Apple HealthKit recently made the news when Cedars-Sinai announced that it was integrating HealthKit with 80,000 health records, the largest implementation of the trendy new platform yet. Duke Medicine, after being one of the first health systems to adopt Apple's HealthKit software, is continuing to pioneer usage of the platform.
Ricky Bloomfield, MD, director of mobile technology strategy at Duke Medicine, spearheaded the university health system's integration of Apple's HealthKit with their Epic MyChart electronic medical record.
"We first integrated HealthKit into our Epic EHR in September 2014," Bloomfield told Healthcare Dive. "The actual technology integration was very simple. The biggest challenges have been related to determining the best clinic workflow and helping patients set up devices and understand which devices can be used with HealthKit."
Ever since the hospital's early pilot program demonstrated feasibility, clinicians from numerous departments have been expressing their interest in using the platform to engage with patients.
"We are currently engaged in an IRB-approved pilot for oncology and cardiology patients as a feasibility study," he says. "We are also working to expand HealthKit use in interested clinics across the health system."
How to manage and utilize the data
Bloomfield has been a leading voice in discussing integration and usage of patient-generated data, appearing at HIMSS15 on April 15 to discuss how Duke is getting patients' HealthKit data into their EHR and how they are using the technology to prevent hospital readmissions.
As far as how to manage and utilize that data—which has been the complex question for IT leaders—Bloomfield notes several ways Duke is zeroing in on what they see as the most pertinent data among that which patients specifically elect to share.
"Currently when HealthKit is enabled for a patient, the provider is given the option to choose minimum and maximum values for some of the data elements, including blood pressure and glucose," Bloomfield explains. "The provider can also indicate how often he/she would like to be notified when values cross these thresholds. It is our hope that this will allow providers to intervene more quickly when high-risk patients are getting sicker at home."
In additional details described to Healthcare Informatics, Bloomfield notes, "Patients cannot unilaterally enter their data into the EHR, and that's by design." He says that to organize the mass of data, each provider has a flow sheet that separates the patient-generated data from the rest of the system. That way, the patient-generated data can still be included in certain analytics but it doesn't interfere with the rest of the clinical data.
Bloomfield also recently discussed the subject of how to utilize the data with mHealthNews, saying advanced analytics and visualizations will be presented to their providers as part of their workflow. "SMART on FHIR-based applications will help serve this role," he said. "We are currently developing and testing several SMART on FHIR apps and have incorporated the platform into our Epic-based EHR."
What about the Apple Watch?
Another new development expected soon will come through the use of the recently released Apple Watch, which can be expected to impact patient behavior as far as generating and uploading data.
Bloomfield tells Healthcare Dive that Duke is planning to incorporate the Apple Watch into their clinical workflow through use of the Epic mobile apps, MyChart and Haiku.
However, as he has previously told the media, Duke is not providing patients with devices at this time, given the costs and issues involved in providing support. His hope is that ultimately, with sufficient demonstration of efficacy, payers will partner to subsidize the cost of such devices.