University Health is one of the first health systems in the nation to take advantage of a new update to Apple’s Health app that makes it easier for physicians to access the health data collected by their patients’ personal devices and wearables. Dr. David Voran is currently leading an effort across University Health to encourage the adoption of these tools and explore how physicians can take advantage of the data to improve treatment outcomes.
Apple’s Health app, first released in 2014, functions primarily to aggregate all of the health and wellness data collected by user’s apps and devices. This could include everything from the user’s heart rate to the number of steps they take each day and the quality of their sleep. In 2018, Apple added the ability for patients to use the app to download their electronic health records from participating healthcare providers. This improved users’ access to their own health data, but didn’t allow health provider to take advantage of all of the information being collected on the patients’ end. In July of 2021, University Health received an invitation from Apple to test out the newest feature of the app, which would allow users to grant their doctors access to the data being collected by their Apple devices. After a few months of troubleshooting University Health established a way for users to be able to share their Apple Health data with their physicians on an ongoing basis.
For the patient, setting this up is as simple as opening the app, clicking on the sharing tab, and then searching for their healthcare provider. After logging in through their patient portal, the patients have the option to toggle which classes of information they want to share with their doctors. Once the user finishes the setup process, physicians are able to pull up a dashboard of health and wellness data sourced from the patient’s Health app. Physicians are also able to see lab results from any location that the patient has a portal connection, turning the dashboard into a one-stop shop for health information about the patient.
One way this data is already having an impact on treatment is the case of patients who experience atrial fibrillation (Afib). Using Apple Watch’s ECG capabilities, patients are able to take an ECG whenever they are concerned they may be experiencing Afib. With Apple’s new data sharing capabilities, not only are these ECG results available to those users’ physicians, but also the heart rate data that their device was collecting both before and after the patient realized something was wrong. Ordinarily, getting this granularity of information would require a physician to order an expensive and complicated remote monitoring solution for the patient, but with Apple Health this can happen in 5 minutes while sitting in the exam room.
Dr. Voran also related the story of how Health app data helped to resolve the case of one patient who came into the hospital complaining of headaches with no clear cause. Once the patient shared health data from their iPhone, Dr. Voran noticed that the Health app had logged notifications of two falls that had occurred 1-2 weeks before the headaches started. The patient said that he had forgotten all about it, but that he indeed had fallen while shoveling snow during that period. Thanks to this data, the patient was able to quickly be diagnosed with post-concussion syndrome, and begin receiving the correct treatment.
University Health’s experience so far with the app has shown that its primary benefit is helping physicians shift from data entry to information retrieval. Having access to user-reported data lets doctors be more efficient when they’re in the exam room with their patient, and the data reported by the app often proves a more reliable source of information than the patient’s memory. Some information from the dashboard can also be copied into a patient’s chart, further reducing the amount of manual data entry physicians have to engage in.
One of several reasons that this represents a great advance is that as suppliers of electronic health records have begun to put protocols like FHIR in place for the exchange of the data, they have faced the challenge of ensuring this data can be stored and presented without compromising the official medical record. Currently, established practice is to include only clinically-validated data in the medical record. That is, only data entered by a relevant clinician or delivered via a device that is maintained and controlled by the health organization (or its direct contractors). Patient-reported data is excluded due to reliability concerns. However, the supplier to University Health has solved this need to keep patient-supplied data separate from clinically-validated data by giving it a separate tab within the chart browser. Without this feature, a separate system would have to be put in place to collect patient data, and the care provider and the patient each would have to interact with that system. Now, the provider can just select the tab and view patient-reported data, including the kind of data reported from the Apple Health app.
While over 1,500 health systems across the country are set up to allow users to download electronic health records to their Apple Health app, only around 50 are set up to allow patients to share their data with doctors. University Health is one of the early leaders in this area, but many doctors and patients remain unaware that these tools are available to them. Apple has not been aggressive in advertising these new features, so raising awareness will primarily require engaging with individual physicians to encourage them to bring their patients into the system.
Currently, because this sharing is only available through Apple’s ecosystem, patients who are a part of the Android ecosystem, or who lack any type of smartphone at all, have no way of taking part in this system. However, University Health has found that a greater share of its patients have Apple smart devices than it had initially expected. According to surveys conducted by medical students at University Health, 95% of patients have a smartphone of some type, with the remaining share primarily being made up of disabled individuals or the very elderly. Of those with smartphones, almost two thirds had an Apple device. There is currently no estimate for when an Android equivalent will be established, but in the meantime it appears as if a significant portion of the health system’s patients could potentially benefit from these new data sharing opportunities.
Another possible barrier for greater use of these tools are the liability issues they raise. If patients begin sharing their health data without physicians realizing it, or without them understanding how to access and use it, then health systems may become liable if that data would have pointed towards medical issues that the doctors didn’t otherwise catch, or treatments that doctors didn’t otherwise recommend. These legal issues may have to be clarified before many health systems become comfortable with the idea of signing up to be a part of the app’s data sharing ecosystem.
Because this kind of data sharing is so new, there are no studies so far looking at the health outcomes for patients who take advantage of these tools. However, University Health is currently working on a grant proposal that would fund research looking into this question, and hopes to be able to begin working to better quantify its benefits by next year.
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Dr. David Voran, Associate Professor of Clinical Informatics at UMKC and a physician with University Health’s Department of Community and Family Medicine, presented to KC Digital Drive’s Health Innovation Team on June 29, 2022. A recording of his presentation, along with the PowerPoint slides used, can be accessed here.