Issue link: https://beckershealthcare.uberflip.com/i/961245
98 CIO / HEALTH IT Geisinger's Dr. Alistair Erskine shares 5 elements of Apple's Health records app By Julie Spitzer I n late January, Apple said its latest iPhone iOS update would in- tegrate patient health records into its Health app as part of a beta run, shaking up the EHR industry and taking a giant leap toward interoperability. e company partnered with prominent EHR vendors — including Epic, Cerner and athenahealth — to integrate patient data into the iPhone's Health app in a way that would abide by Fast Healthcare Interoperability Resources guidelines, the standards for transferring electronic medical data. A dozen hospitals are taking part in a pilot of the program, includ- ing Baltimore-based Johns Hopkins Medicine, Danville, Pa.-based Geisinger, Los Angeles-based Cedars-Sinai and Philadelphia-based Penn Medicine. e feature will be available to their patients with an iPhone and a patient portal. Since Apple aims to embed patient data from multiple providers into the iPhone's main system, the app could enable patients to grant permission for other app developers to use their data and provide the best deals on medications or connect patients taking the same medications, among other features. Alistair Erskine, MD, chief clinical informatics officer at Geisinger — one of the 12 hospitals pioneering Apple's health records — has been working with Apple on this roll out. "We've had a relationship with Apple for a long time. I think that one of the reasons is that Geisinger is obsessed with improving our patient experience," Dr. Erskine says, adding it makes sense to partner with organizations that have demonstrated the value they bring to the con- sumer experience. "[Geisinger] likes to partner with non-typical organizations that are outside of healthcare to learn from them what is the better way to … understand the whole patient and to be able to meet their expecta- tions," he says. "I think it was a natural fit with Apple. And, in terms of Apple's health record component of their Health app, we saw it as an opportunity to take advantage of some of the industry advances that have been made over the recent few years." He shared the project's five dimensions with Becker's Hospital Review. Here is what he had to say. 1. Interoperability. "For many years — actually decades — we've been changing the name of what we call interoperability and hop- ing that it is actually going to make a difference," Dr. Erskine says. However, interoperability remains a key hurdle in the healthcare industry. e problem boils down to a "battle of the data models" where each EHR vendor abides by its own data model and language resulting in a "Tower of Babel" effect during the transfer of health records. To get a record from one vendor into another vendor's sys- tem, a lot of translation functions are needed, but Apple streamlines these, he explains. "Why this is different with the Apple Health app is the dramatic sim- plification," he says. Apple curates information including medication lists or procedures patients have had. en, FHIR and the Apple data model are aligned across multiple EHR vendors, rather than Apple having to chase aer each hospital. Since the process becomes uni- fied, each translation function has already occurred by the time the data is collected. 2. Security. e Apple Health app enhances security of users' medi- cal data by using the same login credentials users established for their pre-existing, hospital-specific patient portals. is helps each partici- pating hospital ensure the right patient is accessing the right records, and it helps Apple confirm the right user with the right permissions connects with it. "From a security standpoint, by having the patient being the one do- ing that transaction, as opposed to somebody incident to the patient like a health system or health information exchange that signed a lot of business associate agreements or data use agreements defined in many contracts … [patients] unalienably have that right to make that transaction without anybody else having to ask or write contracts for them," Dr. Erskine says. 3. Record locator services. In the current medical records sys- tem, physicians verify each patient's identity and link them to each of their records. With Apple, the patient becomes the owner and manag- er of their health data. "e patient serves as the owner, individual record locator service, and their own individual master patient index, since they know where their own data sits and they've used their existent portals to access and identify themselves," Dr. Erskine explains. "is is a much more granular access of one patient at a time, one record at a time, making those connections, as opposed to having to do that broadly across ev- ery patient with a series of different processes." 4. Patient reported data. With the suite of apps available on the Apple app store, rather than the limited number of patient-facing apps for Epic, Cerner or athenahealth, other apps on a patient's iPhone can connect with and feed data into the Health app. is makes it easier for patients to marry their patient-entered information, such as signs and symptoms and how they progress along an illness, with their elec- tronic patient record. "e iPhone is endowed with a whole series of different additional features, like I can tell how many steps I am taking, I can tell what my heart rate is if I am wearing an Apple watch, I can put reminders in to take medications at certain times and I can keep track of when a medication wasn't taken [as well as] a series of additional value that [makes up] the last mile in [whole] patient [care,] in terms of indi- "We are not competing for patients in this debate. We are really competing against illness." — Dr. Alistair Erskine, Chief Clinical Informatics Officer, Geisinger