UC San Diego Health Publishes Early Research on Apple Health Records Feature

Jan. 16, 2019
The first research on Apple’s Health Records initiative has been released and the research findings indicate that patients are generally satisfied with the app’s ease-of-use and feel that it improves their understanding of their health.

The first research on Apple’s Health Records initiative has been released and the research findings indicate that patients are generally satisfied with the app’s ease-of-use and feel that it improves their understanding of their health and has facilitated conversations with clinicians.

The University of California San Diego Health was an early adopter of the Apple Health Records feature, as one of the first 12 health systems to test the app, and researchers set out to gauge the initial reactions of patients to the new platform. The research, led by Christian Dameff, M.D., department of emergency medicine; Brian Clay, M.D., department of medicine, and Christopher Longhurst, M.D., department of pediatrics as well as CIO and associate CMO at UCSD Health, was recently published in the Journal of the American Medical Association.

In January 2018, Apple announced that it would be testing the Health Records feature out with 12 hospitals, inclusive of some of the most prominent healthcare institutions in the U.S. Then 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. As of a January 10, 2019 update from Apple, about 160 provider institutions are on board with the project.

To gauge patients’ responses, UCSD Health researchers sent a brief, three-question, anonymous online survey to 425 patients who activated the personal health record feature in 2018. Of the 132 patients who responded, 96 percent indicated that they could easily connect their mobile devices to the platform and 78 percent said they were satisfied with using the feature. What’s more, 90 percent of survey respondents said the smartphone solution improved their understanding of their own health, facilitated conversations with their clinicians, or improved sharing of personal health information with friends and family. However, less than half (48 percent) reported improvement with all three of these outcomes, according to the research.

As of fall 2018, UC San Diego Health has hundreds of personal health record users who have downloaded thousands of clinical results and other pieces of medical information though the platform.

“As with many other new products and solutions, such enthusiasm is common from early adopters,” the researchers note. “The platform will need to prove that it is useful, sustainable, scalable, and actually improves health outcomes.”

The key questions are whether this personal health record will improve patient outcomes and lower costs while also increasing quality, the researchers wrote. “Three key developments may contribute to success: the ubiquity of mobile technology, the maturation of health data communications standards, and the widespread use of mobile software distribution platforms,” Drs. Dameff, Clay and Longhurst wrote.

The researchers note that interoperable personal health records are not a novel concept; unsuccessful attempts to collect digital patient records have been pursued by several major technology companies.

When Microsoft introduced HealthVault (2007) and Google launched Google Health (2008) personal health records, the first iPhone and Android devices had just been released, according to the UCSD Health researchers. “The newly launched Android Market and iOS App Store offered just hundreds of apps to download compared with the millions of apps available today. Thousands of apps on these devices are related to health or fitness. Since that time, smartphones have become the de facto standard for communication for consumers,” the researchers wrote.

The researchers also point out that if device manufacturers incorporate these features into the core smartphone operating system, this would lead to wide dissemination of these applications with a simple software update, and could possibly seamlessly push features to millions of patients.

“Although it remains too soon to draw firm conclusions, the continued development of patient-facing health care technologies by well-established technology companies suggests that the digital health care landscape may now be sufficiently mature to foster the broad adoption of personal health records. Whether these technological advances ultimately improve patient outcomes, lower costs, and improve quality remain the most important unanswered questions,” the UCSD Health researchers wrote.

The UCSD research is the first to gauge patients’ responses to the Apple Health Records feature, however, back in May, Orem, Utah-based KLAS Research published a report that gathered feedback from executives at all 12 of the early adopter health systems that partnered with Apple through the beta process. The report sought to validate the significance of Apple’s move. KLAS researchers spoke with healthcare executives at participating health systems to gauge their experience.

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.”

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, back in March, 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,” according to the KLAS report.

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.”