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Apple’s Healthcare Data Plans Become Clearer

Posted on October 3, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though it’s not without competitors, I’d argue that Apple’s HealthKit has stood out since its inception, in part because it was relatively early to the game (mining patient-centered data) and partly because Apple products have a sexy reputation. That being said, it hasn’t exactly transformed the health IT industry either.

Now, though, with the acquisition of Gliimpse, a startup which pulls data from disparate EMRs into a central database, it’s become clearer what Apple’s big-picture goals are for the healthcare market – and if its business model works out they could indeed change health data industry.

According to a nifty analysis by Bloomberg’s Alex Webb, which quotes an Apple Health engineer, the technology giant hopes to see the health data business evolve along the lines of Apple’s music business, in which Apple started with a data management tool (the iPod) then built a big-bucks music platform on the device. And that sounds like an approach that could steal a move from many a competitor indeed.

Apple’s HealthKit splash
Apple made a big splash with the summer 2014 launch of HealthKit, a healthcare data integration platform whose features include connecting patient generated health data with traditional systems like the Epic EMR. It also attracted prominent partners like Cedars-Sinai Medical Center and Ochsner Health System within a year or so of its kickoff.

Still, the tech giant has been relatively quiet about its big-picture vision for healthcare, leaving observers like yours truly wondering what was up. After all, many of Apple’s health data moves have been incremental. For example, a few months ago I noted that Apple had begun allowing users to store their EMR data directly in its Health app, using the HL7 CCD standard. While interesting, this isn’t exactly an earth-shattering advance.

But in his analysis — which makes a great deal of sense to me – Bloomberg’s Webb argues that Apple’s next act is to take the data it’s been exchanging with wearables and put it to better use. Apple’s long-awaited big idea is to turn Apple’s HealthKit into a system that can improve diagnoses, sources told Bloomberg.

Also, Apple intends to integrate health records as closely with its proprietary devices as possible, offering not only data collection but suggestions for better health in a manner that can’t be easily duplicated on Android platforms. As Webb rightly points out, such a move could undermine Google’s larger healthcare plans, by locking consumers into Apple technology and discouraging a switch to the Google Fit health tracking software.

Big vision, big questions
As we know, even a company with the reputation, cash and proprietary user base enjoyed by Apple is far from a shoo-in for consumer health data dominance. (Consider the fate of Microsoft HealthVault and Google Health.) Its previous successes have come, as noted, by creating a channel then dominating that channel, but there’s no guarantee it can pull off such a trick this time.

For one thing, the wearables market is highly fragmented, and Apple is far from being the leader. (According to one set of stats, Fitbit had 25.4% of the global wearables market as of Q2 ’16, Xiaomi 14%, and Apple just 7%.) That doesn’t bode well for starting a health tracker-based revolution.

On the other hand, though, Apple did manage to create and dominate a channel in the music business, which is also quite resistant to change and dominated by extremely entrenched powers that be. If any upstart healthcare player could make this happen, it’s probably Apple. It will be interesting to see whether Apple can work its magic once again.

Apple App Store Toughens Guidelines For Health Apps

Posted on September 13, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In a precedent-setting move, Apple has released new guidelines for its iOS App Store which impose new limitations on health and medical app developers.  iMedicalApps contributor Iltifat Husain, M.D., who wrote a piece about the changed standards, said they contain “the most stringent language I have ever seen Apple used for the health and medical category of apps.”

According to Husain, highlights from Apple’s new developer guidelines include:

  • A warning that if an app could possibly cause physical harm, Apple could reject it
  • A warning that apps which provide inaccurate data or information that could be used to diagnose or treat patients will get increased scrutiny
  • A reminder that apps which calculate drug dosage must come from the drug manufacturer, a hospital, university, health insurance company or other approved entity. In other words, independent developers cannot post a medical app for drug dosages themselves.
  • A ban on marijuana-related apps
  • A ban on apps that encourage people to place their iPhones under a mattress or pillow while charging (such as some sleep monitors)

Historically, Apple has been relatively lax about hosting potentially dangerous health apps, Husain says. For example, he notes that apps purporting to measure a consumer’s blood pressure by using the iPhone’s camera and microphone tend to be quite inaccurate in their measurements, but that Apple had not screened them out.  Now things have changed for the better, Husain writes. “Apps [like these] would not get through the screening review process under Apple’s new guidelines.”

Husain argues that the new guidelines are more important than the FDA’s recently-updated guidelines on health apps: “There is no way the FDA can regulate the hundreds of thousands of health and medical apps and the updates made to them,” Husain writes. “The screening process is what has to change.” And given Apple’s market footprint and influencer status it’s hard to disagree with him.

