Just days after Apple released its health-and-fitness platform HealthKit in 2014, medical software company EMIS revealed it had, in effect, made 50 percent of the UK's medical records compatible with the system. So, over a year later, is Apple shaping up to be the new middleman between Brits and their doctors?
EMIS, which makes the EMIS Web patient records system used by over half of GPs surgeries in the UK, announced in September 2014 that it had integrated HealthKit with its Patient Access app.
That meant anyone with HealthKit activated on their iPhone, iPad, or Watch could gather information -- for example, on their weight or blood pressure -- into a mobile personal health record through Patient Access, and then elect to share it with their GP, who could view that information directly within the EMIS Web system.
Around 40 percent of smartphone owners in the UK have an Apple iPhone, according to market researchers Kantar WorldPanel and with most of those likely to be running versions of the HealthKit-compatible iOS and above, that means a potentially huge number of people can now share medical data with their general practitioner.
Over 13,500 people in the UK have chosen to create a mobile personal health record using Patient Access and HealthKit, Ben Foster, patient operations director at EMIS told ZDNet, and they've recorded over 4.4 million health observations in those records.
However, it's not known how many of them have chosen to give their GP access to the data, as EMIS doesn't collect that information for reasons of data privacy.
The idea behind the personal health record is not to be a general repository of fitness data -- steps taken or meals consumed, for example. "In my view, it's of most benefit with a patient with a long-term condition, that's when we see them becoming more engaged -- [the condition] is part of their lives and they want to manage it themselves more," Foster said.
For now, the system is being used to give doctors insights into a handful of conditions, rather than to give GPs a general picture of individuals' health. For example, a woman in Leeds suffering from white coat hypertension -- where the nervousness of being at the doctor's office causes a patient's blood pressure to spike higher than it might otherwise be -- avoids it by measuring her blood pressure at home and submitting the readings to her GP through the Patient Access app on her iPhone. Similarly, an asthmatic patient in Liverpool uses the system to let her GP view her peak flow readings -- a measure of lung health -- and adjust her medication accordingly.
"The technology's there, it's now about creating the individual case studies and examples to inspire people to take it on more as part of the working practice... as we move into 2016, I think we'll see more of that adoption," Foster said.
In future, the system could be used for those looking to lose weight for health reasons, or as a way to engage harder-to-reach millenials with diabetes.
GPs' ability to let their patients share details through their smartphone is largely determined by the patient records software their surgery uses. While EMIS Web surgeries are able to implement the functionality, TPP, which makes the SystmOne patient records system used by around one-third of GP surgeries, has so far not announced any plans to introduce similar capabilities.
A survey of over 130 clinical commissioning groups (CCGs) -- bodies that organise delivery of primary healthcare services -- in England and Wales found mixed interest in smartphone health apps. Over 60 of the CCGs said that patients could not share details with their GPs using HealthKit, while 15 said it was currently possible. A further 11 said they were looking into enabling the functionality or might consider it in future, and another said it had looked into it, but had no plans for a rollout. Given that the ability to receive information from Patient Access via iOS HealthKit is standard with EMIS Web systems, these numbers may reflect GPs' awareness of the functionality being available, or a preference for not using it yet.
"NHS Eastern Cheshire CCG is looking into how to use telehealth technologies to support patients' health and wellbeing, with the main focus on patients' needs and preferences. Whilst this is not limited to a single product, it could include the possibility of integrating data from application programmes such as Apple HealthKit or Google Fit into patients' health records in future," NHS Eastern Cheshire CCG said.
A number of CCGs said that they are looking into healthcare apps to help patients to manage their conditions as part of IT strategy refreshes.
"The future of health and wellbeing 'apps' is being considered in the current refresh of the CCG information governance management and technology strategy. At this time no current plans exist to do anything other than explore opportunities presented by these types of technology," Nottingham North and East CCG said. Contributing patient data through HealthKit or Google Fit-enabled apps "is included as part of the Stockport Together informatics strategy for the next five years. This strategy is currently in development," Stockport CCG said.
Others cited a recent plan, the personal health and care 2020 framework, as a potential stimulus for allowing patients to submit health data from their phones to the health records held by their GPs. "It is essential that citizens have access to all their data in health and care, and the ability to 'write' into it so that their own preferences and data from other relevant sources, like wearable devices, can be included... this framework prioritises comprehensive access - with the ability for individuals to add to their own records -- by 2018," the framework document says.
While the framework doesn't mention any product by name, Apple looks to be the most obvious beneficiary, as so far, no GP software provider has confirmed plans to integrate with other mobile fitness platforms like Google Fit.
For EMIS' part, the company hasn't ruled out adding an Android version of the patient health record one day. "Early on, we reviewed Google and we may choose to revisit that in future depending on how this gets adopted. Ultimately, if this trend continues, we'll work with any data repositories -- it's about where the patient is and what they're using," Foster said.
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