research gather feedback from executives at all 12 of the early adopter health systems that partnered with Apple through the beta process to validate the significance of Apple’s move. KLAS researchers spoke with healthcare executives at participating health systems to gauge their experience, so far, and executives were asked: How soon might it make a difference? What is the experience like so far and what hurdles do providers face? What challenges does Apple face and how likely are they to succeed where others have flopped?
Fifty percent of respondents were CIOS, 17 percent were CMOs or chief medical information officers (CMIOS) and 33 percent were other executives or directors.
KLAS researchers note in the report that Apple’s revelation created a stir for at least a few reasons: Apple is a consumer-oriented healthcare outsider; Apple is attempting to make inroads where peers Google and Microsoft have failed; and the feature has the potential to impact millions of patients given the iPhone’s broad customer base.
According to the report, early participants say that Apple’s move is not just a marketing ploy and that it has both short-term benefits and long-term potential to impact how provider organizations interact with patients and how patients manage their health.
Close to 60 percent of respondents say they expect Apple’s “ready-to-go” patient-record portability to have an immediate positive impact, within zero to six months. Another 33 percent expect to see benefits from the Apple health records feature within six to 12 months. According to the report, one CIO said, “Honestly, there are no hurdles for us. The work effort to turn the app on is measured in days. There is no IT team that needs to do anything fancy or complicated. The wonder of this app is that the lift is tiny and the benefit is huge.”
These executives feel that allowing patients to access personal medical records on their smartphones is a revolutionary idea, one that disrupts current paradigms by setting off a series of small changes that may have major impact downstream. Three of the most mentioned benefits include empowering patients (67 percent), helping solve interoperability (58 percent) and speeding innovation and change (50 percent). When asked how impactful they think the effort will be for healthcare, on a scale of one to nine (most impactful), 33 percent rated the effort a ‘9,’ 11 percent an ‘8’, 33 percent a ‘7’ and 22 percent a ‘6’.
“Immediately, Health Records is expected to help solve the intractable challenge of interoperability by allowing iPhone users to store their health records on a device that is already omnipresent in their lives. This convenience is expected to increase patient satisfaction and also engender in patients an expanding sense of self-ownership and self-involvement in their own care,” the report states. “In the long term, making health records available on the iPhone promises to speed innovation by breaking down the door between healthcare and consumer fields.”
Respondents say that non-healthcare vendors understand patients in a different way and that out-of-the-box research and development from these vendors may result in efforts that motivate and direct patients better than the methods that have historically been available.
According to the report, early participants believe the time is right for Apple to leap over healthcare hurdles—EMR (electronic health record) 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, the report states. “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,” the report states.
The report also found that optimistic participants choose a strategic back seat, with most participants viewing the health records feature as an add-on for patient convenience that does little to alter their patient engagement strategy. Most organizations’ formal plans for the health records solution are limited to its most immediate benefit—allowing patients to download their patient record. In fact, 75 percent of respondents cited giving patients access to their data as their plan for Apple Health Records. Half of respondents said they will use it as an additional option for their current patient engagement strategy and 33 percent said they will integrate data into patient care. A quarter of respondents said they will let Apple drive adoption.
Can Apple Scale?
KLAS researchers also looked at next steps and participants indicated that Health Records’ impact will depend on Apple’s ability to scale education, adoption, and data complexity. The KLAS report notes that there are over 2,000 hospital-based health systems in the U.S., and, 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). According to KLAS data, of all the acute care hospitals in the U.S., only 5 percent are among the health systems that are participating. What’s more, 48 percent of hospitals of non-participating health systems use Apple partner EMRs (athenahealth, Cerner and Epic) and 47 percent of hospitals are currently using other EMRs (Allscripts, CPSI, Meditech).
“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,” the report states.
According to the report, one CIO said, “That is a huge leap from where we were three years ago, and an even bigger leap from ten years ago. I think upcoming versions will take the data that is now on the phone and, with the patient’s consent, import that into a designated EMR to close the loop.”
The KLAS report notes that, eventually, if this general capability is going to benefit all patients in the U.S., it will need to expand beyond Apple to other smartphone vendors. One CIO stated, “If an Android version becomes available that will be a home run for a lot of people.”
Looking ahead, healthcare executives said the biggest obstacles would be to educate both patients and clinicians about what Apple’s PHR means to them. Participants face a similar issue as they attempt to find a place for Apple inside their existing patient portal strategy by differentiating the capabilities and use cases for each tool. One CMIO said that it is going to take some time for his staff to understand what Apple’s tool means.
Time will tell if Apple can scale in signing up more provider organizations and EMR vendors and then deliver bidirectional data exchange and expand Apple’s current data model beyond basic C-CDA elements. The KLAS report concludes that, regardless of the timeline or eventual strategy, Apple has changed the discussion, if not the landscape, of patient and consumer engagement in healthcare.
