20 ms·

Apple, in Sign of Health Ambitions, Adds Medical Records Feature for iPhone

459 points by alwillis 9y ago

sjroot 9y ago
Apple Health already had the ability to view medical record documents, using the CDA standard. I think this is a huge step in the right direction for the Health app. Here's a question for HN people: what do you use to manage your medical records on Android?
- hpaavola 9y ago
  Why any individual should manage their medical records?
  - pm90 9y ago
    Because its their personal health record? I would be curious to know what doctors see when they read my records.
    - jbob2000 9y ago
      People are bad at managing themselves, especially when they are ill. It is a bad idea to expose patients to their health records. It will get lost, they will change things, they will fight with their doctor over what is put in the record, they'll want things clarified they don't understand putting undue burden on overworked doctors. Health records need to be impartial and unbiased so future medical care can be given with the best possible information.
      - moonka 9y ago
        >they'll want things clarified they don't understand putting undue burden on overworked doctors. People should be able to have things they don't understand about their body clarified. There's fewer things scarier than not understanding why your body isn't reacting the way you'd expect.
      - macintux 9y ago
        People can't be trusted to write their own records, but they can't not be allowed to see them. The consequences of that access have to be managed, for better or for worse.
      - jmull 9y ago
        Patients just get a read-only copy of their records. Also, providers don't use the patient as an intermediary when updating and exchanging medical records. That addresses most of your concerns. - "they'll want things clarified they don't understand" This is, by far and overwhelmingly, the reason it is a good idea to expose patients (and their defacto caregivers, AKA, their families) to their medical records. When it comes to preventative medicine and chronic conditions people have far more control over their health than the doctor does and the better they understand their health, the better they are able to do something positive about it.
        macintux 9y ago
        I'm reminded of a sad story about a kid, probably 10ish, who overdosed on prescription meds designed to help him not sleep so deeply (he had problems with bedwetting because his bladder wasn't noisy enough to wake him). Failing to understand the purpose of the pills, he decided that if he just took all of them, his problem would go away. Granted, adults (usually) have better judgment than a 10-year-old about things like that, but nonetheless patients almost inevitably are able to make better decisions when they understand why they're being asked to do things.
        jbob2000 9y ago
        The things that are in your medical record are technical and won't help you at all. "Patient's CD4+-T-Cell count reduce from 5^9/L to 5^6/L, advised increase Prolenaslezapam from 50mg to 75mg" (I'm making this up). Your doctor won't tell you this, instead they'll say "Your HIV is progressing and we're upping your dosage". There's no benefit to reading the technical note, you'll just ask for the clarification... which the doctor already gave you. Or you're going to waste his time having him explain undergrad biology to you. Think of it like this: Would you want your customers reading the comments you leave in your code? Probably not! They'll waste your time asking you about the comment you left saying "this could cause an error and bring the servers down". Or they completely misunderstand something and cancel the service. Or they'll complain that you left a swear word in. Etc. etc.
      - robbiemitchell 9y ago
        > Health records need to be impartial and unbiased Sorry, but they're already neither. Medical records are also the same mechanism used to determine reimbursements, meaning the codes in them that represent diagnoses and treatments are subject to multiple incentive structures.
        criley2 9y ago
        Care plans and diagnosis codes are very different things. Just because a coder massages the specific codes in use doesn't mean the clinicians are altering care. Honestly, there's a lot of new incentive structures on care givers and their institutions focused on so many things, like reducing readmissions (thereby reducing all forms of medical error in the process), or forming provider cohorts and using comprehensive comparison metrics between similar hospitals in similar areas and situations, to incentivize and reward those facilities which achieve the best care. And, on the subject of the MR/EHR itself, of course most of it is unbiased! Do you think your lab results, prescriptions, vital signs, demographics are subject to bias? Your medical record isn't where a doctor leaves a long note about their opinion of you. It's where all that stuff above, and allergies, and outpatient care history, and inpatient history, and all kinds of factual unbiased things go.
      - EamonnMR 9y ago
        Let's solve the issue of healthcare providers not playing nice with each other (will only communicate via fax, etc) before we worry about the very rare case of mentally ill patients falsifying records and such (which does happen, but not nearly on the scale of healthcare companies simply being difficult to wrangle.)
  - Waterluvian 9y ago
    Manage a local copy. Every individual should be in possession and have a basic understanding of their medical records. Medical professionals are there to help you manage your health. As the manager, you need that information.
  - macintux 9y ago
    For multiple reasons, but here's one that strikes close to home: not every person who you may wish to have access to information contained in those records will have it via the health care system. E.g., I need a personal trainer to help me work around my back problems. It's useful to be able to answer his/her questions by referencing my records, instead of vague shrugging about some random disc. Another e.g.: my aunt does a good job of sharing family medical records so that we know who in our past had conditions that may be relevant to our healthcare as well.
