Insightful Perspectives



    CitiusTech Mobile Health Team on Nov 20, 2014

    Written by Vinil Menon for mHealthNews (Source)

    Vinil Menon is the Chief Technology Officer at CitiusTech.
    Along with the recent iOS 8 release, Apple has introduced a new health app that allows the user to monitor and track personal health metrics such as sleep, movement and caffeine intake. The new app (and the underlying HealthKit framework) is likely to find significant uptake considering Apple’s enormous user base for iOS devices, and it's a promising attempt to bring robust mobile capabilities to the consumer health space.
    Other than sheer volume, the kind of impact this app will have on the mobile health ecosystem depends on whether it can address key challenges in the market as well as the needs of both enterprise healthcare customers and end users.
    Engagement challenges faced by the mobile health market
    The mobile health market has certainly taken off in the last few years, especially in areas such as wellness management, fitness monitoring and nutrition tracking. However, a lot of these apps fail to find traction with users. The ones that are installed face a constant uphill battle to keep users engaged while also growing their user base. The rapid growth in the mobile health ecosystem has also lead to a proliferation of apps with very similar functionality, but with non-standard user interface (UI), identical data sets captured under different guises and lack of a concerted effort to help consumers engage with their providers.
    At the other end of the spectrum, we also have a large number of unengaged providers, PCPs and other healthcare professionals. While many use apps for a variety of functional needs, there hasn’t been a lot of success in bringing patients into the apps they use. Reasons for disengagement may range from data sanity, trustworthiness or concerns around patient privacy.
    Will Apple’s Health app address these challenges?
    Based on our early assessment, the Apple Health app has the potential to go further than its predecessors. The app and the underlying framework are designed to aggregate data from various third party devices (blood pressure monitor, pulse meter, vital sign tracking devices, etc.) and other apps. The company is also partnering with healthcare vendors like Epic to share EHR data through the tool. However, how the app will integrate data from Epic implementations is still unclear. Apple should be committed to providing a product that provides secure, controlled, uniform movement of data from other devices and programs, while minimizing any privacy and security concerns.
    What will hold the Health app back?
    Based on early beta releases, we expect to see quite a few chinks in the armor when the Health app is launched. Some notable areas that need to be addressed are:
    • Inconsistent/non-standard data types - It seems as if the data model for the HealthKit framework has been approached from a discrete data-capture application's perspective, and as a result some of the data types are present without the healthcare context. HealthKit also lacks the ability to support industry standard data dictionaries like HL7, RIM or CEDD. It doesn’t allow for complex data types like blobs (for DICOM data) or the CDA, or have the ability to add new public data types that can be shared with other apps.
    • No integration history - With the potential number of devices getting the iOS 8 update and health app running into millions, how to gather data from of all these devices in a standards compliant manner and onto servers where they can be further analyzed, is still unclear.
    • Single user per device - User identity is mapped to a particular device. This means a parent would not be able to check a child’s health metrics on his or her personal iOS device.
    • No audit log functionality - Without an audit log, there are likely to be multiple issues in terms of data trustworthiness. If a provider is looking at data from a patient's phone, the lack of an audit log means that there is no way the provider can distinguish between manually entered data and device captured data.
    • No guidance on UX - Apple has always been synonymous with world-class User Experience (UX). With the Health app, the company has the opportunity to bring that rigor to defining the way we capture and consume health data. While the app currently does not provide any guidance on UX, it is an opportunity for it to pave the way for future apps in terms of user engagement and health data.
    • iCloud has not been leveraged - It would be beneficial to the user community if Apple were to expose health data through iCloud, especially now that most iOS users have a connection. In addition to taking the interoperability story forward vis-à-vis health data, it can also provide a mechanism for a server based integration model - where interested parties could retrieve patient data via the cloud. It does require a granular permissions model but also enables non-app specific consumers of data.
    There are, of course, many additional features that we would like to see, including support for additional data, fine grained permissions model and subscription-based data access.
    Pragmatically, those can be introduced after the app’s general availability. With the sizable iOS market presence among physicians and consumers, there is a significant market opportunity for healthcare independent software vendors (ISVs) to leverage HealthKit to provide a ubiquitous, independent platform for consumer and enterprise healthcare data.