A burden or an asset?


SYeah, Apple announcement recently, it will allow doctors to monitor the health data of their patients’ phones and watches between visits, part of the push in healthcare that Apple CEO Tim Cook has brought to bear. declared will be the company’s greatest contribution to humanity.

Since 2014, healthcare systems across the country have partnered with Apple to harness the mountains of data the company’s devices generate for patients. But most are still experimenting with these tools. While some physicians enjoy seeing blood pressure, exercise, and other records between visits, for others, data is more of a burden than an asset.

Over 100 types of data are available in Apple’s Health app through iPhone, Apple Watch, and third-party apps. In June, Apple said that patients whose doctors work with any of the six electronic medical records companies participating in the new functionality will be able to send them tracked data such as heart rate, hours of sleep, minutes of exercise, stages, falls, or history of the menstrual cycle.

Some see great promise in building “pipes” between a patient’s phone and the medical records viewed by their clinicians. Apple is “democratizing the flow of health data” between doctors and patients, said Anil Sethi, former Apple chief health officer and current CEO of Citizen, a startup that manages the health data of cancer patients.

But Apple’s announcement was surrounded by ambiguity and detail. The company would not provide a full list of data that patients can share with doctors and declined to comment for this article. Apple’s previous initiatives to put more data in the hands of doctors have been heralded with much fanfare, but questions remain as to how many healthcare providers are using the data and to what effect, and whether the successes are. the norm or outliers. To date, rigorous studies showing clear health benefits of monitoring these types of data stay limited.

While Apple has built pipes for patients to share increasing amounts of data with healthcare professionals, it’s unclear exactly how much data is flowing through them.

In 2014, Apple released HealthKit, a tool for healthcare systems to extract patient health data, with their permission, from their iPhones. At the time, Mayo Clinic CEO John Noseworthy noted it would “revolutionize the way the healthcare industry interacts with people.” But a Mayo spokesperson told KHN that the system’s use of HealthKit is now limited.

Cedars-Sinai Medical Center noted in 2015 that, thanks to HealthKit, more than 87,000 patients were able to share their data, a Cook arrangement boasted during a call for quarterly results. A spokesperson for Cedars-Sinai declined to comment on what happened to the project.

Even Apple’s attempts to use data from its own employees’ apps to improve their medical care have yet to be successful. the The Wall Street Journal reported that an Apple initiative testing a new primary care service that allows doctors to monitor the health of Apple employees through their devices has stalled. The company said many claims in history were inaccurate.

To date, rigorous studies showing clear health benefits of monitoring these types of data remain limited.

There have been some reports of success. Ochsner Health in Louisiana reported that patients in a hypertension management program that provided health coaching while monitoring blood pressure data from cellphones were more likely than a control group to control their blood pressure, follow their medication regimen and feel satisfied with their care. The healthcare system now also has remote monitoring programs for diabetes, chronic obstructive pulmonary disease and pregnant women, an Ochsner spokesperson said.

And Epic, the country’s largest health records company, said more than 100 of its major healthcare system customers use Apple HealthKit to capture data from home monitoring devices such as blood pressure cuffs. .

But patient-generated data has not been widely adopted in healthcare, said Dr. Benjamin Rosner, associate professor of medicine at the University of California-San Francisco. He and others point out the main obstacles.

One, Rosner said, is that the evidence is mixed that monitoring this data improves health.

Another is that doctors are generally not reimbursed by health insurers for reviewing data that patients collect at home.

“In America, we typically pay doctors and health systems to see patients in front of them and do things to them when they show up,” said Matthew Holt, health technology startup consultant.

In cases where doctors can be reimbursed for remote monitoring of patients, such as those with certain chronic conditions, the payment is generally low, Rosner said.

And many physicians already feel inundated with patient health information and electronic health record tasks.

“Primary care physicians are overwhelmed with their inboxes,” said Dr. Rebekah Gardner, associate professor of medicine at Brown University. “Before people start buying Apple Watches and sending in all their sleep hours, let’s show that it improves health.”

She said she wanted to see more rigorous and independently funded studies showing that monitoring data from wearable devices makes people healthier or improves their care.

Liability issues weigh heavily on the minds of some physicians. Dr Oguchi Nkwocha, an executive physician at a community health center in Salinas, Calif., Fears he will be held responsible if he missed something in “a data log” but said it could be more open to data that has been analyzed and presented with predictive insights.

Apple isn’t the only tech company that has struggled to mainstream data sharing of healthcare apps. Both Google and Microsoft allowed patients to share their data in their personal health records over a decade ago, but shut those companies down due to limited user adoption, Holt noted.

Optimists believe that eventually, research will show more forms of data monitoring improve health and that technology could help make data more digestible for doctors. Then Apple could succeed in integrating its apps into medicine – assuming the payments system changes in a way that gives more incentives to vendors to identify issues early and intervene before people get seriously ill, Holt said. .

“This is exciting for the future of chronic care management,” said UCLA Health cardiologist Dr. David Cho of the new feature. With data at hand on risk factors like exercise, diet and blood pressure, he believes he could help his patients manage chronic disease more easily. This data, combined with virtual tours, could mean fewer office visits.

Apple’s announcement that it can integrate patient-generated data into the electronic medical record could be critical for doctors who want to see information collected by their patients themselves but don’t have the time to research it said Dr. Seth Berkowitz, who is leading a remote monitoring application pilot program at Beth Israel Deaconess Medical Center in Boston.

“Before people start buying Apple Watches and sending in all their sleep hours, let’s show that it improves health,” Gardner said.

Some patients welcome a feature that would make it easier to share data with their doctors. Jen Horonjeff, a New York patient with autoimmune disease and CEO of a healthcare startup, recently discovered using an Apple Watch tracker that her heart rate, which doctors had described as irregular , was recorded as normal.

“I would absolutely send this to my doctors,” Horonjeff said, noting that her data would give doctors an accurate baseline of her heart rate if she was hospitalized.

But Gary Wolf of Berkeley, Calif., Co-founder of Quantified Self, a movement of people who track their health and other personal data, said it was impossible to find a doctor trained to make decisions with ” fine resolution data ”.

Without more evidence that passing data from health apps to physicians is clinically beneficial, it will be difficult to assess whether Apple is successful, said Neil Sehgal, assistant professor of health policy at the University of Maryland.

“At this time, we don’t know if there are consequences if you don’t put your Apple Watch data in your electronic medical record,” he said.

If the evidence ultimately shows any benefit in sharing this information with doctors, he said, “that benefit will be concentrated among people who can buy the $ 1,000 phone and the $ 400 watch.”

Sarah Kwon reports for Kaiser Health News.

This story was produced by KHN, which publishes California Health Line, an editorially independent service of the California Healthcare Foundation.

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