First, there was HealthKit, Apple's platform for tracking health and fitness data through your iPhone or Watch. Then came ResearchKit, the Apple framework for gathering health data from iOS devices for use in medical research. Now, CareKit, announced in March, could be able to set to fill in the gaps.
The aim of CareKit, according to Apple, is to create a software framework that developers can use to help people "to actively manage their own medical conditions".
There are similarities between HealthKit and CareKit -- both can be used by patients to gather information on a condition and potentially provide data back to healthcare providers. In the case of HealthKit, an individual could take blood pressure readings to track their hypertension; in CareKit, that could be monitoring your mood to see if a medication is working -- as in the case of Iodine's CareKit app, Start.
While both are health-focused, HealthKit is as much about good health as ill health, whereas CareKit's focus is more on the how to manage longer-term illnesses and other events that can affect health on an ongoing basis, such as pregnancy or surgery.
Apple has released four 'modules' as part of CareKit, which developers can use to build care apps: Care Card, a tool that allows patients to track if they're taking their medical or completing other therapies as scheduled; Symptom and Measurement Tracker, for patients to keep tabs on the physical and mental effects of their illness and treatment; Insight Dashboard, which compares the two datasets to see how treatments are working; and Connect, which patients can use to share their data with friends, family, or medical professionals.
"There is this middle area [between ResearchKit and HealthKit] that's so important -- which is around routine, day-to-day, clinical decisions. How can mobile technologies in general and iPhone in particular be used to solve that problem or address that opportunity? That's what the impetus behind CareKit," Thomas Goetz, CEO of Iodine, told ZDNet.
Iodine was one of the first handful of organisations to work with Apple on CareKit, along with the Beth Israel Deaconess Medical Center; One Drop; Glow, Inc; The Texas Medical Center; and Sage Bionetworks and the University of Rochester.
Iodine's Start for Depression app allows those with depression to track the effectiveness of new treatment regimes, and uses modules including Connect and CareCard.
"For most people it takes about six weeks for a medication to fully kick in, and meanwhile you're coping with the symptoms of your depression and the side effects of your medication... We thought we could make this trial-and-error process informed and hopefully faster by giving people a clear sense of how they're doing and how the medication is doing," Goetz said.
App users complete a PHQ9 questionnaire to monitor their mood every couple of days, and can use the data to see if a change in treatment has brought a corresponding change in symptoms, or not. By allowing people to track subjective symptoms -- how they're feeling over time, for example -- in an objective way, the app can give the patient a clear idea of how a treatment and its side effects are affecting them. The data can also be sent to their physician in a stripped down format.
"We talked to doctors about what they wanted to see... we asked them how long would you, as clinicians, give us to show you data. They said, 'we will give you 12 seconds to produce a report'," Goetz said. "What we had developed for the patient would take a lot longer than 12 seconds. There was a recalibration of the amount of information, we dialled it back, we timed it, and we made sure the doctor-facing view is something they can scan and get the gist of the information they would use to make a clinical decision in 12 seconds."
At present, the information has to be faxed to doctors -- "the reason we use fax, as antiquated as that seems, is that two-thirds of doctors in the US still use fax, it's still the coin of the realm" -- though Iodine is also looking at how to integrate the data with healthcare providers' electronic health records. "CareKit got us part of the way there. This last foot requires a manual technical integration," Goetz added.
CareKit is not just being taken up by consumer-focused app makers, but by healthcare institutions themselves.
The Texas Medical Center, another of Apple's CareKit early adopters, is also working on apps using the platform that can be used to share information between patients and their physicians. The Center, which encompasses 21 hospitals, two medical schools, and six nursing schools is working on an app for those who have just had cardiothoracic surgery. With around 20 percent of surgery patients having to return to hospital within 90 days after their operation, the Texas Medical Center hope the app will allow the organisation to monitor the signs that a patient may be experiencing difficulties.
"When you leave the care of hospital, typically you'll be given some paperwork to take with you. That goes into the back of [the patient's] car and stays there, and then people go off on their own. Imagine if you could take those care pathways and could transfer them from your electronic medical record to your cellphone," William McKeon, COO of the Texas Medical Center, told ZDNet.
As well as offering patients information on how to improve their health when they're out of hospital -- reminders to take light exercise like walks, for example -- it can also send information back to the physician and to the center's medical records.
"What was exciting about the CareKit approach was that many of the components you would need already come in a package that you could very quickly develop. Our vision is to take our medical data right from an electronic medical record, put it into the system, let the application coach the customer along, for example, to get on the scale... Weight is a really important measure to see how patients are doing -- patients doing well after surgery rarely gain weight after surgery. That's an indication to the surgeon or the care team that there's a problem," McKeon said.
The patient could either manually enter their weight, or have a Bluetooth-enabled scale that works with Apple devices enter it automatically. "The care thing about CareKit is they've already done the heavy lifting," McKeon added.
The Texas Medical Center is also planning to use the CareKit to build a suite of apps that can be customised to suit the condition they're designed to monitor or even according to the healthcare team using them.
Using mobile technology like CareKit, healthcare can go from being something that just happens in the hospitals or physicians' offices to being delivered wherever the patient happens to be, according to McKeon.
"That's what we want from the healthcare system: we want it to be as efficient as possible, we want our the buildings to be filled with people that need to be seen, and we don't want people coming into the buildings when they don't need to be seen. How do you do that? You connect, you get good objective and subjective information to allow them to be well at home, and identify those things early and on and get them in well ahead of them having an urgent event."