  - dave5104 9y ago
    Why wouldn't you want to have a copy of all your medical records? Perhaps this isn't super useful if you've gone to the same doctor your entire life, but I've gone to multiple doctors (and I know I'll be going to more in my lifetime). It'll be nice to have the ability to pull up my full history if I needed to provide a new doctor with some (more accurate than memory) history.
    - hycaria 9y ago
      Because some people don't have any medical history.
  - tammer 9y ago
    Not sure if you live in the US but my experience with the US healthcare system (I work adjacent to one of the top US research hospitals) is that there is a critical problem of patient identification between institutions. Because we have no national ID system, patient data is coded for individual institutions (with some limited exceptions). So, transporting your medical data between institutions is a headache that can result in lost information. Further, access to this information for your own knowledge, research or simple interest is quite limited if you don't have a healthcare provider using one of these established secure platforms Apple Health can pull from.
    - deleted 9y ago
      [deleted]
  - lostlogin 9y ago
    Move countries and watch what happens if you don’t take charge. My grandparents did and 3 years later it still hasn’t come straight.
    - Redoubts 9y ago
      Move counties... Kaiser still can't sort out my past records after I moved from SoCal to NorCal, and remained with Kaiser the whole time.
    - gumby 9y ago
      Much confusion ensued when my pregnant wife and I arrived in the US. I translated the medical records and gave them to the obstetrician. She was quite worried and sure that I had left something out -- there were all these tests that are routine in France but in the US are only done when something goes wrong. Needless to say nothing was wrong.
  - maxxxxx 9y ago
    You absolutely should own your records. In my view there should be a central location for all your records that is controlled by you. Then you should be able to give doctors access to them as needed. But the owner of your records is you, not the doctor, not the hospital.
  - EamonnMR 9y ago
    Because good luck getting your old doctor to talk to your new doctor, for example.
  - cmiles74 9y ago
    If you are moving from one health care provider to their competitor, you will find it is difficult to get the data successfully (and entirely) moved from one organization to another. Typically you will need to personally gather the data from the one provider and physically move it to another. In some cases they may provide a CD, DVD or thumb drive but it's more likely you'll have piles of paper. Having a copy of your medical record in a format that is easy to carry and, even more important, easy for your clinician to read will go a long way towards insuring your new doctor, etc. has enough information not to do you more harm.
- Psilidae 9y ago
  I don't use any apps at the moment for tracking medical records, but if I did, I'd be using Microsoft's HealthVault.
- house9-2 9y ago
  My medical records are made of paper and in a folder in a file cabinet :) I rarely go to the doctor so not much to keep track of, yet...
- mikeymop 9y ago
  Android has an option to display Medical Information however I do not know if it can import using CDA or HL7.
- dynofuz 9y ago
  We're an early startup called 1upHealth (https://1up.health https://1up.health) that has a similar web based product (https://1up.health/products/patient https://1up.health/products/patient) supporting 90+ health systems. Additionally for all the devs on here, we make those health system integrations available to your app via an API.
- brynlewis 9y ago
  Not android specific, but a means of viewing your records in a browser is here: http://backbeachsoftware.com.au/challenge/index.htm http://backbeachsoftware.com.au/challenge/index.htm Renders CDA documents.
- joe5150 9y ago
  The last time I got medical records, it was a thick stack of papers (the images were on a CD at least). Another provider sent an "electronic" record, which was just a PDF of essentially the same stack of paper. This was way back in May 2017.
heavymark 9y ago
Excited for this. Like most, my Health Care Provider already has an app, well they use one of the standard ones that other providers use. It shows health records and all, but in a rather ugly interface even though it doest now support FaceID and some other latest tech. Can't wait until that data will be in Apple Health which is more future proof (in case you leave your current health provider) and a far better UI experience.
agumonkey 9y ago
Watching the screenshot I felt happy to have a centralized way to track exams instead of printed record scattered here and there.
- hwang89 9y ago
  Agreed, I have no idea where my vaccine records are from 10+ years ago.
  - agumonkey 9y ago
    And often lots of time and energy is wasted (on patients and doctors) onto restoring context. I can see that when they access your file on their computer. 5 minutes of catching up, with potential errors or mistakes.
jedberg 9y ago
> said Jeff Williams, Apple’s chief operating officer. On a side note, I think that's the first time I've ever seen a quote from Apple's COO since Tim Cook left the job.
- IBM 9y ago
  Jeff Williams has been the pointman on Health stuff at Apple for a while now and he's definitely spoken on-the-record about it before [1]. [1] https://www.cnbc.com/2017/11/30/apple-ceo-jeff-williams-talks-to-cnbc-complete-transcript.html https://www.cnbc.com/2017/11/30/apple-ceo-jeff-williams-talk...
