
Healthkit  - vidyesh
https://developer.apple.com/healthkit/
======
kyro
This focus on health from Apple is a big move. It's a signal that, for now,
the digital health/QS space is here to stay.

They're taking out a large chunk of general wellness apps. Apps like Fitbit,
LoseIt, etc, will be rendered significantly less useful with Apple now
controlling the experience for the majority of commonly captured health data
(calories, sleep, nutrition, etc). Wearable and other health companies will
have to find a way to differentiate their app offerings by including features
well outside the scope of Health and HealthKit (think Strava and RunKeeper).
Apple is also going after the PHR space, specifically Microsoft's HealthVault.
The PHR space has historically struggled to catch on (e.g. Google Health), but
I suspect both Google and Microsoft's products were ahead of their time.
Although I have concerns about whether PHRs are actually useful, Apple with
its marketshare might finally make them mainstream. I can see them extending
their new Family Sharing features to family PHR management.

However, I'm struggling to think of how Apple may be able to crack the
barriers to data access on the provider/EHR side, if they aim to.

~~~
specialist
I prototyped the personal health portal for a handful of our customers
(hospitals). Circa 2008. Little different from Google Health or Microsoft
HealthVault. Some deploys went live but most were still born.

The money people were motivated by increasing admissions, thru greater
engagement, etc.

The doctors were completely uninterested. They would never trust patients self
reporting.

I anticipate adoption will be driven by

#1 niche use cases, such as home blood glucose monitors, where the data
gathering is automatic

#2 younger doctors more comfortable with the newer tech

#3 patients embracing the "quantified self" movement

~~~
doc99
I'm a doctor and I don't see these personal health portals being utilized by
physicians. Unless they sync to the docs EMR and they don't have to do
anything extra, then they won't be utilized. Doctors don't take/have time to
sift through that kind of information for every patient. Too much volume. Too
much detail. Docs make decisions based on parcels of data, not continuous
streams. Most docs would be shocked by the hourly variance in a patient's
pulse and bp and end of overprescribing.

The real use of phrs is for insurance and drug company data mining. Drug
companies could perform mass retrospective trials very cheaply, and insurance
companies could make huge quality/cost analyses, thereby "directing"
healthcare cost and physician treatment.

As a doctor, I actually see these potentials as beneficial, though possibly
restrictive for docs until medical education caught up.

Feel free to email me about this to. Kmitch00@yahoo.com

~~~
leonth
Do you see value in having longitudinal / long-term trend of the pulse, BP,
etc? Intra-day variance may be very high, but wouldn't there be value of
having an average of 100 measurements over a month, as compared to the 2
measurements that you do in the clinic?

Doesn't mean that the doctor needs to see the data as it goes in - you can
review the average BP over 1 month when the patient comes for consultation,
for example.

~~~
AUmrysh
There's a big push right now to implement such systems. Hospitals now have a
monetary incentive, due to the ACA, to not have patients return for anything
more than a follow up for something like 30 days after an emergency room visit
[1]. I'm not sure what Apple has to offer in regards to this kind of data
storage, but it's going to have to be HIPAA compliant if they want any sort of
acceptance.

Also, a lot of what is being done is automated monitoring. An algorithm can be
developed to measure, for example, blood pressure, and if the patient deviates
from acceptable ranges, the algorithm can trigger a contact to the patient,
their healthcare provider, and family to begin an intervention to correct the
bad blood pressure.

Adherance (doing it when you're supposed to) and validity (the measurements
reported for Bob Smith are actually from Bob Smith) are big concerns, and
there are also a lot of things done to ensure that the patient is doing their
part correctly.

[1]: [http://www.acep.org/Legislation-and-Advocacy/Practice-
Manage...](http://www.acep.org/Legislation-and-Advocacy/Practice-Management-
Issues/Physician-Payment-Reform/Medicare-s-Hospital-Readmission-Reduction-
Program-FAQ/)

------
exceptione
_A user’s health information is stored in a centralized and secure location
and the user decides which data should be shared with your app._

Well, that 'centralized location' (accessable by Apple) would require my trust
a bit too much.

~~~
k-mcgrady
I was under the impression the data was stored locally and not with Apple. I
thought the 'centralised' place they were referring to was the Health app.

~~~
exceptione
Centralized would then mean local, and that's almost never the case as far as
I have seen such service advertisings.

~~~
rimantas
Yes local, meaning on your device, centralised, meaning each app has access to
some central repository instead of havint its own.

------
jnorthrop
> A user’s health information is stored in a centralized and secure location
> and the user decides which data should be shared with your app.

I'm glad the information is stored securely and the user has control over what
is shared with targeted apps, but it says nothing about what is shared with
Apple. Companies need to be clear about these things right up front.

~~~
Brakenshire
In my opinion, this sort of data needs more than "we double promise we'll
store it securely".

~~~
codyb
It's starting to remind me of the book 'The Circle" by Dave Eggers[1]. Where a
company ("The Cirlce") eventually, essentially, takes over the control of all
information in the world.

It wasn't my favorite book, although I very much respected my Mom for getting
it for me. It's an easy read. And it makes you realize what could potentially
happen I suppose. It's like 1984 written in 2010. And the ending...well I
won't spoil it. Probably worth the read for the reminder. And it is very
engaging. A lot of my complaints are almost metaphysical in nature. In that it
is very hard to describe definitively what my issue was.

[1] [http://www.amazon.com/The-Circle-Dave-
Eggers/dp/0385351399](http://www.amazon.com/The-Circle-Dave-
Eggers/dp/0385351399)

------
sgarman
I interested in how wearable companies use this. If they give up their data to
Apple that removes a large barrier for users to adopt a different wearable
company(or apples own product). On the other hand users might demand their
current wearable product work with the health app.

