Apple’s eye on the long game: from music and computers to healthcare
In January, Apple, the Cupertino-based company known for its sleek design and history of innovative consumer products, announced an update to iOS that would aggregate health care data, previously locked away in medical center EHR systems, and bring it directly to patients on their phones (Apple, 2018). Industry experts predicted that Apple’s cult-like following and consumer demand for additional access to their health data could spell disaster for EHR companies which have long fought to maintain their proprietary advantage and have limited interoperability with other systems. In March, the list of centers was released, a veritable Who’s Who of health systems on the cutting edge of healthcare and precision medicine, including Stanford Health, Geisinger Health System, Vanderbilt Health, and NYU Langone Health (Apple, 2018).
At the end of February, the technology giant publicized that it was opening two concierge-style health clinics for its employees and their families under the name AC Wellness Network (Arndt, 2018, Farr, 2018). Again, pundits noted the significance of the move which puts the employer on a growing list of employers that have begun to open employee clinics in order to cut escalating health costs (Lorenzetti, 2016, Royse, 2015). These announcements have generated substantial publicity for the company and have occurred when the industry is in a state of upheaval, with rapid pace M&A activity, uncertainty about quickly evolving regulatory changes, and a growing role for data and technology to revolutionize healthcare. But these are just the latest in a long line of innovations that demonstrate the company has been moving into healthcare for more than a decade.
Apple Wellness & wearables
Remember the Nike+ iPod? Some Nike shoes had a cutout in the foam insole for an Apple sensor; by linking the Nike+ app and the iPod, users could track their running and walking mileage while listening to their favorite music (Apple, 2006, Dormehl, 2017). Where serious athletes may have been using devices from Garmin and others to track their fitness, the Nike+ iPod brought fitness to the mainstream. In a few short years, the sensors were replaced with integrated technology in the iPod and later the iPhone, hundreds of fitness and wellness-related apps were available on the App Store, and Apple would have competition for the growing number of consumers jumping on health and wellness trends.
By the time the Apple Watch was released in 2015 (Apple, 2014), smartphone use had become nearly universal and by 2016, nearly 1 in 6 consumers used a wearable technology (Piwek, Ellis, Andrews and Joinson, 2016). The Apple Watch capitalized on that trend with a device that could more nearly meet an “all in one” definition: in addition to messaging capabilities, notifications and alerts for calendar appointments, email, even stock prices, the watch has a built-in heart rate sensor and includes the Activity app, which can capture a variety of indoor and outdoor workouts, from mapping a run using the GPS to swimming laps in a pool. Consumers responded favorably to the new device, giving Apple a dominant position for market share of smartwatches (Cakebread, 2017).
Today, there are more than 90,000 apps related to health or wellness on the App Store (Terry, 2015)and numerousthird-party compatible devices like digitally-connected thermometers and blood pressure cuffs. At the 2013 TEDMED conference, a health-focused offshoot of the TED Conference, attendees were even treated to an “iPhone physical” using a variety of devices that connected to the smartphone and even emailed participants their results afterward (Parikh, 2013).But digital health is quickly moving from entertainment and wellness to patient care and clinical trials. Apple has demonstrated its intent to continue with this, beginning with the launch of ResearchKit in 2015 (Apple, 2015, Apple, 2015). Scientists and medical researchers can use the open-access platform of ResearchKit to develop their own apps for studies of disorders like asthma, Parkinson’s disease, diabetes, and breast cancer.
These apps have generated some of the largest patient enrollments seen for some trials in record time (Apple, 2016). Researchers recently published the results of a study in the Journal of the American Medical Associationwhere the Apple Watch and Cardiogram app correctly identified atrial fibrillation in users (Tison, Sanchez, Ballinger and et al., 2018). Future studies like this one could further make the case that wearable devices and digital health tools are not just for entertainment anymore.Heart rate analysis is just the tip of the iceberg. Already, numerous third-party apps leverage the technical capabilities of the Apple Watch and iPhone for disorders like diabetes and to monitor sleep quality—and there has been speculation that Apple is looking to create its own non-invasive, continuous glucose monitor (Farr, 2017). Pharmaceutical companies and scientists already have been experimenting with adding patient-collected data to clinical trials (Muoio, 2017); as digital approaches to clinical trials become more commonplace, Apple’s technologies and experience with healthcare research will may set it apart from competitors.
The user experience has always been a key factor to Apple’s consumer success and helped to set them apart from other employers. In 2014, the company announced a handful of perks for their employees, ranging from a longer parental leave and educational reimbursements to a wellness center which opened in 2013. Stocked with Apple devices, Denise Young Smith, previously head of worldwide human resources for the company, said in an interview with Fortune, ‘“It’s the experience that sets it apart”’ (Lev-Ram, 2014). Now, having a wellness center isn’t just a perk of employment—it’s a strategy that could save the company billions in healthcare costs (Arndt, 2018, Canal, 2018).
That emphasis on user experience is part of what makes Apple’s foray into medical records not unexpected. For years, consumers have been able to input blood glucose levels, body measurements, and limited other health information in Apple’s Health app, either manually or through a variety of third-party devices. With EHR adoption nearly ubiquitous across the nation, the partnership with major health centers giving patients the ability to have their medical record data on their smartphone eliminates many of the deficiencies of the Health app, which has never been as complete as a medical record would be(Apple, 2018, Dolan, 2014). Patients who travel to other health centers for specialized care, such is often the case for cancer, can find having their medical records at the tips of their fingers not merely helpful, but essential.
While some health providers offer mobile access to their patient portals, the data remains largely in control of the health system and at the whim of the EHR provider to provide that functionality. Instead of having to cart boxes of records from hospital to hospital or dealing with the lack of interoperability between different EHR systems, this announcement gives some of the control back to the patient. If consumers respond favorably, hospitals and EHR platforms may find that participation in Apple’s health records program (or similar programs) is a competitive advantage.
After Steve Jobs’ death, many suggested that beyond smart design, healthcare would be his greatest legacy (Miliard, 2011). It seems that may have always been the intent.