The Future of Health Care
May 6, 2021
#2. The apple bites back
A serial blog by Charles J. Shanley, M.D., and David Ellis, M.S.
The behemoth technology companies of the US and China are formidable vectors for disruption of the ways healthcare is delivered, administered, financed, taught and practiced. For example, Google recently announced a partnership with Ascension Health for an EHR search tool called “Care Studio”[i] which could have an impact in all these areas.
The development of such a tool was inevitable, yet the major EHR vendors have made it difficult to implement such a function within even their own EHR systems, never mind across competing EHR systems. In so doing, however, they have also made themselves vulnerable to third parties that find ways to cross the barriers, intended to keep competitors out, that have kept customers from deriving full benefit from their EHR data.
Enabling clinicians to find both patient-specific and aggregated patient data using a Google search-like plain language search is a welcome disruption to the status quo for patients, clinicians, and researchers; but not so welcome to EHR vendors who have resisted calls to make their systems interoperable. If Google eats their lunch, they have only themselves to blame.
Other disruptive forces may emerge from seemingly nowhere. In little over a year, a startup called Truvesta has emerged to tap the combined troves of patient data held by its partners, normalized and de-identifed as necessary to protect patient privacy. A group of former executives and developers from Amazon, Apple, Microsoft, and Google literally Zoomed in on the same need and opportunity that Amazon appeared to be going after through Haven. Zoom meetings, which have been much easier to get than in-person meetings during the pandemic. The result: Partnerships between Truvesta and AdventHealth, Advocate Aurora, Providence, Sentara, Tenet, Trinity, and Henry Ford Health System, among several other major health systems.
The ultimate goal of every would-be disruptor of healthcare is to make data aggregated across EHRs accessible to providers, patients, researchers, and others to enable better healthcare at lower cost.
While Google and Truvesta (and others) work on linking, analyzing, and searching disparate and vast health databases, Apple is working to contribute a vast database of its own through its Health app by monitoring, recording, analyzing, and reporting on vital signs of over a hundred million Apple Watch wearers.
Although Apple’s ultimate goals are different the results will be no less disruptive. According to CEO Tim Cook those goals are (1) to be of “service of the user so they can own their health in a way that they haven’t been able to in the past” and (2) to “democratize” research by moving from small representative statistical samples to large, almost parametric, population samples). Entrenched healthcare institutions should pay attention when Cook says he expects Apple’s greatest contribution to humanity to be “in the wellness-and-health area.”[ii]
Beyond measuring vital health parameters, the bigger picture for Apple also involves connecting with multiple provider EHRs. Its Health app already lets patients of participating providers download and share parts of their medical records, and lets providers send test results, medication regimens, and other data directly to a patient’s iPhone. More than 39 providers including Cedars-Sinai, Geisinger, Dignity Health, Johns Hopkins, and the Cleveland Clinic[iii] are making patient personal health data available via the Health app. AthenaHealth and Epic are prominent among EHR vendors in their willingness to make their EHRs accessible on iPhones.
With the Health app installed on 140 million American iPhones, with a strong and growing reputation as an advocate for and enable of consumer privacy, and with Apple’s status as a global technology leader, it is no surprise that progressive health systems are beating down Apple’s door to partner. Duke University School of Medicine and Stanford University Hospital are among institutions using Apple technology to allow chronically ill patients to track and manage their symptoms.[iv]
Apple is providing SDKs (software development kits) to providers for individual patient and population health monitoring and interventions like Duke and Stanford’s, as well as to researchers to recruit study participants easily from the millions of Health app users. Stanford Medicine took advantage of this to detect atrial fibrillation using the Apple Watch, recruiting more than 400,000 participants via their iPhones into its Apple Heart Study.
According to the Healthcare Advisory Board, Apple is “reportedly in talks with at least three Medicare Advantages plans about providing subsidized Apple Watches to the plans’ patients in hopes of detecting atrial fibrillation early. It also signed deals with Aetna and UnitedHealthcare to provide discounted watches to health plan beneficiaries who walk at least 10,000 steps a day.”[v] The same report claims Apple Watches are being used in studies of migraines, blood pressure, adherence in psychiatric care, and even as a virtual therapist for arm recovery in stroke patients. Future versions of its devices might measure blood pressure and body fat.[vi]
In 2020 Apple showcased the effectiveness of its Watch as a clinical tool with projects such as the Heartline Study, which investigates the impact of the Watch on cardiovascular outcomes in Medicare patients; an asthma management program using the Watch’s blood oxygen sensor; an online coronavirus screening platform, built in conjunction with the CDC; an app with Stanford to help connect first responders to coronavirus testing sites; (jointly with Google) coronavirus contact tracing and exposure notification system.[vii]
These are just the tip of an iceberg of activity at Apple designed to improve healthcare, and thereby to disrupt it, and Apple is by no means alone among the technology giants in seeking to do so. The major progressive health systems and medical schools—the Geisingers, Clevelands, Mayos, Dukes, and Stanfords—have the intellectual, managerial, and financial means to partner with the technology behemoths. But we have to wonder: Where will it leave the middle and lower tier health systems that lack such resources and cannot afford to take risks? Will they be out in the cold? At the mercy of the disruptive partnerships? Does Truvesta point to a way forward?
We believe the answer for health systems and medical schools is both disruption and advance. The key lies not in the balance sheet but in vision, in understanding what is happening and what is coming, and then setting goals and priorities accordingly. Wayne Health has followed this strategy in investing in a Center for Population Health Accountability to seek partnerships with all players who can contribute to the wellbeing of its patient population, digital transformation through the adoptiong of a cloud-based EHR platform (athenaClinicals) that facilitates rather than obstructs patient and population data sharing and reporting and by taking healthcare delivery paradigm to patients where they are through Mobile Health Units in an innovative partnership with Ford Motor Company.
Wayne Health’s vision is a care delivery paradigm and ambulatory-health ecosystem that is increasingly patient-driven, technology-enabled and provider-supported.
As always, we welcome your comments on this article and thank you for reading
[i] Cohen, Jessica Kim (2021). “Ascension to expand pilot of Google EHR search tool.” Modern Healthcare, February 23. Accessed online at https://www.modernhealthcare.com/information-technology/ascension-expand-pilot-google-ehr-search-tool
[ii] “Behind Apple’s healthcare strategy: 4 quotes from CEO Tim Cook.” Jackie Drees – December 14th, 2020 Becker’s Health IT. https://www.beckershospitalreview.com/consumerism/behind-apple-s-healthcare-strategy-4-quotes-from-ceo-tim-cook.html
[iv] “The 5 ways Apple wants to transform health care.” Advisory Board Daily Briefing January 22, 2019. https://www.advisory.com/daily-briefing/2019/01/22
[vii] “A look back at Apple’s most significant healthcare plays in 2020.” Erum Ahmed, Dec 23, 2020,