  - sah2ed 9y ago
    The "ceo" typo in the "apple-ceo-jeff-williams" fragment from your URL initially threw me off. For a moment I thought there had been a change of guard at the CEO level.
pjungwir 9y ago
It seems like Apple's interest in health data is an important part of their unusual concern for user privacy. The less secure the phone, the more problems they'll have with something like HIPAA.
- craftyguy 9y ago
  Does HIPAA motivate hospitals to take security seriously? The recent outbreaks in cryto-ransomware seem to suggest the answer is 'no.'
  - lliw 9y ago
    Yes--HIPAA provides a mechanism for fines to be levied against (most) healthcare organizations that suffer data breaches through the office of civil rights (OCR), with a public reporting of organizations that have been penalized. https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/data/index.html https://www.hhs.gov/hipaa/for-professionals/compliance-enfor...
    - chimeracoder 9y ago
      > Yes--HIPAA provides a mechanism for fines to be levied against (most) healthcare organizations that suffer data breaches through the office of civil rights (OCR), with a public reporting of organizations that have been penalized. Unfortunately, HIPAA is an incredibly rigid, incredibly broad law, and it's applied to a field in which security practices are incredibly inconsistent. As a result, HIPAA violations are pretty commonplace, and the vast majority are never reported to HHS, let alone penalized.
  - ef4 9y ago
    They take HIPAA seriously (because there are fines), but that is definitely not the same thing as taking security seriously.
    - freehunter 9y ago
      That's a big thing that many don't seem to understand: there is a massive gulf between compliance and security.
davisr 9y ago
I think this touches upon one of the most important things Apple has done for its users: a convenient way to encrypt things. In every iPhone shipped today is a key and hardware to perform en/decryption. It's the dream that was never consumer-viable with smart cards. Shipping medical records to users is only one application.
- jrs95 9y ago
  Smart cards made for a cool plot device in 24 though.
- gcbw2 9y ago
  it is the same as having an all powerful application with saved credentials on your 90's PC, protected by a BIOS password. All fine and convenient until it is compromised by some other application.
  - gruez 9y ago
    iOS has a sandbox. my 90s PC doesn't.
    - fooker 9y ago
      JVM?
      - ams6110 9y ago
        It's not iOS that has the sandbox it's the iPhone hardware. The encryption key management is performed in a hardware sandbox. iOS and apps running on the phone cannot access it. I think that's the gist of it anyway. I'm too frugal for an iPhone so I haven't read up on it in detail.
        ggg9990 9y ago
        iPhones are perfect for the frugal. They are usable and get security updates for about 5 years rather than the ~2 of most Android devices.
lliw 9y ago
Two particularly exciting aspects of this announcement: (1) Hospitals include more than one EHR vendor (both Epic and Cerner), which shows multi-vendor interoperability. (2) Apple is using a leading healthcare standards organization (HL7)'s clinical data specification (FHIR, or Fast Healthcare Interoperability Resources), which is a huge win, and will hopefully increase adoption and usage of this open standard by provider organizations.
- lostlogin 9y ago
  HL7 is such a monstrosity. Once you have used it you are forever sadder and that this became the default spec for everything in health is really disappointing. Edit: for the uninitiated. Excuse the readable line breaks, this isn’t defined in the spec (or at least is done differently by all vendors). You won’t have to suffer long though as you’ll go blind reading the ||| and ^^ when debugging. MSH|^~\&|EPIC|EPICADT|SMS|SMSADT|199912271408|CHARRIS|ADT^A04|1817457|D|2.5| PID||0493575^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^|19480203|M||B|254 MYSTREET AVE^^MYTOWN^OH^44123^USA||(216)123-4567|||M|NON|400003403~1129086| NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC||||||||||||||||||||||||||| PV1||O|168 ~219~C~PMA^^^^^^^^^||||277^ALLEN MYLASTNAME^BONNIE^^^^|||||||||| ||2688684|||||||||||||||||||||||||199912271408||||||002376853
  - midhunsezhi 9y ago
    This! If there is one thing to fix health data communications, its coming up with better spec than HL7. Nothing makes me more sad than dealing with HL7 messages.
    - nradov 9y ago
      HL7 operates under a very open standards development process. If you have ideas for improvement then get involved and submit formal change proposals.
      - cmiles74 9y ago
        I have worked in the field and I strongly disagree with this statement. The implication is that one can submit suggestions to the HL7 organization and hope to see improvement or changes in the spec. I would contend this is only the case for the larger vendors who are already established in the field, and quite happy with the current state of the (pretty much entirely non-interoperable) specification.
innagadadavida 9y ago
Does making the hardware HIPPA compliant give any special protections agains FBI requests unlock phone or other government regulations and requests? May be I'm connecting too many dots but Apple might be killing two birds with one stone here.