At this point the question is whether Google will follow suit. After all, while the Apple app store hosted 2 million apps as of June, Google Play offered 2.2 million apps, according to one study, and as of February there were three Android users for every iPhone user. So If Google doesn’t put more stringent health app requirements in place as well, creators of dodgy health apps can still develop for Android and find a wide audience.

That being said, neither Google nor Apple are required to impose new restrictions on health apps, and are likely to be governed by commercial pressure more than medical appropriateness. Also, both parties are free to set any rules they choose, and uses might not be aware of important differences between the two sets of policies. In other words, if the goal is to protect consumers, relying on guidelines generated by app store hosts probably won’t fly over the long-term.

I’m not necessarily suggesting that the FDA or other regulatory body should come down on the app stores like a ton of bricks. That would be overkill, and as Husain notes, is probably beyond their capabilities.

But doctors in the know about apps might want to warn patients about their potential limitations, and offer some criteria as to what they can expect from health apps. After all, most consumers have experimented with one health app of the other, so even if the doctor doesn’t prescribe them, patients need to be educated about their options. So if you’re a mobile health savvy clinician reading this, consider increasing patients on these issues.

Access to Encrypted iPhones – The Apple Encryption Debate

Posted on February 19, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The tech world is in a frenzy over the letter Apple’s CEO Tim Cook sent to the FBI in response to a request for Apple to create essentially a backdoor to be able to access the San Bernardino terrorists iPhone. It’s a messy and a complex situation which puts government against industry and privacy advocates against security advocates. Tim Cook in his letter is right that “this moment calls for public discussion.”

My favorite venture capitalist blogger, Fred Wilson, summed it up best for me when he said this in response to Tim Cook’s assertion that the contents of your iPhone are none of Apple’s business:

That is not an open and shut case to me.

Of course I’d like the contents of my iPhone to be out of reach of everyone other than me. But if that means the contents of the iPhones of child pornographers, sex slaverunners, narco gangsters, terrorists, and a host of other bad people are “none of our business” then that gives me pause.

I don’t think we can have it both ways. We have to choose one way or the other.

I think this is also complicated by the fact that Apple had unlocked phones previously. Albert Wenger expresses my fears around this subject:

We cannot and should not be living in digital fortresses any more than we are living in physical fortresses at home. Our homes are safe from thieves and from government not because they couldn’t get in if they wanted to but because the law and its enforcement prevents them from doing so. All we have to do is minimal physical security (lock the doors when you are out).

Please repeat after me: Surveillance is a political and legal problem, not a technical problem.

This quote is particularly interesting to me since this weekend when my family and I were away on a trip for President’s Day weekend, someone broke into our house (Side Note: We’re all fine and they realized once they got in that we didn’t have anything valuable to take. We mostly just had to deal with a broken door).

I feel similar to my favorite VC who said “I am struggling with this issue this morning, and I imagine many others are too.”

Turning to the healthcare perspective, privacy and security of health information is so important. It’s literally the intimate details of your life. I’ve heard some argue that Apple creating a way for the FBI to access this one phone would mean that all of our health information on iPhones would be at great risk of being compromised. I think that’s an exaggeration of what’s happening, but I understand the slippery slope argument.

What’s interesting is that none of us want our healthcare data to be compromised. However, if we were in a coma and the life saving information was on our iPhone, we’d love for someone to have a way to access that information. I’ve seen startup companies who’ve built that ability into the iPhone home screen for just this purpose.

I guess I’m torn on the issue. Privacy is important, but so is security. This weekend I’m going to be chewing on “We cannot and should not be living in digital fortresses any more than we are living in physical fortresses at home.” The problem with this concept is that fortresses are something we can plan and build. The other solutions are much more complex.

Is The Future of Smart Clothing Modular or Integrated?

Posted on September 4, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at

OMSignal recently raised $10M to build sensors into smart clothes. Sensoria recently raised $5M in pursuit of the same mission, albeit using different tactics. Meanwhile, Apple hired the former CEO of Burberry, Angela Ahrendts, to lead its retail efforts.

And Google is pushing Android Wear in a major way, with significant adoption and uptake by OEMs.

There’re two distinct approaches that are evolving in the smart clothing space. OMSignal, Sensoria, and Apple are taking a full-stack, vertical approach. OMSignal and Sensoria are building sensors into clothing and selling their own clothes directly to consumers. Although Apple hasn’t announced anything to compete with OMSignal or Sensoria, it’s clear they’re heading into the smart clothing space in traditional Apple fashion with the launch of Health, the impending launch of the iWatch, and the hiring of Angela Ahrendts.

