Geisinger's Dr. Alistair Erskine shares 5 elements of Apple's Health records app

In late January, Apple said its latest iPhone iOS update would integrate patient health records into its Health app as part of a beta run, shaking up the EHR industry and taking a giant leap toward interoperability.

The company partnered with prominent EHR vendors —  including Epic, Cerner and athenahealth —  to integrate patient data into the iPhone's Health app in a way that would abide by Fast Healthcare Interoperability Resources guidelines, the standards for transferring electronic medical data.

A dozen hospitals are taking part in a pilot of the program, including Baltimore-based Johns Hopkins Medicine, Danville, Pa.-based Geisinger, Los Angeles-based Cedars-Sinai and Philadelphia-based Penn Medicine.

The feature will be available to their patients with an iPhone and a patient portal. Since Apple aims to embed patient data from multiple providers into the iPhone's main system, the app could enable patients to grant permission for other app developers to use their data and provide the best deals on medications or connect patients taking the same medications, among other features.

Alistair Erskine, MD, chief clinical informatics officer at Geisinger — one of the 12 hospitals pioneering Apple's health records — has been working with Apple on this roll out.

"We've had a relationship with Apple for a long time. I think that one of the reasons is that Geisinger is obsessed with improving our patient experience," Dr. Erskine says, adding it makes sense to partner with organizations that have demonstrated the value they bring to the consumer experience.

"[Geisinger] likes to partner with non-typical organizations that are outside of healthcare to learn from them what is the better way to … understand the whole patient and to be able to meet their expectations," he says. "I think it was a natural fit with Apple. And, in terms of Apple's health record component of their Health app, we saw it as an opportunity to take advantage of some of the industry advances that have been made over the recent few years."

He shared the project's five dimensions with Becker's Hospital Review. Here is what he had to say.

1. Interoperability. "For many years — actually decades — we've been changing the name of what we call interoperability and hoping that it is actually going to make a difference," Dr. Erskine says. However, interoperability remains a key hurdle in the healthcare industry. The problem boils down to a "battle of the data models" where each EHR vendor abides by its own data model and language resulting in a "Tower of Babel" effect during the transfer of health records. To get a record from one vendor into another vendor's system, a lot of translation functions are needed, but Apple streamlines these, he explains.

"Why this is different with the Apple Health app is the dramatic simplification," he says. Apple curates information including medication lists or procedures patients have had. Then, FHIR and the Apple data model are aligned across multiple EHR vendors, rather than Apple having to chase after each hospital. Since the process becomes unified, each translation function has already occurred by the time the data is collected.

2. Security. The Apple Health app enhances security of users' medical data by using the same login credentials users established for their pre-existing, hospital-specific patient portals. This helps each participating hospital ensure the right patient is accessing the right records, and it helps Apple confirm the right user with the right permissions connects with it.

"From a security standpoint, by having the patient being the one doing that transaction, as opposed to somebody incident to the patient like a health system or health information exchange that signed a lot of business associate agreements or data use agreements defined in many contracts …  [patients] unalienably have that right to make that transaction without anybody else having to ask or write contracts for them," Dr. Erskine says.

3. Record locator services. In the current medical records system, physicians verify each patient's identity and link them to each of their records. With Apple, the patient becomes the owner and manager of their health data.

"The patient serves as the owner, individual record locator service, and their own individual master patient index, since they know where their own data sits and they've used their existent portals to access and identify themselves," Dr. Erskine explains. "This is a much more granular access of one patient at a time, one record at a time, making those connections, as opposed to having to do that broadly across every patient with a series of different processes."

4. Patient reported data. With the suite of apps available on the Apple app store, rather than the limited number of patient-facing apps for Epic, Cerner or athenahealth, other apps on a patient's iPhone can connect with and feed data into the Health app. This makes it easier for patients to marry their patient-entered information, such as signs and symptoms and how they progress along an illness, with their electronic patient record.

"The iPhone is endowed with a whole series of different additional features, like I can tell how many steps I am taking, I can tell what my heart rate is if I am wearing an Apple watch, I can put reminders in to take medications at certain times and I can keep track of when a medication wasn't taken [as well as] a series of additional value that [makes up] the last mile in [whole] patient [care,] in terms of indirect interactions with them and getting information and engaging with them," he says.

5. Patient empowerment. Because patients select at a granular level which EHR to pull information from and which apps have permission to contribute data to the Apple Health app, Dr. Erskine believes the patient is more empowered. "It is what the industry has been looking for, which is basically a patient-controlled exchange of their own data, but it is done in such a way that the experience of using it is delightful and that the patient ends up being in control of how it happens," Dr. Erskine says.

What's next for the Apple Health app?

Dr. Erskine highlighted a key flaw in the early version of the Apple Health records feature: it doesn't yet push information back into the EHR in a reliable way. For example, if a user enters a note indicating they think they may have diabetes, it may be useful to mark who —  patient or physician —  entered that problem since right now, there is a disconnect. This communication-documentation issue is something Apple will likely have to solve, he explains.

As for the next steps in Apple's venture into the EHR space, Dr. Erskine speculates it may eventually make sense for insurance companies, device makers or even the pharmaceutical industry to get on board. He argues this integration could be useful in determining whether certain medications are having the anticipated impacts on each specific person.

"We are not competing for patients in this debate. We are really competing against illness —  be it diabetes, hypertension, stroke or whatever," he says. "Trying to figure out the population as a whole, as opposed to just the patient and members within a health system, is an important component to getting this right."

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