Eight things we learned about HealthKit from Duke, Ochsner

By Jonah Comstock

HealthKitDuke University and Ochsner Health System in Louisiana are two of the first hospitals to integrate with Apple HealthKit via Epic. At the mHealth Summit in National Harbor, Maryland this week, Duke's Dr. Ricky Bloomfield and Ochsner's Dr. Richard Milani took the stage for a packed Q&A session about the new technologies, applications and opportunities. Here's eight takeaways from the session.

1) Patients and doctors are clamoring for patient-generated data 

Bloomfield and Milani dispelled the notion that their hospitals are jumping on the bandwagon of a popular consumer technology. On the contrary, HealthKit is enabling programs their staffs wanted to do previously, but couldn't, which is part of why they've so enthusiastically championed the platform.

"Earlier this spring, I had a couple of clinicians approach me -- one from cardiology, one from oncology -- and they both had pilot studies they wanted to conduct using remote patient monitoring and patient generated data," Bloomfield said. "My answer at the time, as director of mobile technology, was one that was very unsatisfying to me: That there wasn’t an easy way to get that data into our Epic EHR, which we just went online with in the last two years. There was technology coming in a future version of Epic that would give us access to Fitbit and Withings data but that wasn't available yet. So when Apple announced HealthKit at their Worldwide Developer Conference in June, I knew that it would solve the problem we had. So we were very excited to work with both Apple and Epic to make it happen."

Since news of HealthKit -- and Duke and Ochsners' involvement with it -- broke, both doctors have received unprompted emails from patients asking to be involved.

2) The Epic integration is a one-way pipe

To allay any concerns about HIPAA and privacy, the programs Duke and Ochsner are piloting take data from patients' apps into the EHR, but don't send any data back out, Milani stressed. In addition, HealthKit addresses the problem of physicians being overwhelmed with data by only providing them with the specific fields that they request.

"It doesn’t come in as an unintended flood of information I didn’t ask for," Milani said. "So if I’m seeing a patient and we’re having a discussion and I want to monitor their blood pressure, I can put an order in and I can determine the frequency with which I want to be notified or my staff to be notified, and off we go."

Additionally, Milani shared, the data stays stamped with the app it originated from, so if the hospital determines that a particular app or device has an accuracy problem, they can flag it and disregard that data in the future, or recommend that patients switch to a different app.

3) The current set of data fields is just the beginning

Right now, Apple reads 50 to 60 data fields from tracking devices, but Bloomfield sees that as version 1.0 of HealthKit.

"Their intent with version 1.0 was simply to account for the use cases that are currently available in the market," he said. "And that’s why you see things like activity tracking, vital signs, blood pressure. You also see elements related to asthma -- number of times you used your inhaler, peak flow. There were devices already in market that require this to support them. As the use cases grow Apple wants to be there to support it."

Later in the talk he speculated that as wearable devices become more common and more advanced, 50 or 60 fields will become "50,000 or 60,000".

4) Apple can't access patients' data

Bloomfield said one of the biggest misconceptions about Apple HealthKit he's seen is people worrying about what Apple might do with their health information. But Bloomfield says Apple has told him they can't even see that information.

"Apple makes its money on [consumer] electronics, they don’t make their money on data. So when they tell me ‘We can’t even access that data. We can’t see that data’ [I believe them]. Which is why the FBI is upset that Apple can’t give them access. When the FBI’s upset that they can't access the data you know Apple’s probably telling the truth. That makes me feel really good. That’s why Apple will succeed where other personal health records have not. Google has not been able to give that assurance yet."

5) HealthKit is already reimbursable by CMS

As of last October, Bloomfield shared, there are two CPT codes (99090 and 99091) for patient generated data that work with HealthKit. He said they can get reimbursed about $56 a month from CMS. So far, no private payers have followed suit, but both Milani and Bloomfield think it's only a matter of time and demonstrating ROI. One of the Blues is even considering reimbursing for the tracking devices themselves in chronic disease cases where the potential is high for reducing reimbursement, Bloomfield shared.

(UPDATE: Dr. Bloomfield has written a post on his blog explaining some of the intricacies of the CPT codes and one additional code, 99490. Read here for an explanation of how these codes could be used to make HealthKit reimbursable.)

6) Hospitals don't want to leave Android users out

Right now, only HealthKit integrates with the EHR. But Bloomfield and Milani are keeping their eyes on Google Fit as well. The problem right now is that Google Fit allows developers to create their own data fields, which allows the platform to be more open, but hurts efforts at standardization.

"I think Google needs to do a little bit more to get it into the place where HealthKit currently functions, but I can’t wait until we can use Android devices as well as iOS devices, one to the other," Bloomfield said. "For me the most important thing is we give this ability to our patients. And I don’t care which device they have, I just want them to be able to give us the data so we can make good clinical decisions to help them out."

7) Apple's glucose goof hasn't shaken doctors' confidence

The fact that Apple pulled its glucose functionality shortly after launching the platform is embarrassing, Bloomfield said, but their response to the goof was actually heartening.

"There were problems," he said. "But they’re committed to fix it and to make sure patients stay safe in the process. There will be problems, because human beings wrote this code and they’re not perfect. We have to be careful, which is why we’re rolling this out in phases as part of a pilot program. Because we want to make sure this stuff works before we’re saying all of our millions of patients are going to be using this."

8) HealthKit has big implications for medical research

The immediate use case for HealthKit in the hospital is chronic disease, Milani said. But Bloomfield added that the collection of this data is going to have big implications for medical research, because it increases the depth and richness of data in a patient's health record.

"We don’t know what we don’t know yet," he said. "That’s the concept of a learning health system. We try to get data from as many people as possible and use that going forward. We know the more data we get, the better informed we’ll be to make better decisions, but we don’t have that data yet. So this is just one more way to open one more door."