- chimeracoder 9y ago
  > Does making the hardware HIPPA compliant give any special protections agains FBI requests unlock phone or other government regulations and requests? Not in the least, and it's sort of a category error to say "make the hardware HIPAA-compliant". Apple doesn't really have to do anything to make the hardware HIPAA-compliant. In fact, pretty much any phone that's on the market today could be used for accessing protected health information in full compliance with HIPAA. What happens at the software level is more relevant.
thomasruns 9y ago
This is great news if you or someone in your family has ever: - Moved and had to come up with child vaccination records from another state (or multiple states) from 5+ years ago. - Seen doctors across multiple health organizations who all want to run the same tests, or fill out a records request form that gets faxed and delays treatment by another month. - Applied for disability or anything else that requires medical records and had to fax 10 different records request forms, wait a month or more, then pay printing fees for each.
- nwhatt 9y ago
  It looks to be read-only at the moment, meaning you can't necessarily walk into one of those few health care systems with your iPhone and have the data sync with the EHR.
  - thomasruns 9y ago
    Syncing would be nice, but just being able to show that a test was already done and was negative means the doctor can move on to whatever is next instead of having to request that record and wait for it. I think there are already benefits like that, plus the potential for much more if syncing and printing of records can be added.
- ams6110 9y ago
  How so? What organization demanding immunization records is going to accept a screenshot from your phone?
  - thomasruns 9y ago
    They currently accept a printout from Walgreens, so you'd probably be surprised what they would accept. But at the very least this is a great first step that will hopefully lead to a printout or some method of providing records that others will accept as valid.
  - prepend 9y ago
    I was really surprised by this. When I moved to the state I had to get immunization records for my kid’s school. My pediatrician was able to pull up some automatically, but it was missing some. She asked me about it, I told her that the kid got the shots didn’t know the exact day. The doc added that to the form that I gave to my school. I was shocked that there was no real data checks. What’s even crazier is that I once had to travel on official business to some travel restricted regions that required a ton of vaccinations. My proof that was checked by immigration in lots of 1st World and 3rd world countries? A little yellow folded up piece of paper with checkboxes and initials from a doctor.
mikeymop 9y ago
I see this on Android 8.1 as well. If on the lock screen tap emergency, double tap emergency. Below emergency contacts there is medical information.
- prepend 9y ago
  It’s not direct from healthcare and it’s not device encrypted.
- nkozyra 9y ago
  Is it imported via electronic health records, though, or just something you enter in case somebody needs to access it?
- dwighttk 9y ago
  that is not the same thing.
prepend 9y ago
This is great that data are encrypted and solely accessible by user and sharing by user. This does two things- puts patient in control of their health data as they are the only only able to pull together medical data from all their sources (try getting 5 hospitals to share data with each other) and it’s a sustainable business model since the device manages storage/backup/whatever. There have been personal health records for a decade (remember Google Health) but they never made money and/or were oriented around research needs or clinical needs; not patient needs. So they shriveled up a bit because they lost money (eg, Google Health) or are hard to use (eg, HealthVault).
- EamonnMR 9y ago
  I think the biggest adoption factor here might be a giant like apple forcing smaller companies to take notice.
hitgeek 9y ago
Microsoft and Google both failed with forays into medical records, so I'm skeptical apple will see much success. Most people do not want to manage their own health records, or only become interested for short periods of time after illness. For those who do want this service, I'm hopeful Apple will improve user experience such that its easy but provides value. EHR vendors do not make data sharing easy so having an even larger player in the space, pushing innovation, is welcomed.
- prepend 9y ago
  This is a lot cheaper for Apple since there’s no site and database to maintain. And this is a bit of a differentiator since Google is not interested in having encrypted user data they can’t analyze.
  - r00fus 9y ago
    Bingo. It's all about incentives. Google's customers are the advertisers. Microsoft's customers are largely OEMs and Corporations. Apple's are consumers for the main part. Consumers benefit could from this feature, and they will buy more product (or stay more loyal).
- robbiemitchell 9y ago
  > Most people do not want to manage their own health records How do you know? This isn't a capability right now. I suspect that once people have their record and can plug it in wherever they want, they'll like having it.
  - hitgeek 9y ago
    I was previously the administrator of a "patient portal" that was connected to our health record system. we had a hard time getting people interested in using it and signing up. and those who did sign up rarely used it after the first few weeks. when talking to people, the primary reason seemed to be that they wanted to communicate with a person for most healthcare related needs b/c they had questions or wanted clarification/re-enforcement. They used the online portal so infrequently that they never felt confident they could quickly get what they needed accomplished. The notable exception is parents managing the records of their children, which I don't think will be a feature of this v1 health records app. its all about user experience though. i'm hopeful Apple can delivery something that is better than what is available and has come before. i'm worried b/c I don't see it as a v1 and done feature. It will take consistent interaction and improvement as health record systems change and capabilities increase. hopefully apple is committed to it.
wehadfun 9y ago
I feel the correct solution to this problem is for legislation that forces hospitals to quickly, easily, and cheaply share patient information. If you go to one hospital and then go to another hospital up the street even though they probably both use epic they have to fax or mail records. Not for technical reasons but bureaucratic ones.
