This article is part of Update or Die, a series from Future Tense about how businesses and other organizations keep up with technological change—and the cost of falling behind.
If you’ve ever had to deal with a health problem more serious than a cough, you know that keeping track of your medical records is a pain. If your doctor works for a major hospital, she may have a decent website where you can log in and, say, check your latest blood-test results. But moving information from one physician to another can be a slog that requires multiple phone calls bugging office managers to fax over files, because parts of the health care industry still rely on technology that felt retro in 2002.
Thanks to Apple, some of those frustrations may become a thing of the past. This year, with uncharacteristically little fanfare, the company rolled out a feature on the iPhone’s Health app meant to make managing your medical info as simple as online banking. For the first time, users will be able to download their own clinical data from different doctors and hospitals directly onto their smartphones and access it all in one place, in much the way you can connect all of your checking and credit card accounts to a personal-finance app like Mint that will track your budget. The process is fairly simple: You pull up the app, search for your health care provider, and then log in as you ordinarily would to its online patient portal. The data is kept privately on your phone and never hits Apple’s servers, but updates automatically.
Right now, the Health app presents fairly basic information—lab results, medications, immunizations, and past procedures, for instance—and just a limited number of hospitals are participating in the rollout. But several industry experts I spoke with said they had high hopes for the project. The most optimistic told me that Apple might not just make it simpler to cart around your health records, but could fundamentally change the way doctors and patients use data to manage health.
“This is a big story,” Peter Greene, the chief medical information officer at Johns Hopkins, one of Apple’s partners, told me. “This is game changing for digital health innovation.”
Apple isn’t the first tech company to try to bring personal health records to the masses—Google gave it a brief shot, and Microsoft still technically offers its HealthVault. But those efforts were in many ways too early, coming before most Americans were carrying around miniature computers in their pockets, and their interfaces were notoriously clunky, requiring a deadly amount of manual data entry.
Apple, meanwhile, is building on a decade of effort by the federal government to drag health care providers into the digital world—a painstaking process that for complicated reasons hasn’t yet delivered all the promises that many policymakers have hoped. As part of the 2009 stimulus bill, the Obama administration offered doctors and hospitals money to finally ditch their antiquated paper-filing systems and adopt electronic health-record systems. The dream was that, within a few years, physicians would be able to access all of their patients’ information at any hospital in the country with just a few keystrokes, leading to better, faster diagnoses and fewer redundant, expensive tests. Things didn’t quite work out that way. While the vast majority of hospitals took the funding and digitized their own internal records, the systems they used couldn’t necessarily talk to one another. A study published in 2017 in the Journal of Health Affairs found that while 71 percent of hospitals had some sort of electronic health-record system by 2015, only about 30 percent had setups that were fully interoperable with those of other providers, and just 19 percent said they often used outside data for patient care.
One reason the industry has moved so slowly is that many hospitals lack a business incentive to share data in the first place. “Do you think Walmart wants to share data with Amazon? Other hospitals in the area are competitors,” A. Jay Holmgren, a Harvard Business School Ph.D. student who co-authored the Health Affairs study, told me. “Especially if you’ve spent a lot of time diagnosing a patient, you don’t want them to go to another hospital where they like the surgeon better.” The companies selling health-record software didn’t help matters by making it hard for their competing data systems to communicate in the first place—as one doctor put it to me, the whole industry has suffered from a “tower-of-Babel problem,” where nobody speaks the same digital language.
Those issues, however, are starting to give way, and the new iPhone feature is one important example of what that could mean for patients. Nudged first by regulators and later the 21st Century Cures Act, electronic-health-record vendors have had to adopt open programming standards that make it easy to plug in to their systems, which Apple is taking advantage of with its Health app. As of June, 55 different health systems—many including multiple large hospitals—are working with the company. That includes major names such as NYU Langone, Scripps Health, Weil Cornell, and the Cleveland Clinic.
An app like Apple’s won’t replace the need for more hospitals and doctor’s offices to be capable of seamlessly sharing records. “I wouldn’t view it as the end-all of what’s important about electronic health data,” Fredric Blavin, a researcher at the Urban Institute, told me. The information it provides as of now is too limited, not everybody has a smartphone, and expecting patients with chronic mental or physical health conditions to perfectly manage their data is far too large a burden. But it does give people an easy, quick workaround to get their basic medical history to a new doctor who might not be able to pull it up themselves. (The app also includes an emergency medical ID, which will let physicians get critical details from an incapacitated patient’s phone, even if it’s locked.)
That’s not really what excites the doctors I spoke with, though. What’s enticing about Apple’s project, they say, is that it will finally put clinical data directly into patients’ hands, which they can then feed into other apps that will help them manage their health. You could have better tools that help people stick to their diabetes or HIV regimen, or that connect cancer patients to support groups based on their treatment experience. Apple has been working with Stanford to study whether the Apple Watch can detect an irregular heartbeat (a recent Cleveland Clinic study suggested that it could, using a special band), which may improve cardiac care. This month, Apple also opened its health-records platform to third-party developers, a crucial step that could lead to any number of new applications. “It thinks the sky’s the limit on this,” said Mark Smith, chief innovation officer of MedStar Health, one of the major hospital operators that’s working with Apple. “We are on the verge, I believe, of having an explosion of useful applications for patients.”*
Some uses could involve research, commerce, or a bit of both. Health-privacy laws currently make it hard for companies to get medical data on individual patients, since doctors are (rightly) barred from simply releasing it. Jonathan Slotkin, a spinal doctor who oversees digital tech at Geisinger Health System in Pennsylvania, suggested that putting data in the hands of patients could let them sell their own information to pharmaceutical or life-insurance companies on open marketplaces, if they so chose. (Today, he told me, patients are lucky to get a Starbucks gift card if they volunteer their data.)
“If you think about it, we as a society would never sit down and accept a situation where our banking information was possessed by others [and] could be tapped by us only intermittently and with great effort,” Slotkin told me. “And yet somehow we’ve lived with the fact that health records and health information were possessed really in a paternalistic way.” That data is finally starting to get unlocked. It’s certainly better than waiting for a fax.
*Correction, June 18, 2018: This article originally misquoted Mark Smith as saying we were on the verge of having “an exposition of useful applications” for patients. The correct word, instead of exposition, is explosion.