Garry James, 60, is perched on the edge of his hospital bed, temporarily unhooked from monitors that track his vital signs. It’s his third week waiting for a heart transplant, a nerve-wracking process that can stretch out months or even years, but he greets me with a wide smile.
“I’m an Android guy,” says James, while clutching the iPad that Cedars-Sinai Medical Center in Los Angeles gave him when he was admitted into the hospital. Unlike some of the more senior patients on the ward, he got up to speed with the technology in no time. “My son, who is 10, knew exactly what to do,” James says. These days, James uses the iPad to message his nurses, order magazines, make notes, browse medication side effects, reserve lodging for his family when they visit from Las Vegas, and review his medical record.
The device has helped him feel more in control of his own care. “I want to have an intelligent conversation with my doctor,” James says. “Just enough to be guided on the right path.”
An iPad might not seem revolutionary in the internet age, but it’s actually a big step forward for patients to have digital health information at their fingertips. Many doctors, like Cedars-Sinai’s Shaun Miller, remember a time even five years ago, when many processes were still paper-based and medical information sat in silos. It took a $35 billion investment from the federal government back in 2009 with the HITECH Act to kick-start the process to digitize health data. Even today, many patients still receive their health data on a USB stick or CD-ROM, making the shift to mobile at some hospitals truly cutting-edge.
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. It has also been a challenge to get doctors and other health professionals on the same page. As the associate chief medical officer, it’s Miller’s job to help convince doctors to change their processes. It’s only recently that the majority of fellow physicians have fully adapted to the shift away from clipboards, fax machines, and pagers. “A lot of it has been resistance to change,” Miller tells me. Changing the way their work is done “can feel scary” to some medical professionals, Miller says.
Meanwhile, patients seem to have adapted quickly to the changes, as many already use mobile devices in their daily lives. James pulls up a page with all of his prescriptions, and clicks on each to review possible side effects. If he has any concerns, he can send a direct message to a specific person on his specific care team and get a response in minutes, rather than pressing a button for any on-call nurse to show up. “I’ve never seen anything like this,” he says.
AN ALLURING MARKET
For Apple, the $3 trillion health care sector offers a lot of potential for growth for its iPad. The company is likely to restate its commitment to the tablet device as early as next week, with the rumored announcement of the 9.7-Inch “iPad Pro 2.” From an enterprise sales perspective–a priority for the iPhone maker in the wake of recent partnerships with Cisco and IBM–large hospitals and health systems that shift to iOS tend to buy devices in bulk. “We now have hundreds of iPads for patients to use,” says Miller, who uses a compliant iPhone app called Voalte to text with other providers. “As we expand to more wards, it’ll be thousands.”
iPhones and iPads have been used by some hospitals for more than five years, but it’s only recently that the company went public about its interest in health care. “Leading hospitals and health systems are using Apple products to transform all aspects of health care inside the hospital and beyond,” says an Apple spokesperson, emphasizing the “privacy and security of iOS” as a key factor for its growing popularity among hospitals for remote patient monitoring and in-patient care.
For Apple, health care is one of the largest sectors it is tackling as part of its enterprise efforts. It isn’t alone. Rival phone makers Samsung and Alphabet also see huge potential to bring mobile technologies to patients and clinicians. “There’s still some transitions that have to take place in the industry,” explains Ben Bajarin, a technology analyst with Creative Strategies, who has been tracking Apple’s move into health care. Some of these challenges include the lack of reimbursement from insurance companies for new technologies that are shown to improve patient outcomes and cultural resistance among some doctors.
“NO PASSING FAD”
Apple’s interest in health care was also initially surprising to many outside observers, given the complexities and regulatory constraints that many tech companies shy away from. “Health is a sensitive area, and it’s not consumer-oriented,” says Bajarin, who suggests that it wasn’t an obvious target for Apple. “You don’t just have to pass the Federal Communications Commission,” he says. “You have to go through a lot of regulatory protocols,” including the FDA. But Bajarin says the move was a long time coming: The late Apple CEO Steve Jobs realized how “broken and bad” many health care processes were, such as the poor user experience, after he got sick with cancer.
After consulting with dozens of experts and building a team, Apple opted to “look at themselves as a platform,” Bajarin adds. Rather than making its own apps for hospitals, the company is working with top developers who are already building apps for health–as it does in other industries–by taking feedback from experts, like developers and hospital executives, and connecting them to its developer relations team to answer ongoing questions from top app makers.
In response to conversations with industry experts, Apple introduced a slew of software services–CareKit, ResearchKit, and HealthKit–that are all designed to make it easier for mobile developers and consumers to pull together disparate health information such as steps, sleep, and heart rate in one place. HealthKit, which was introduced first, is designed to make it easier for developers to gather health data–with the user’s consent. ResearchKit, already in use by developers at major academic hospitals and universities like Mount Sinai, Stanford Children’s Hospital, and Harvard University, helps researchers recruit participants for their studies on mobile. CareKit is geared at helping patients with chronic conditions share data with their care team.