- toomuchtodo 9y ago
  You would be correct. The fix is to have the Department of Health and Human Services administer health records [1], and use Medicare funding as the stick to require its use. [1] This requires public policy implementation, US Digital Service/18F levels of technical competency, along with ruthless transparency and governance.
  - ams6110 9y ago
    After the OPM debacle with security clearance records, I would not trust the government to do this properly. https://www.cnn.com/2015/07/09/politics/office-of-personnel-management-data-breach-20-million/index.html https://www.cnn.com/2015/07/09/politics/office-of-personnel-...
    - toomuchtodo 9y ago
      But you would trust a single hospital (or hospital network) to run Epic securely (and all that entails from a security and risk management perspective)? As someone affected by the OPM breach, I agree that it is bad. You can't paint the entire government with a broad brush though.
      - ams6110 9y ago
        Absolutely not. I'd like to opt out of all of it. But there's really no way.
        toomuchtodo 9y ago
mc32 9y ago
IIRC, hospitals have been looking for something akin to encrypted "digital dogtags" which can be accessible by qualified medical personnel. Obviously a tricky proposition to both keep data secure while also accessible to those to whom this data should be accessible. Perh their reputation for privacy combined with their market share can enable a viable solution to this dilemma.
minimaxir 9y ago
Given the centralization of the data in the Health app, I would like to see Apple make it easier to get Health data out of the iPhone for personal analysis. The Export feature in the Health app currently exports all data as a large XML blob, which is not easy to load up into a spreadsheet. (for reference, I wrote a script to extract heart rate data from the XML and get it into a CSV: https://github.com/minimaxir/get-heart-rate-csv https://github.com/minimaxir/get-heart-rate-csv) The workaround is to use a 3rd party app, which complicates privacy.
- killerdhmo 9y ago
  Would you have to do something similar to aggregate all my steps for the year (or miles running) for example?
  - minimaxir 9y ago
    For my quick example, you'd have to change the key in the regex appropriately, and there may be other various metadata involved that has to be handled (i.e. whether the steps are from running or from walking). Again, there are 3rd party tools, but I do not want to use them. The actual data filtering/aggregation/visualization is a different story, and beyond the scope of getting the data. (here's why I was getting the heart rate data in the first place: https://twitter.com/minimaxir/status/949306256874913792 https://twitter.com/minimaxir/status/949306256874913792)
    - killerdhmo 9y ago
      Thanks for your response! Even just an aggregation would be useful (outside of 3P apps). Congrats on your new gig! Looks a little more exciting than your previous one ;)
    - mercutio2 9y ago
      Why are you using regular expressions to parse XML? Python has excellent XML libraries.
      - 9y ago
rambossa 9y ago
This is essentially what all "blockchain for healthcare" idealists are trying to advocate/accomplish. With buzzwords like "security" & "interoperability" ... Apple is really pushing for both here (though it would be centralized). I think the absolute key is to win the users first, and force the industry to adopt a strategy that is best for users vs what is best for Hostpitals/EHRs/Health-Networks. Interoperability is a beast of a problem to solve for healthcare, and it'll be interesting to see how far Apple is willing to push or disrupt (i.e. standardizing & forcing the adoption of their chosen data formats & integration) ------- shameless plug about healthcare & blockchain: https://hackernoon.com/developing-blockchain-for-healthcare-primer-d23004de7aed https://hackernoon.com/developing-blockchain-for-healthcare-...
- saosebastiao 9y ago
  I really do not know why a blockchain is necessary. If people have ownership over their own data, all that is really needed is a place to store it and some kind OAuth scheme to access and manage it. I mean, sure, smart contracts on a blockchain could do that, but so could hundreds of other architectures.
  - JAFTEM 9y ago
    It's not a matter of what's possible but rather a matter of who has control and access to that data. Do you want a decentralized platform or Apple to protect your records. Fwiw I'm not advocating one way or the other.
  - rambossa 9y ago
    Agreed -- I don't think blockchain introduces anything _entirely_ new to any type of application. Blockchain in healthcare goes a lot further than user control/convenience though, and a "holy grail" success would mean complete interoperability across the industry in terms of security and data & knowledge sharing. Also the whole "centralization" bit was already mentioned.
rs86 9y ago
this is going to fail because blockchains solve this much better.
- CabSauce 9y ago
  I agree. As long as thousands of hospitals and clinics agree on, and use, a standard. Edit: Which is a pretty big caveat.
- prepend 9y ago
  This is the blockchain solution. Just wait, my guess is that this is the beginning of all the blockchain nodes with every phone serving it’s part to process transactions and store data. It’s probably something like in addition to your own record, you’ll store 10 other patients in an encrypted manner. And 10 other phones will store yours.