Google, on the other hand, is licensing Android Wear to OEM vendors in traditional Google fashion: by providing the operating system and relevant Google Services to OEMs who can customize and configure and compete on retail and marketing. Although Google is yet to announce partnerships with any more traditional clothing vendors, it’s inevitable that they’ll license Android Wear to more traditional fashion brands that want to produce smart, sensor-laden clothing.

Apple’s vertically-integrated model is powerful because it allows Apple to pioneer new markets that require novel implementations utilizing intertwined software and hardware. Pioneering a new factor is especially difficult when dealing with separate hardware and software vendors and all of the associated challenges: disparate P&Ls, different visions, and unaligned managerial mandates. However, once the new form factor is understood, modular hardware and software companies can quickly optimize each component to drive down costs and create new choices for consumers. This approached has been successfully played out in the PC, smartphone, and tablet form factors.

Apple’s model is not well-suited to being the market leader in terms of raw volume. Indeed, Apple optimizes towards the high end, not the masses and this strategy has served them well. But it will be interesting to see how they, along with other vertically integrated smart-clothing vendors, approach the clothing market. Fashion is already an established industry that is predicated on variety, choice, and personalization; these traits are the antithesis of the Apple model. There’s no way that 20% or even 10% of the population will wear t- shirts, polos, tank tops, dresses, business clothes, etc., (which I’ll collectively call the “t-shirt market”) made by a single company. No one company can so single-handedly dominate the t-shirt market. People simply desire too many choices for that to happen.

OMSignal and Sensoria don’t need to worry about this problem as much as Apple since they’re targeting niche use cases in fitness and health. However, as they scale and set their sites on the mass consumer market, they will need to figure out a strategy to drive massive personalization. Apple, given its scale and brand, will need to address the personalization problem in the t- shirt market before they enter it.

The t-shirt market is going to be exciting to watch over the coming decades. There are enormous opportunities to be had. Let the best companies win!

Feel free to a drop a comment with how you think the market will play out. Will the startups open up their sensors to 3rd party clothing companies? Will Apple? How will Google counteract?

Around Healthcare Scene: EMRs and Health Technology Talk

Posted on March 10, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMRs are supposed to increase efficiency and patient care. However, because of the amount of data they contain, sometimes the opposite happens. Anne Zieger discusses a recent report in Modern Healthcare, which talks about how nearly 30 percent of PCPs claim that they missed notifications of test results, leading to a delay in care, thanks to the over-abundance of information the EMR collects.

Would the use of mHealth technology such as tablets and smart phones cause harm like this as well? We’re sure to find out soon with mobile technology advancing among providers. Research shows that some providers are “gradually shifting their use of smart mobile devices from business functions like e-mail and scheduling to a much wider range of activities. Be sure to read some of Anne’s thoughts on the matter, and find out if this growth will continue at this pace.

And speaking of tablets, around 4,000 home care staff will be receiving a brand new Android tablet. Bayada, a national home care agency has recently sent out Samsung Galaxy Tabs to therapists, medical social workers and other home health professionals. Considering the fact that iPads are often the tablet of choice, this was an interesting move. The workers can document information while at a patient’s home, as well pull up data before going to the house. Will more healthcare providers be taking on the Android tablets, because of their lower cost? Chime in over at Hospital EMR and EHR.

There’s always some kind of new app being created to help people keep track of their health. Now, people can use uChek, an at-home urinanalysis, to keep their health in check. The mobile app, along with the uChek kits, allow people to test their urine for a variety of different markers. While it shouldn’t be used to replace a necessary visit to the doctor’s office, it could help prevent certain issues from getting worse by catching them early on.

With all this talk of technology in the healthcare world, one might wonder how it affects patient engagement. We recently switched pediatricians for my house, and while the last office was very tech savvy, this new office doesn’t have a computer in the offices, they give out paper prescriptions, and they have paper files. And to be honest, I love this office way more because of how personal the visit was, with no technology to distract the doctor. At our old office, the doctor stood far away from us, only looked at the computer the majority of the time, and it just wasn’t personal. However, because a lot of the mHealth technology does a lot of good, Dr. West over at the Happy EMR Doctor has some suggestions. He has created a list of 7 tips to help improve EHR etiquette, and this is definitely something all healthcare providers should follow. Just because there’s technology, doesn’t mean the importance of patient engagement should disappear as well.

How Serious Is the Security Threat to Connected Medical Devices?

Posted on June 23, 2011 I Written By

I’m in New York City this week for the second Mobile Health Expo, which wrapped up Thursday afternoon. You may have seen the story I wrote for InformationWeek based on one session related to the security of networked medical devices.

