June 22, 2021 — A growing number of consumers can now download their electronic health records to the Apple Health Record on their iPhones as more health care providers get onboard.
Meanwhile, Apple just announced what could eventually prove to be a breakthrough for patients: the ability to share with their doctor health records from other providers and the data that they generate themselves on their iPhones, Apple Watches, and third-party apps.
But some observers say we have a long way to go before much of this information will be useful to doctors. And it’s not clear how many people will download their records, partly because medical terms can be hard for consumers to understand, they note.
Apple launched its free electronic health record (EHR) download feature in 2018 and beta-tested it with a dozen health care systems early in 2019. Now, about 700 health care organizations with 12,000 care sites offer patients the option of downloading their records into their iPhone Health Records app, a company spokesperson tells WebMD. That’s 200 more organizations than took part late last year. And EHR vendors that own most of the market have connected to Apple Health for the record downloads.
Eventually, experts say, most health care providers will allow patients to put their records on their iPhones. “It will become table stakes. Even if not many patients use it, if you don’t do it, you’ll look like a dinosaur,” says Joseph Kvedar, MD, a Harvard Medical School dermatology professor who is chair of the American Telemedicine Association.
Beyond Patient Portals
Most hospitals and doctor groups already provide online access to medical records on their patient portals. But you must log into the portal to view the data, and the records are only for that provider. If you want to see another provider’s records, you have to log into a different portal. And there’s no way to look at the records side-by-side.
In contrast, Apple Health, using an industry-standard application programming interface (API), enables downloads of records from multiple providers using different EHRs. The data on diagnoses, medications, allergies, lab results, and other areas is then combined into a single view of each category, along with patient-generated data from iPhones, Apple Watches, and other sources.
Here’s how it works: A consumer can scroll through a list of institutions that use the Health Records app and find out whether their hospital or clinic offers record downloads. If it does, the patient can ask their provider to be enrolled in the program. They must also use the organization’s patient portal, because the portal login information is needed to authenticate users of the Health Records app.
Once the consumer is set up in the system, the app automatically downloads their latest records and notifies them when new data is available. None of the information is available to Apple or its business partners, even if the user backs up the data in the iCloud.
A number of third-party apps enable people to download their records, but none has the reach of Apple Health. Medicare patients can also download their records as a file using Blue Button 2.0 from the Centers for Medicare and Medicaid Services (CMS). Some commercial apps make this information more user-friendly.
Sharing Data With Providers
Apple recently announced several new health-related features that will be available in its next release of the iPhone and the Apple Watch. These include new trend graphs to measure progress on various metrics; new tools to understand medical records; data on walking steadiness, fall risk, and respiratory rate during sleep; the ability to share records with caregivers and loved ones; and the ability to store data on immunizations and test results.
But the most important new feature is the ability for consumers to send data to their doctors in a form that the doctors can view within their EHR. Among the types of patient-generated data that Apple cites are heart rate, detected falls, hours of sleep, and exercise minutes. In addition, third-party apps that patients have selected and that have been developed to Apple Health’s specs can send their data to providers.
All of the EHR vendors that allow downloads to Apple Health, except for Epic (the largest EHR supplier), plan to provide some version of this service, and Cerner and Meditech — two big hospital EHR vendors — say they will make it available this fall.
The data provided to doctors is not intended to support their clinical decision making. According to Apple, it’s meant to promote “more informed conversations” between patients and doctors. Kvedar says that certain kinds of patient-generated data, such as the arrhythmia detection feature of the Apple Watch, might be useful to doctors. But before any such data were used in clinical decision making, he says, the FDA would have to approve the software. This is an involved and expensive process, and he doesn’t know whether any company — whether Apple or a third-party developer — would want to invest in it.
Kaveh Safavi MD, senior managing director for Accenture’s global health care business, says doctors will never rely on data from consumer wearable monitoring devices, which are not as accurate as medical-grade devices. If a patient has a chronic disease and the doctor wants to monitor their condition remotely, he says, the doctor will prescribe a medical-grade device. If the person is undiagnosed and untreated, the main purpose of generating data from a wearable device and viewing it on their iPhone is to encourage them to see a doctor.
On the other hand, Safavi says that some doctors may be interested in certain kinds of data from wearable devices. Knowing a person’s sleep patterns could be helpful in treating their sleep apnea, for instance.
“This is not an either/or conversation,” he notes. “The whole field is slowly evolving toward making objective information more freely available between participants in the health care system, if they need it and choose to share it.”
Barriers to Exchanging Records
Both Safavi and Kvedar see the value in patients being able to send their downloaded records from multiple providers to a new doctor, or to show it to an emergency room doctor. “It’s a pain point for all of us that at the moment when we’d like to have our health information to provide it to someone else, there’s no simple way to get it,” Safavi says.
For several years, the government has required that the EHRs it certifies include the ability to exchange records between providers with different EHRs. But those records typically are exchanged as lengthy documents that are hard for doctors to scroll through when they’re providing care. The industry-standard API has made it easier to exchange records at a detailed data level, and all EHRs must now include this capability. But EHRs from different vendors are still far from being able to mesh.
Patients can make this data from other providers available to their doctors, who can view it within their EHRs using a specialized dashboard, according to the Apple source. “At participating health care organizations, a physician can review the Apple Health app data that a user chooses to share directly in the electronic health records system,” she said.
Whether or not Apple’s record sharing feature turns out to be transformative will depend on how many consumers use it and on whether doctors find the information relevant. Consumer demand will also determine the fate of downloads to the Apple Health app.
While it’s still too soon to tell how many consumers will see value in downloading their health records to their iPhones, Safavi notes that Apple’s strong point is in the consumer space. “Apple understands that the value proposition to the consumer is a critical part of getting this right,” he says.
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