- pat2man 9y ago
  No one wants their data on a public blockchain. A private blockchain doesn't solve this any better.
jacksmith21006 9y ago
Apple who had root able to use on a Mac with just hitting enter a few times is not very encouraging to protect my health data.
- madeofpalk 9y ago
  On the other hand, Apple vs FBI has shown that this is something they do take seriously.
troyastorino 9y ago
Hopefully Apple entering the space will move things forward in terms of interoperability, but so far, this announcement doesn't really change the status quo. It seems like it's is coming out of Apple's participation in the Argonaut Project [1], which has been around for a few years and is (currently) the strongest vehicle for push FHIR and SMART on FHIR, but hasn't really seen wide participation. They have 12 hospitals participating right now [2], which is in line with the ~10 systems that interoperability plays typically get on board. Apple has been moving on health records for a while, with their acquisition of Gliimpse [3] a couple years ago a clear indication, and I had hoped that Apple would have been able to get more systems participating before they made an announcement. 12 systems is a far cry from the 5,500 hospitals [4] and 230,000 practices [5] in the US. In order to make medical records really useful for people, they needs to have all of their records. That means records from whatever system they've been seen at, and all of the information in those records. Every purely electronic approach to aggregating records that I've seen doesn't get doctors notes, procedure reports, pathology reports, radiology reports or medical imaging (x-rays, MRIs, CTs, etc). Sadly, it looks like Apple's attempt also won't address those issues. Collecting medical records is an extremely hard problem. Technical integration is not only expensive and annoying (see many other comments about the shittiness of HL7, which FHIR is the latest, least-bad iteration of), but health systems don't have strong incentives to push interoperability. Health systems have way bigger IT problems facing them than aligning with interoperability standards (e.g., update the failing, 10-year-old software in the pediatric ICU), releasing records automatically could open them up to a lot ill-defined of legal risk (is a health system liable for what happens to information it releases to third parties?), and interoperability is kinda against business incentives (more interoperability => easier to lose patients). It doesn't look like Apple is taking a fundamentally different approach than Google Health did to any of these incentive problems (if we build, it they will come). disclosure: I'm one of the founders of PicnicHealth (YC S14), and follow these things pretty closely. If you want to chat about the space, feel free to email me: troy{at}picnichealth{dot}com [1]: http://argonautwiki.hl7.org/index.php?title=Main_Page http://argonautwiki.hl7.org/index.php?title=Main_Page [2]: https://www.apple.com/newsroom/2018/01/apple-announces-effortless-solution-bringing-health-records-to-iPhone/ https://www.apple.com/newsroom/2018/01/apple-announces-effor... [3]: https://techcrunch.com/2016/08/22/apple-acquired-gliimpse-a-personal-health-data-startup/ https://techcrunch.com/2016/08/22/apple-acquired-gliimpse-a-... [4]: https://www.aha.org/statistics/fast-facts-us-hospitals https://www.aha.org/statistics/fast-facts-us-hospitals [5]: https://en.wikipedia.org/wiki/Group_medical_practice_in_the_United_States https://en.wikipedia.org/wiki/Group_medical_practice_in_the_...
EamonnMR 9y ago
I'd be elated to see healthcare companies forced to adopt this. Fax machines and paper records are a hazard to patient health.
jlarsson89 9y ago
So basically what we've had[1] for ages in Sweden but an app shipping to one platform and vendor? [1]: https://www.gemalto.com/govt/customer-cases/digital-doctors https://www.gemalto.com/govt/customer-cases/digital-doctors
- extrememacaroni 9y ago
  Well if Sweden doesn't want to bring it outside Sweden, someone else will, right?
m3kw9 9y ago
Google shuttered their HealthVault service. Who in their right mind would let google who openly sells and uses your data..
jrowley 9y ago
I guess I just submitted this too early. Dupe (which should be deleted I guess?): https://news.ycombinator.com/item?id=16222839 https://news.ycombinator.com/item?id=16222839
Sonnol53 9y ago
We're already cyborgs
blackflame7000 9y ago
After conquering the difficult feat of integrating LTE and GPS into the Apple Watch 3, the question is what's next? I personally love the iwatch3 for its ability to allow you to stay connected even when disconnected. (ie take a business call in the middle of an outdoor jog without your phone) Nevertheless, I'm still not sure if there's anything else they can do that will be as groundbreaking as the watch3 is. Obviously, Apple feels there is a lot of potential for the watch and health, however.
throwawazqq 9y ago
At some point we need to stop calling it a phone.
- therealdrag0 9y ago
  I've always liked the sound of "mobile".
dawhizkid 9y ago
The entity with the most complete information about you is not the doctor with the EMR, it's the health insurance company that has every claim (i.e. drug prescription, hospital admission, doctor visit, specialist visit across all providers) with all your diagnosis/procedure codes on each claim.
im3w1l 9y ago
Tech companies are eating the world.