Since I just do news and not commentary for InformationWeek, I figured EMR and HIPAA—specifically, the HIPAA part— was the perfect forum to discuss a small controversy that I may have stirred up with that story.

The two presenters from Indianapolis-based security firm eProtex talked about how connected medical devices have recently been popping up all over the place. “As little as two years ago, we checked some hospitals and found that there was less than one networked clinical device per bed,” eProtex Executive Director Earl Reber said.

With network connection and exposure to the Internet came heightened threats from viruses and malware, both internal and external, Reber and eProtex Chief Security Officer Derek Brost said. Sometimes it’s because devices are so old that they still run DOS and simply weren’t built for the HIPAA era. Other times, the greater reliance on various versions of Windows makes medical devices vulnerable to attacks.

Often, Brost said, hospitals are trying to protecting the wrong assets. “It’s not the actual medical device in most cases [that is at risk]. It’s the individual patient’s health information,” he said.

All this makes a lot of sense, though it is important to note that the warnings are coming from a security vendor with a real interest in selling products and services to prevent and combat insidious threats to medical equipment and other connected devices such as smartphones and tablets.

This was not lost on at least one person, “ZigZagZeke.” In a comment titled “Ignorance,” this poster said in no uncertain terms:

The speaker is using scare tactics to try to make sales of his protection software. Makers of such software are desperately trying to convince people that their Apple products need protection, because as more and more users switch to Apple, sales of anti-virus software are declining. This use of scare tactics is know by an acronym: FUD, which stands for “fear, uncertainty, and doubt.” It is the speaker’s only hope.

I suspect some of the criticism was directed at me for not differentiating between malware and viruses or between Linux/Unix/Macintosh and Windows.

Did I screw up here by not pressing the speakers on these differences, or are Apple devices and operating systems becoming just as vulnerable to data corruption as Windows? Windows became a prime target not just because of security holes, but because of its ubiquity. Now, the iPad and iPhone seem to rule at least the physician market. Wouldn’t that critical mass put Apple iOS in the crosshairs of a growing number of hackers and malware spreaders?

So what’s the real story here? As devices get connected to EMRs and hospital networks and produce more protected health information (PHI), should healthcare providers be concerned about greater HIPAA liability? If so, where should they focus prevention efforts?

iPad EMR

Posted on April 8, 2010 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

EMR and EHR has been getting a ton of traffic related to my posts on the iPad EMR. It’s a really interesting discussion that I think people that love technology and EMR will enjoy. I have no doubt that the interface that the iPad is helping to promote and develop is going to have a major impact on healthcare. Not that everyone will have an iPad in healthcare, but that the technology behind it will be copied and we’ll see lots of interesting documentation methods for EMR software.

Dr. Larry Nathanson, MD from BIDMC seems to disagree with me in his writeup about his experience using the iPad in an Emergency Room. However, what I found most interesting about his writeup is his comments about the challenges of the iPad.

The first was how well it will hold up in a clinical environment. The iPad doesn’t seem to be the most rugged device and clinics like to abuse devices (from my experience). The second was the challenge that plagues all tablets: difficulty entering strong passwords. between the numbers, symbols and mixed case, it’s harder to enter these passwords on a device like the iPad. Is biometrics the solution to that?

What do you all think about the iPad and EMR? Will we see an iPad only EMR develop into a real power player in the industry?

Body of Medical Knowledge Too Complex for the Human Mind

Posted on May 20, 2009 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a recent comment, Steven suggested that an EMR and HIT in general might be necessary because the volume of medical knowledge is so large and complex that it’s too complex for the human mind. Here’s a short section of his comment:

Another set of reasons to adopt EMR, and sooner rather than later, are the reasons that are beyond the horizon. With the rate of change continuing to accelerate in the health care industry, along with our body of medical knowledge, I see a day where a person’s care plan is simply going to be too complex for a human brain alone to work out all the contributing factors. Sometimes I think we’ve already reached that point and haven’t quite realized it yet.

I absolutely love this concept of the body of medical knowledge being “too complex” for us to work it all out on our own. The idea that we need good clinical decision support systems, EMR and other technology we might not have even developed is really intriguing to me. Reminds me of my previous post about not knowing the true benefits of EMR.

The basic concept being that we won’t know the real benefits of EHR adoption until we have a platform for smart people to be really creative. Think about the Apple iPhone. If you look at the creativity that’s come out of the iPhone platform, it’s amazing. However, we would have never seen all this creativity until the platform was adopted in a broad way.

I believe that being able to managing and delivering all the medical knowledge out there is going to be one of those long term benefits we can’t realize until we have broad EMR adoption.