Apple HealthKit sparks security concerns

December 10, 2014 in Medical Technology

While publicly known early adopters of Apple HealthKit still number in the single digits, the actual degree of interest in the new platform ranges far and wide. But whether its momentum continues or wanes remain to be seen.

Right now, though, there’s no arguing that the app is gaining steam.

Take Duke Medicine, for instance. One of the first to integrate HealthKit with its Epic electronic health record, the health system has already been putting it to use in research and clinical trials.

“We have people beating down my doors to do both,” Ricky Bloomfield, MD, director of mobile technology strategy and an assistant professor of pediatrics at Cary, N.C.-based Duke Medicine, citing OBGYN and perinatal among the broad swath of departments interested in what Bloomfield is doing with the app.

It’s not just Duke, either.

“We’re piloting HealthKit,” the chief medical information officer of a major east coast health network told Healthcare IT News on Tuesday. On the other end of the spectrum, a rural pediatrician-entrepreneur divulged that its developers, too, are working to integrate an existing app that both doctors and patients use with HealthKit.

Those remarks came after a Tuesday afternoon session at the mHealth Summit 2014 drew a standing-room-only crowd. Part of the day-long Healthcare IT News Clinical Mobility Forum, the ‘open mic’ panel starred Bloomfield alongside Richard Milani, MD, chief clinical transformation officer at the New Orleans-based Ochsner Health System — the two health systems widely credited as the first to integrate HealthKit with their Epic electronic health records platforms.

Duke and Ochsner’s urgency to integrate Epic and HealthKit was fueled by both consumers and clinicians desire for “the ability to get meaningful, actionable information from patients,” Bloomfield said. That data will come from wearable devices and other home monitoring solutions that can transmit patient information through HealthKit to the EHR.

The hope is that as time goes on, more and more devices and solutions will integrate with HealthKit, allowing for myriad types of structured data to be pushed from the consumer into the EHR.

Questions raised

And while the session shone a light on the potential benefits of incorporating HealthKit into physicians’ quivers, a shot of questions from the audience also highlighted many concerns other providers are facing as they consider whether or not to move quickly on HealthKit.

When pressed by Adrian Gropper, MD, chief technology officer of Patient Privacy Rights, about the security implications of pulling patient information into Epic via HealthKit, Milani pointed out that HealthKit, in its current form, is transmitting a limited set of 50 or 60 discrete data points through to the EHR, based on use cases from devices that are already on the market – and said that data can only flow into the EHR, not out of it and back through the app.

It’s important to note – Apple maintains, at least – that any patient data is not stored in its cloud alongside the notoriously hackable celebrity photographs of celebrities such as Jennifer Lawrence. Bloomfield cracked that even the FBI is angry at Apple for not enabling it to access the data.

Other questions tossed at Bloomfield and Milani on Tuesday evoked concerns that HealthKit would truly be interoperable with many devices and EHRs.

“This is all early,” Bloomfield cautioned. “We want to use the best solution and, right now, HealthKit is the best solution.”

Milani added that the platform has immense value in the monitoring of patients at home — especially those with chronic conditions, such as hypertension. Early pilots, he said, have shown decreases on hospital readmissions, as well as higher patient activation rates.

Bloomfield also noted that payers are slowly coming around to the concept of reimbursing for telemedicine encounters, and that a physician’s conversation with a homebound patient over data collected and passed on through HealthKit would qualify. The Centers for Medicare Medicaid recently revised its CPT codes to allow for some reimbursement for telemedicine services, and other players like Blue Cross and Blue Shield “are all ears” if it can be proven that this process improves clinical outcomes.

Still, not all mobile health advocates are convinced that HealthKit, as it stands today, will survive – let alone thrive ubiquitously among healthcare providers.

During a keynote just a day earlier, Joseph Kvedar, MD, director of Partners HealthCare’s Center for Connected Health, wondered whether HealthKit will meet a fate like that of other once-upon-a-time exciting, if not ground-breaking, tools.

“How is HealthKit going to be different from Google Health, Samsung’s mHealth apps or Aetna’s CarePass?” Kvedar asked, referring to now-defunct products that once appeared to have a bright future.

The answer to that question, as Bloomfield and Milani suggested, will take time and more case studies — indeed many CIOs and clinicians have suggested that they are looking to Duke and Ochsner to glean lessons learned.

Among those: The compliance and legal puzzle pieces Bloomfield said Duke is currently fitting together.

“Those are the biggest pieces we have to wrap up,” Bloomfield said. “We’re close to a larger rollout: Bigger, better, faster.”

This article originally appeared on Healthcare IT News sister site mHealth News

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