~~~
neohaven
I would be more inclined to use a product that interacts with it cleanly for
specifically that reason. It just means that the quality of the hardware and
software needs to be the differentiator, instead of it just being "Whoops,
you're stuck in this silo now."

It just seems better to me, even for the market itself.

~~~
VLM
Oh you're still going to be stuck in a silo, it'll just be an Apple branded
silo instead of a Runkeeper branded silo.

Switch to Android? Hope you aren't keeping your insulin / blood sugar records
in there.

~~~
dawson
There's nothing stopping you, or the developer of your chosen application
exporting/downloading/synchronising the information from HealthKit's APIs.

------
marincounty
Aside for diabetics, I have found most people don't want or need to monitor
their vital signs. Plus, it's a reminder of how unhealthy it is to sit in font
of a electronic devise. Now, if the technology got great and could monitor
lipid levels I might be interested. On the other hand, when my time is up I
don't want Apple emailing me a Advanced Directive? "Good morning--did you sign
your organ donor card? You have a 79% percent chance of a spinning wheel
today, or window speak, you might have a blue screen today? Please, download
our Pallitive care song app?" Would Jobs want to be reminded daily of his own
mortality? No-- , I really miss that man. Lately, I have been thinking of
making my MBP a Linux machine; That thought never would have entrpered my head
If Jobs' was still around.

~~~
Infinitesimus
I don't think it is worth much to speculate about what an individual _would
have done_. We can't predict the future or human actions that well. There are
several internal forces at work with Apple that we do not know much of. It's
not like Jobs never made bad decisions...

------
aquadrop
Apple could provide push for others to follow. This can be very big change in
the way medical system works.

------
dawson
Well, I'm excited!

Interoperability, standards, security, governance, (PAS) integration, health
professionals mindset change are all required too – however, if EHR/EMR/PHR
[clinical/enterprise] innovation is ever going to happen, it's going to be
driven by consumers. I'm sure all the integration/interface engine vendors
will be working over time for the next few months.

I especially liked this line :P ...

“How are you?” now has a really accurate answer
[http://www.apple.com/ios/ios8/health/](http://www.apple.com/ios/ios8/health/)

------
shas3
Apple probably has to work on improving the accuracy of activity monitoring on
its devices.

This paper from ACM Ubicomp 2013 concludes (as of ~2012), that iPhone (Moves
App)performed worse than Nike+Fuelband, Nike+Sportsband, and Fitbit in
tracking step-recording, with Fitbit performing the best.

[https://www-old.comp.nus.edu.sg/~brown/pdf/pdm_workshop2013....](https://www-
old.comp.nus.edu.sg/~brown/pdf/pdm_workshop2013.pdf)

~~~
orasis
The iPhone 5s now has dedicated movement tracking hardware with the M7 chip.

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ejain
It seems near impossible to create a service in this space that is both
general purpose and also usable enough to get the kind of adoption that a
company the size of Apple needs to justify its involvement.

So I'm really eager to see what Apple has come up with, and how it's going to
be different from Microsoft HealthVault, Google Health, RunKeeper's
HealthGraph, and Samsung's SAMI.

------
hakcermani
The healthStore is probably like the contacts database on the phone. Apps will
need the user permission to access (read/write) to the store. Like contacts
Apple might make the only sync option for the healthstore via iCloud. It is
also likely that the structured data options on the healthstore will not
satisfy all class of apps, except to what is supported by healthkit.

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joshdance
This is another step in the long long road to everyone being able to easily
track their health electronically. This will not be the break-thru, but it
will help.

------
msuprovici
If Apple successfully handles EHR integrations & HIPPA, it will create a
significant opportunity for developers to improve our healthcare system.

~~~
XorNot
Why would Apple bother with this? This is functionally them entering the
"fitbit" space.

It's showing people neat graphs, which they'll rapidly get bored with because
at the end of the day once you're even slightly away from reinforcing the
feedback loop of "how much of a good person am I by proxy of my
exercise/weight/calories?" _no one cares_ and people specifically do not want
to know.

Everything else about health is messy, full of legacy systems and liability,
and completely facing away from the consumer.

~~~
msuprovici
I agree with you. Most people don't care about neat graphs and data.

Apparently, Apple is already integrating with Epic, one of the largest EHR
systems out there. Preventive health is becoming a large opportunity and I
think Apple is aspiring to become the main platform here.

------
orasis
Does anyone have a link to the actual API docs?

~~~
daigoba66
I would love to see what this is actually capable of. I suspect, at least for
now, it's probably limited to not-so-useful counters like weight, height, age,
calories, etc. I'd love to this turn into a full fledge PHR that people
actually want to use, but I'm leary of that happening (see passbook).

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mercantiles
I'm surprised by how minimal this is.

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wnevets
do we really need separate post for each of these?

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seanhandley
There goes your health insurance premiums.

~~~
markolschesky
In the United States, insurers can no longer discriminate against members
through the ACA in most ways (like healthkit):

(a) IN GENERAL.—A group health plan and a health insurance issuer offering
group or individual health insurance coverage may not establish rules for
eligibility (including continued eligibility) of any individual to enroll
under the terms of the plan or coverage based on any of the following health
status-related factors in relation to the individual or a dependent of the
individual:

(1) Health status.

(2) Medical condition (including both physical and mental illnesses).

(3) Claims experience.

(4) Receipt of health care.

(5) Medical history.

(6) Genetic information.

(7) Evidence of insurability (including conditions arising out of acts of
domestic violence).

(8) Disability.

(9) Any other health status-related factor determined appropriate by the
Secretary.

~~~
gergles
They can still change the premium.

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general_failure
This sort of explains Samsung's recent simband release. Samsung just wanted to
throw something out of the door before apple.

