Digital Health Platforms – A look at Apple HealthKit’s early lead

A Reuters report last week claimed that Apple’s HealthKit is being trialled by more hospitals in the US than Google Fit. Fourteen out of twenty-three ‘top’ (no info on how they were selected) hospitals contacted had already rolled out a pilot programme with Apple, way ahead of where they are with other significant personal health platforms. This clearly indicates that the convergence between personal devices and real medical healthcare, is beginning to move beyond the somewhat narcissistic counting of steps, fitness goals etc, at least in the US.

So what are the major players doing, and how do their solutions compare?

Apple HealthKit – The frontrunner 

Apple’s HealthKit platform was introduced in the latest version of its iPhone operating system, iOS 8. At its heart lies a central repository, residing on the phone where health and fitness data can be shared between apps and wearable devices. This platform has been embraced by many manufacturers of wearables, including Jawbone, Withings and Nike. Pointedly not Fitbit, who presumably feel that they have enough of a brand, device and market presence to wait out any commitment, and push their own data platform which extends beyond Apple devices.

Apple Health App
Apple Health App

So how does Healthkit work? Essentially, it provides a single database in the phone where data from a users iPhone, Apple Watch and compatible hardware can be collated. For FDA health data compliance reasons and liability, Apple will not store any of this data on the iCloud, but will instead allow HealthKit compatible apps to access the information and pass it on to other systems – obviously with the user’s consent. In the wake of the Apple iCloud security issues last year, Apple have been questioned repeatedly by the FTC about the security of personal health data. Typically this data will include activity tracking, weight measurements, food consumption, and any other user-input data from relevant health apps. As an example of what lies ahead, a company called DexCom has produced a glucose monitor app and a tiny under-the-skin probe to monitor glucose levels which can be monitored via apps on the iPhone and the soon-to-be-launched Apple Watch.

Apple HealthKit. Source: InTouch Solutions
Apple HealthKit Architecture. Source & Copyright: InTouch Solutions

What is significant in this context is a partnership between Apple and Epic Systems, a healthcare records company that manages over 50% of patient data in the US, serving over 170m patients per year. Already, Epic’s MyChart app gives patient access to lab results, appointment info, medications and so on. Now, it is able to add patient data collected by the HealthKit system into its Electronic Hospital Record (EHR) systems. In this way, HealthKit acts as the main gateway between all the apps and devices collating health-related information (pulse, temperature, glucose, oxygenation etc) from where it can then be accessed by other platforms. Presumably most of the trials mentioned above are using this integration by Epic as basis of their trials.

Google Fit – Still early steps

As its name implies, Google’s proposition in the digital health space, Google Fit, is currently targeted at the fitness market rather than the broader health space. In fact, Google goes so far as to say that medical or biometric data should not be stored on the Google Fit system, an acknowledgement perhaps, that it is not yet fully compliant with the relevant regulatory regime for health data. In fact Google’s approach is quite different to that adopted by Apple. Like in Healthkit, the data collated by devices and apps is stored in a central repository.

Google Fit

However that data store is in the Google Cloud rather than on the device and can be accessed by any website or app across any device type (Android, iOS, Windows Phone etc) that has been granted permission by the user. So while the platform is currently useful for sharing fitness goals achieved, it does not really provide a meaningful solution for health applications.

Microsoft Health – Built in the Cloud

So this leaves us with the third major player in this space – Microsoft, with its imaginatively titled Microsoft Health platform. Like Google’s offering, Microsoft Health is a cloud-based solution, but one that is targeted at both health and fitness application. The area where Microsoft seeks to differentiate from its rivals is in its use of machine learning and artificial intelligence using its “Intelligence Engine” to provide actionable insights on training, calorie consumption, weight loss, sleep etc. So far, the platform is compatible with all major smartphone platforms, though device support is limited to a smaller set of devices and Microsoft’s own Microsoft Band (see review here) and, if the press is to be believed, an upcoming smart watch produced by Asus.

Microsoft Health - (c)  Microsoft
Microsoft Health – (c) Microsoft

Microsoft’s intention appears to be to use Microsoft Health as a complement to its HealtVault patient data system which is targeted at hospitals, health providers as well as patients. Like Epic’s MyChart app, users of HealthVault can keep all details relating to their healthcare, such as medications, appointments, lab results in one place.  However, for the time being, the strategy appears to be somewhat muddled, as numerous third-party devices such as Fitbit already interface directly into HealthVault, and both propositions currently are patient-facing. I can only assume that in time, these will be rationalised so as to provide a single patient-facing product, coupled with extensive cloud-based integration to hospitals and other healthcare providers.

Conclusion

In a nutshell, it appears that both Apple and Microsoft are playing to their strengths. Apple is ensuring that its iPhone and Apple Watch users will have access to best-in-class health and fitness products, while leaving the management and integration of sensitive patient data to other parties. Microsoft on the other hand is playing in all the right spaces for a software and cloud services provider, providing health data aggregation services for healthcare providers as well as cross-platform health and fitness solutions for users. Time will tell whether the execution of this strategy will match its ambition. As for Google, since it withdrew its Google Health platform, it now seems to have more modest plans, focusing on fitness rather than a full-fledged digital health solution, and so at this stage cannot really be considered a serious player.

Moving forward, it will be interesting to see how business models and healthcare approaches evolve to take advantage of biometric and medical data being collected from personal devices. Already, employers in the US are considering sharing employee data with medical insurance providers in order to reduce individual or company-wide premiums, in similar ways to which car insurance providers can tailor premiums according to driving style as measured by a tracker in the car. Indeed, one insurance company, Oscar Insurance is already providing cash incentives in the form of gift cards to customers who exceed their fitness goals as measured by a free fitness band it gives them. Notwithstanding whether these business models succeed or not, it is clear that collation and analysis of personal biometric information will very quickly become a significant part of disease prevention and treatment toolkit.

 

 

 

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