Through these efforts, the company has now made strides in three foundational areas: hospital care, at-home care, and medical research. That’s a markedly different approach than a rival like Alphabet, which previously tried and failed to launch a personal health record system for patients called Google Health. Part of the reason that the product floundered was that Google, unlike Apple, did not at that time strike as many partnerships with traditional health companies. Meanwhile, Apple is working with many of the largest electronic medical record companies, including Epic Systems, and mobile app developers. At the time, Google admitted that it failed to reach sick patients in hospitals, with most of its user base confined to fitness enthusiasts and digitally savvy millennials.
Despite the complexities, those who work with Apple’s various health teams say the company is in it for the long haul. “These folks are taking it seriously,” says Sterling Lanier of Tonic Health. In true Apple style, he stresses, “this is no passing fad.”
Developers like Lanier and Patient Safe Solutions’ Si Luo made an early bet that iOS would take off in health care. For them, Apple’s public announcement about its first steps in health care with HealthKit couldn’t have come quickly enough. “We had been trying to sell iOS into hospitals for seven years, only to see tremendous uptick in recent months,” says Luo. One of the earliest customers to come on board was Pueblo, Colorado-based Parkview Medical Center, which uses the Patient Safe Solutions app to help nurses manage patients’ medications at their bedside. To help minimize errors, nurses can scan a patient’s wristband to pull up a system on an iPhone that determines if the staff is administering the right medication at the right dose at the right time. The hospital also uses the app to ensure patients get the right blood for their type, as well as for voice and texting communications between nurses, doctors, and the pharmacy.
Luo recalls being invited to a meeting last winter with folks from Apple’s growing health unit, alongside several chief information officers at hospitals and fellow iOS health developers. At that meeting, he says, the group discussed how various apps like Tonic Health and Patient Safe Solutions could integrate together, as well as three major issues with iOS that were causing some concern among the largest hospitals. According to Lanier and Luo, who both attended, those issues were: order fulfillment in device life-cycle management (meaning reassuring these enterprise customers they wouldn’t need to order new devices in less than three years), security, and wireless connectivity.
Since this conversation 18 months ago, Luo says sales have jumped from 30 hospitals using the technology to 85 hospitals. He attributes the success to Apple making available an enterprise solutions architect by phone to reassure IT buyers about security and privacy, and a growing awareness of existing features like encryption of health data. “Apple now feels like the safest choice,” he says (security analysts tend to agree with this assessment, but note that Android might well make strides in the coming years).
Parkview Medical CIO Steve Shirley recalls another meeting with Apple, Cisco, and Patient Safe Solutions, with discussions ongoing for about a week. One of the big challenges involved ensuring that the hospital’s internal wireless network could support the iOS devices, and that the data would be secure with health care hacks on the rise. In the past few years, both Cisco and Apple have enhanced security, made feature updates so that the most critical apps are prioritized on the wireless network, and bolstered marketing efforts to reach IT buyers. “Ever since then, we have been rock solid in terms of our wireless communications,” says Shirley.
PUTTING PATIENTS AT THE CENTER OF THEIR CARE
Cedars-Sinai has also come a long way with its use of HealthKit and other iOS offerings. As of this week, patients can log in to their medical chart, click a download button, access a copy of their medical record, and port it to their Apple health app on a smartphone. That way, they can show it to any doctor they opt to see, even if they leave Cedars-Sinai. This application might seem simple enough, but in health care it’s “cutting-edge,” says Darren Dworkin, chief information officer at Cedars-Sinai, since until recently patients were burdened with the task of requesting and physically transporting their data on a USB Drive or CD-Rom if they wanted to share data between health providers at different institutions. That’s in large part because electronic medical systems historically were developed for billing, not data transfer.
Another digitally savvy hospital is Ochsner Medical Center in New Orleans, which boasts an “O Bar” store modeled after Apple retail stores. This retail store carries products recommended by doctors including iPads, activity monitors, wireless scales, and blood pressure monitors, which patients can buy. “Genius Bar” staff are also available to demonstrate how to use these devices to those who aren’t tech savvy. The goal is to give patients the tools to incorporate data that patients generate outside of the hospital, like their steps and sleep, into their electronic medical record. That gives their doctor insight into how they’re faring once they return home.
Ochsner’s chief transformation officer, Richard Milani, says the hospital also pushed Epic, its electronic medical record system, to notify its doctors via an Apple Watch when a patient’s test results were available. Previously, doctors would often need to wait until they had time to check in to a computer–and “that could be many hours,” Milani explains. That delay could prove life-threatening in urgent cases.
For Milani and other hospital IT executives, the downside to iOS is that not all patients are comfortable using Apple devices or have access to them. Another challenge is that iOS is a closed system and doesn’t integrate with other mobile devices–although HealthKit and other software services were developed with an open-source framework.
But Milani says he has the best relationship with the company over its competitors, as it has incorporated feedback from his hospital executives to develop tools like ResearchKit that are used by dozens of developers, and it struck deals with medical software vendors like Epic. Meanwhile, Samsung’s rival health offerings have relatively stayed under-the-radar in recent years, since the buzz around the initial announcement in 2014. Milani’s appraisal might come as a surprise, given Apple’s notoriously buttoned-up culture. In recent years, “Apple has been good at asking opinions of leaders, and we have been not shy in expressing them,” he says.