• Mario Nicolais

Apple attempts to upend the electronic health records cart



A few days ago, I downloaded the iOS 11.3 operating system to my iPhone. Usually that process causes more annoyance than anticipation; as my wife can attest, I am one of those iPhone addicts who cannot stand being “disconnected” for the fifteen minutes an update takes. I own that. But this week I couldn’t wait for the update to finish because I couldn’t wait to play with the new Apple Health Records beta app. Launched without much fanfare, it might be the most important Apple product since the iPhone itself.


Electronic health records — or EHR for short — have not kept pace with the modern technology driven world. EHR suffer from a plethora of issues and problems. The systems are not intuitive. The regulations can be stifling. Entering information often interrupts the workflow of nurses, doctors, and other healthcare professionals. Companies creating the software, such as Epic and Cerner, use proprietary systems that not only fail to provide true interoperability, but often actively stymie it for business purposes.


Most troubling? Companies design EHR almost exclusively for provider use, not patients.


Last week I asked an expert panel about the issue during a morning seminar on innovations in health care. The panel included people like Kim Bimestefer, the Executive Director for the Colorado Department of Health Care Policy and Financing, and Mike Biselli, the driving force behind the Catalyst Health-Tech Innovation project in Denver. Basically, a panel of people who spend their lives figuring out how to improve health care systems. The first response to my question was an anecdotal account of an interaction with an executive from one of the big EHR companies. When the panelist asked how the records could be made more accessible to patients, the executive responded, “Why would patients want their EHR?”


Maybe that executive should listen to former Vice President Joe Biden’s book, “Promise Me, Dad,” detailing the care and treatment his son, Beau, received for brain cancer. While recounting the difficulties coordinating treatment information between hospitals, Biden’s voice vacillated between raw anger, consternation and despair. One of the most influential men in the world resorted to using Facebook Live to transmit important data because, in 2015, the only other option for transferring EHR required mailing a compact disc. Privacy issues related to Facebook or the Health Insurance Portability and Accountability Act, or HIPAA, aside, that passage highlighted the very real portability concerns currently presented by EHR. When patients don’t have direct and immediate access to their own EHR, care can be compromised.


Biselli provided the second response from a panel participant: “Welcome, Apple.”


Apple hopes to change the entire dynamic by providing a platform for patients to download their health records directly to their iPhone. To avoid privacy concerns — always a hyper-elevated concern in the health care industry — providers transfer the data in a direct, encrypted download. The information does not move across Apple’s network. For those people who can use Apple Health Records, it might help to stop the necessity of patients showing up at a doctor’s office with “stacks of printed medical records and spreadsheets” and “grocery bags full of medications” to understand and explain their prior treatment.


Apple’s entrance into the field shouldn’t be overblown, though. Apple Health Records will not instantly solve the inefficiencies inherent in the system. Navigating regulatory challenges and industry partnerships can be daunting. Furthermore, the product itself suffers from substantial limitations. The data in the beta version is limited, only including allergies, conditions, immunization, lab results, medications, procedures, and vitals. Furthermore, very few health care providers currently participate — only 40 institutions at launch.

Such a cautious approach from a company that once flew the Jolly Roger pirate flag over its headquarters demonstrates just how seriously treacherous the waters surrounding health records really can be. Regardless, if the entrance of Apple into the EHR environment upturns the cart, it might signal a welcome advance in an industry that sorely needs it.


Mario Nicolais is an attorney and Denver Post columnist who writes on law enforcement, the legal system and public policy. Follow him on Twitter: @MarioNicolaiEsq



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