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We’ve seen some spectacular advances in fields ranging from surgery to gene editing, but health care still faces a lackluster problem: Many patients can only get health records from their doctor if the fax machine is working.

Even when records are stored electronically, different chunks of every patient’s health information sit in inaccessible electronic record systems in different doctors’ offices.

Anyone who needs their medical files gets them either printed or faxed or has to log on into separate portals for each doctor and hospital, and even then getting view-only access. That’s a huge pain. View-only apps can’t access data to help patients share information with family and health-care providers, make decisions, monitor disease, stay on course with medications, or just stay healthy.
I believe every patient deserves a bank account of sorts for their health data, under their control, with deposits made after every health encounter. After my colleagues and I demonstrated an open, free version of this bank account idea to companies in 2006, Google and Microsoft launched similar personally controlled health records, known as GoogleHealth and Microsoft HealthVault. Walmart and other employers offered our version, called Indivo, as an employee benefit.

Unfortunately, even these industry giants couldn’t shake loose data from the computer systems in doctors’ offices or make the case to patients that curating the data was worth the effort.

But more than a decade later, things are finally changing.

Using Apple’s iPhone Health app, patients will soon be able to download and view health records on their phones.

Apple’s product enters the health sector under different circumstances.

Today, a lot more patient data is electronic after a $48 billion federal investment in promoting the adoption of information technology to providers, initiated under legislation called the HITECH Act. But those products, mostly older software and purchased at enormous expense, still don’t promote record sharing with doctors or patients.

Recognizing this unacceptable limitation and having received a generous grant for a tiny fraction of that federal investment, our team created a program called Smart. Smart is an interface to make doctors’ electronic health records work like iPhones do. Apps can be added or deleted easily. The major electronic health record brands have all built this interface into their products.

Apple uses Smart to connect the health app to hospitals and doctors’ offices. The good news for patients, doctors and innovators is that Apple chose a standardized, open connection over a proprietary, closed one. This approach lets any other app, whether running on the web, iPhone, or Android, use that same interface to connect.

So Apple will compete on value and customer satisfaction, rather than on an exclusive lock on the data.

Understanding the nuances

Apple’s approach could help Americans trying to stay well or manage their conditions. But only with follow-through by Apple, health systems, technology companies, patient groups, policymakers and government regulators. The emerging ecosystem’s nuances must be appreciated.

First of all, the floodgates for patient information are at least a crack open and will be hard to close. As patients gain access to their data, they will recognize it is incomplete and feel frustrated it’s not available everywhere. But, patients in need will drive demand for data access in their role as health consumers.

Secondly, the government is using law and regulations to compel an open interface. By selecting Smart on FHIR, a framework for exchanging health-care information electronically, Apple and its health-care launch partners mark the importance of standardization. A uniform approach is critical for scale. Imagine if every electrical product required a differently shaped 120V outlet.

Understanding this, Google, Quest Diagnostics, Eli Lily, Optum and many other companies are using the same interface to plug into health care.

Thirdly, while Apple is bringing health records to the phone, that data will still be “view only.”

In 2009, I had the chance to meet with Apple vice president Bud Tribble to talk about how the iPhone could serve health care. We concluded that crucial data — like the medication list — had to be as easy for iOS developers to use in their apps as contacts and location are now. I would not be surprised if this were the next step in Apple’s journey — making the health records available to iPhone app developers. Here, too, is an opportunity to chose open interfaces and to allow patients to export the data to another device.

Finally, competition in health care IT is hot.

Amazon, Google, Apple and Facebook all have health-care divisions. Apple’s hardware, including sensors in the phone and watch, will monitor patients at home. Google’s artificial intelligence will lead doctors and patients to diagnoses and decisions. Amazon is reported to be looking atpharmacy management. Facebook has sifted through posts to detect and possibly intervene when users may be suicidal.

There are so many opportunities to compete. But locking up a patient’s data should never be one of them.

Dr. Ken Mandl directs the Boston Children’s Hospital Computational Health Informatics Program and is the Harvard Medical School Donald A.B. Lindberg professor of pediatrics and biomedical informatics.




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