YTGRK 9y ago
https://youtu.be/VIoEpU7GUoE https://youtu.be/VIoEpU7GUoE
nabeards 9y ago
If I can't add medical records manually myself, this is a useless feature. I'm seldom in the same country for very long, so get medical records from a motley collection of sources. I just want a single place to save all my records for easy access wherever I go.
WhyNotHugo 9y ago
The big issue with Apple Health is that you can't really back it up. The only way to backup Health data is to do a full iPhone backup -- which might include a bunch of garbage you don't want. So if you want to move onto a new, clean phone, your Health data is tied to all the other junk you might want to get rid of. I really wish that backing up Health was really possible.

459 points by alwillis 9y ago

Apple Health already had the ability to view medical record documents, using the CDA standard. I think this is a huge step in the right direction for the Health app. Here's a question for HN people: what do you use to manage your medical records on Android?

hpaavola 9y ago
Why any individual should manage their medical records?
- pm90 9y ago
  Because its their personal health record? I would be curious to know what doctors see when they read my records.
  - jbob2000 9y ago
    People are bad at managing themselves, especially when they are ill. It is a bad idea to expose patients to their health records. It will get lost, they will change things, they will fight with their doctor over what is put in the record, they'll want things clarified they don't understand putting undue burden on overworked doctors. Health records need to be impartial and unbiased so future medical care can be given with the best possible information.
    - moonka 9y ago
      >they'll want things clarified they don't understand putting undue burden on overworked doctors. People should be able to have things they don't understand about their body clarified. There's fewer things scarier than not understanding why your body isn't reacting the way you'd expect.
    - macintux 9y ago
      People can't be trusted to write their own records, but they can't not be allowed to see them. The consequences of that access have to be managed, for better or for worse.
    - jmull 9y ago
      Patients just get a read-only copy of their records. Also, providers don't use the patient as an intermediary when updating and exchanging medical records. That addresses most of your concerns. - "they'll want things clarified they don't understand" This is, by far and overwhelmingly, the reason it is a good idea to expose patients (and their defacto caregivers, AKA, their families) to their medical records. When it comes to preventative medicine and chronic conditions people have far more control over their health than the doctor does and the better they understand their health, the better they are able to do something positive about it.
      - macintux 9y ago
        I'm reminded of a sad story about a kid, probably 10ish, who overdosed on prescription meds designed to help him not sleep so deeply (he had problems with bedwetting because his bladder wasn't noisy enough to wake him). Failing to understand the purpose of the pills, he decided that if he just took all of them, his problem would go away. Granted, adults (usually) have better judgment than a 10-year-old about things like that, but nonetheless patients almost inevitably are able to make better decisions when they understand why they're being asked to do things.
      - jbob2000 9y ago
        The things that are in your medical record are technical and won't help you at all. "Patient's CD4+-T-Cell count reduce from 5^9/L to 5^6/L, advised increase Prolenaslezapam from 50mg to 75mg" (I'm making this up). Your doctor won't tell you this, instead they'll say "Your HIV is progressing and we're upping your dosage". There's no benefit to reading the technical note, you'll just ask for the clarification... which the doctor already gave you. Or you're going to waste his time having him explain undergrad biology to you. Think of it like this: Would you want your customers reading the comments you leave in your code? Probably not! They'll waste your time asking you about the comment you left saying "this could cause an error and bring the servers down". Or they completely misunderstand something and cancel the service. Or they'll complain that you left a swear word in. Etc. etc.
    - robbiemitchell 9y ago
      > Health records need to be impartial and unbiased Sorry, but they're already neither. Medical records are also the same mechanism used to determine reimbursements, meaning the codes in them that represent diagnoses and treatments are subject to multiple incentive structures.
      - criley2 9y ago
        Care plans and diagnosis codes are very different things. Just because a coder massages the specific codes in use doesn't mean the clinicians are altering care. Honestly, there's a lot of new incentive structures on care givers and their institutions focused on so many things, like reducing readmissions (thereby reducing all forms of medical error in the process), or forming provider cohorts and using comprehensive comparison metrics between similar hospitals in similar areas and situations, to incentivize and reward those facilities which achieve the best care. And, on the subject of the MR/EHR itself, of course most of it is unbiased! Do you think your lab results, prescriptions, vital signs, demographics are subject to bias? Your medical record isn't where a doctor leaves a long note about their opinion of you. It's where all that stuff above, and allergies, and outpatient care history, and inpatient history, and all kinds of factual unbiased things go.
    - EamonnMR 9y ago
      Let's solve the issue of healthcare providers not playing nice with each other (will only communicate via fax, etc) before we worry about the very rare case of mentally ill patients falsifying records and such (which does happen, but not nearly on the scale of healthcare companies simply being difficult to wrangle.)
