I’ve been working with FHIR APIs for about two years and have anticipated writing this post since Apple pre-announced using FHIR to connect the Health App to patient record systems in January.
After Apple released 11.3 with FHIR support, it turns out they support one of my healthcare systems AND I went to the doctor so I got to use it.
I was sitting in the doctor’s office, the nurse took my blood pressure and put it into their computer. She walked out of the room, so I quickly looked at my phone, and sure enough, there it was.
In fact, strange to see, Apple has exposed the raw message data!
Yet, I’m still unsure what to write, or rather how to write up what it means briefly.
How Important is This?
This is big stuff. Really big.
It’s more than just patient record data though. From last week’s Apple earnings call:
Milonvich: Can you talk about healthcare opportunity? Just Watches? Or is there a Services play? Stuff for employees broadens out?
Tim: We think about it very broadly, and you can see that with things like ResearchKit and CareKit and most recently health records.
— Six Colors liveblog (@sixcolorsevent) May 1, 2018
You can think about the insight Apple is gaining that might help them create better products for healthcare:
Or even just pay attention to the stories to realize that something’s happening with Apple and Healthcare:
- Apple Watch Saves Teen’s Life
- Apple Watch Saves Man’s Life After Ulcer Bursts
- Apple Watch Detects Man’s Pulmonary Embolism
I could spin this, and I’m admittedly an Apple fan, that Apple is targeting the care and wellness of people, not just their health. They appear to be the only ones in the health ecosystem that doesn’t consider the ‘insurance process’ to be integral to their offerings. That means they can explore how to impact patient health without the legacy baggage of the process.
FHIR APIs are Boring
This FHIR / Patient Record stuff is different, and more. It’s boring in some ways, but so much more useful by everyone.
Just the other day I dropped my son on a metal fence and my wife asked “has he had a tetanus shot?”
He’s had only one doctor, so we’d easily be able to find that out. Though, perhaps not on a weekend. (Fortunately, we didn’t break skin, so we didn’t need to find out the answer.)
It gets much more complicated for adults, with longer patient histories and perhaps a variety of medical specialists spread across different institutions. It wasn’t that long ago that a doctor yelled at me and my wife for not taking me to the emergency room associated with a doctor I was seeing (at least an hour away at that time of day when one of us, probably my wife considering that I was laying on a gurney in the ER, had to get home to take care of the kids!).
If I could have opened my phone and shown the doctor all the relevant records, would that have helped? Maybe.
What if I could have instantly sent my records from my phone to his system to integrate with what he was learning in the emergency room? Probably would have been helpful. That’s not especially outrageous to imagine.
Compare Apple Health to Apple Pay
Tim Cook often uses the phrase “over the long arc of time.” I love that phrase. Especially in this situation. Look at what Apple’s done in payments. They got phone payments to go mainstream (outside of Asia; Asia had it’s own momentum around this). Starting with a few banks in the United States, and now available in 20 countries with 1,600 banks in the US alone.
Apple’s health records integration is starting with about a dozen US hospitals… but it won’t be long (a couple of years) before it’s widespread.
Healthcare providers need to get ready because unlike financial data, health data can’t be “reset” in the event of a breach. Security and privacy are critical.
So what does working with FHIR look like?
If you’re curious about working with FHIR APIs, head on over to CA’s FHIR Developer Portal and request an account. You can work with sample data and create your own apps, or do your own integration to the Apple Health App.
How will this type of patient record integration impact healthcare?
It’s so hard to collect one’s own health data in one spot and make sure everyone that needs it, has it. And the language around it is difficult. Asked — have you had an ACE blood test lately? I’d have to search through hundreds of pages of blood test results, because I don’t remember which doctor might have done that test, because I probably wouldn’t remember “ACE” even if I did remember that I had blood work done.
It’s often just easier to redo a test, which of course wastes time and money, leading to worse care outcomes and inefficiency everywhere from the visit to the scheduling to the insurance coverage.
And that’s just blood work. I just had an EKG and want to compare it to an old one I took, but don’t have access to anymore. I feel like I have a second job at the moment trying to get records between doctors to get ready for a surgery I’m having. It’s crazy. And it all goes away when Apple is successful broadly with this ‘long arc’ of health record integration they’ve begun.
After that, the fun begins. Then we’ll start to see some real improvements in care, and quality of life when it comes to managing chronic illness. Because it’s clear today’s players don’t really keep their eyes on the end results of improving people’s lives. Not holistically.