- The Apple Health Records EHR data viewer released in 2018 has steadily grown in popularity over the past eight months, and industry leaders already expect the feature will make waves in health IT innovation, patient engagement, and interoperability.
At the ONC 2nd Interoperability Forum, Apple Clinical and Health Informatics Lead Ricky Bloomfield, MD, offered insight into how Apple Health Records works and why it holds such promise for advancing interoperability, health data exchange, and health data use.
Most notably, the Health app leverages the Fast Healthcare Interoperability Resources (FHIR) standard developed by HL7 for data sharing. While FHIR is still a draft standard and is not scheduled to be finalized until the end of 2018, proliferating the use of FHIR may help to ready the healthcare industry for widespread adoption in the future.
The Health app uses FHIR to aggregate patient health data from disparate sources and present the information to patients in a consumer-friendly interface on iOS devices.
“It makes it very easy for you to manage your health information,” Bloomfield told attendees of the ONC 2nd Interoperability Forum on August 8. “You as a user have complete control over who has access to the data. If you don’t want to share it, it won’t be shared. It stays private on your device until you decide to share it.”
The newest feature on the Apple Health app — Health Records — connects with partner health systems using FHIR to collect EHR data and populate user devices with clinical information.
“To be specific, this leverages the Argonaut implementation guide,” explained Bloomfield.
“Standards are only real if they’re used and if they’re used at scale,” he continued. What we’ve seen is that by adopting the Argonaut implementation guide — which is a more constrained implementation of FHIR — adoption will be greater and far easier for those who wish to adopt this.”
In the early days of the Apple Health Records feature project launch, Apple worked with Epic, Cerner, and athenahealth to access and aggregate patient EHR data.
“They’ve expressed an interest in this for quite a while,” said Bloomfield. “They implemented this Argonaut guide.”
Since the initial feature launch — which included 12 health system participants — the Health Records feature has grown to include almost 80 health system participants that include hundreds of hospitals and clinics.
When a user opens the Health Records feature, he is presented with a list of available health systems. The Health Records feature uses the consumer’s location to first present hospitals and clinics near the user. However, users can search for and connect with any participating health system across the country.
Once the user selects the health system he wants to connect with, he is presented with an OAuth sign-in page.
In a demonstration, Bloomfield used the Health Records feature to connect with UNC Health Care.
“The Health app connected directly to UNC’s FHIR end point — a standard FHIR endpoint — and securely downloaded the records directly from that health system,” explained Bloomfield. “The data that was there did not traverse any Apple servers. It was a direct connection from UNC to the phone I’m holding.”
Once EHR data from UNC populates the Health Records app, users can access information part of the meaningful use common clinical dataset including allergies, vital signs, conditions, immunizations, medications, labs, and procedures.
“If I tap on all records, this represents a single longitudinal record which is easy to understand, secure, and may be updated automatically,” said Bloomfield. “In fact it is updated automatically. When this connection happens to the health system, it’s an enduring link. When new records are available, those records are automatically downloaded to your device.”
“That significantly reduces the friction typically associated with accessing your health information where you need to remember your credentials, log in, and then get the information,” he continued. “And when you have new information, you may get an email that there’s new information, but you still need to log in to access the information.”
With the Health Records feature, new information from a user’s health system is automatically updated and saved to iOS devices.
“So when you actually need it — when you’re at clinic trying to fill out that form — it’ll be right there in your pocket,” Bloomfield noted.
The feature includes straightforward, simple data visualizations that can highlight any values that are out of range if a reference range is provided from the health system. Additionally, users can view all FHIR data in raw form. Displaying the raw FHIR data used in the feature helps to promote complete transparency.
Overall, the feature serves as an example of the potential for increased health IT standardization to surmount long-standing challenges associated with health data exchange and aggregation.
“This is a testament to what happens when you adhere to a standard that folks agree on a very strict way to implement it,” said Bloomfield.