- Waterluvian 9y ago
  Manage a local copy. Every individual should be in possession and have a basic understanding of their medical records. Medical professionals are there to help you manage your health. As the manager, you need that information.
- macintux 9y ago
  For multiple reasons, but here's one that strikes close to home: not every person who you may wish to have access to information contained in those records will have it via the health care system. E.g., I need a personal trainer to help me work around my back problems. It's useful to be able to answer his/her questions by referencing my records, instead of vague shrugging about some random disc. Another e.g.: my aunt does a good job of sharing family medical records so that we know who in our past had conditions that may be relevant to our healthcare as well.
- dave5104 9y ago
  Why wouldn't you want to have a copy of all your medical records? Perhaps this isn't super useful if you've gone to the same doctor your entire life, but I've gone to multiple doctors (and I know I'll be going to more in my lifetime). It'll be nice to have the ability to pull up my full history if I needed to provide a new doctor with some (more accurate than memory) history.
  - hycaria 9y ago
    Because some people don't have any medical history.
- tammer 9y ago
  Not sure if you live in the US but my experience with the US healthcare system (I work adjacent to one of the top US research hospitals) is that there is a critical problem of patient identification between institutions. Because we have no national ID system, patient data is coded for individual institutions (with some limited exceptions). So, transporting your medical data between institutions is a headache that can result in lost information. Further, access to this information for your own knowledge, research or simple interest is quite limited if you don't have a healthcare provider using one of these established secure platforms Apple Health can pull from.
  - deleted 9y ago
    [deleted]
- lostlogin 9y ago
  Move countries and watch what happens if you don’t take charge. My grandparents did and 3 years later it still hasn’t come straight.
  - Redoubts 9y ago
    Move counties... Kaiser still can't sort out my past records after I moved from SoCal to NorCal, and remained with Kaiser the whole time.
  - gumby 9y ago
    Much confusion ensued when my pregnant wife and I arrived in the US. I translated the medical records and gave them to the obstetrician. She was quite worried and sure that I had left something out -- there were all these tests that are routine in France but in the US are only done when something goes wrong. Needless to say nothing was wrong.
- maxxxxx 9y ago
  You absolutely should own your records. In my view there should be a central location for all your records that is controlled by you. Then you should be able to give doctors access to them as needed. But the owner of your records is you, not the doctor, not the hospital.
- EamonnMR 9y ago
  Because good luck getting your old doctor to talk to your new doctor, for example.
- cmiles74 9y ago
  If you are moving from one health care provider to their competitor, you will find it is difficult to get the data successfully (and entirely) moved from one organization to another. Typically you will need to personally gather the data from the one provider and physically move it to another. In some cases they may provide a CD, DVD or thumb drive but it's more likely you'll have piles of paper. Having a copy of your medical record in a format that is easy to carry and, even more important, easy for your clinician to read will go a long way towards insuring your new doctor, etc. has enough information not to do you more harm.
Psilidae 9y ago
I don't use any apps at the moment for tracking medical records, but if I did, I'd be using Microsoft's HealthVault.
house9-2 9y ago
My medical records are made of paper and in a folder in a file cabinet :) I rarely go to the doctor so not much to keep track of, yet...
mikeymop 9y ago
Android has an option to display Medical Information however I do not know if it can import using CDA or HL7.
dynofuz 9y ago
We're an early startup called 1upHealth (https://1up.health https://1up.health) that has a similar web based product (https://1up.health/products/patient https://1up.health/products/patient) supporting 90+ health systems. Additionally for all the devs on here, we make those health system integrations available to your app via an API.
brynlewis 9y ago
Not android specific, but a means of viewing your records in a browser is here: http://backbeachsoftware.com.au/challenge/index.htm http://backbeachsoftware.com.au/challenge/index.htm Renders CDA documents.
joe5150 9y ago
The last time I got medical records, it was a thick stack of papers (the images were on a CD at least). Another provider sent an "electronic" record, which was just a PDF of essentially the same stack of paper. This was way back in May 2017.

heavymark 9y ago

Excited for this. Like most, my Health Care Provider already has an app, well they use one of the standard ones that other providers use. It shows health records and all, but in a rather ugly interface even though it doest now support FaceID and some other latest tech. Can't wait until that data will be in Apple Health which is more future proof (in case you leave your current health provider) and a far better UI experience.

agumonkey 9y ago

Watching the screenshot I felt happy to have a centralized way to track exams instead of printed record scattered here and there.

hwang89 9y ago
Agreed, I have no idea where my vaccine records are from 10+ years ago.
- agumonkey 9y ago
  And often lots of time and energy is wasted (on patients and doctors) onto restoring context. I can see that when they access your file on their computer. 5 minutes of catching up, with potential errors or mistakes.

jedberg 9y ago

> said Jeff Williams, Apple’s chief operating officer. On a side note, I think that's the first time I've ever seen a quote from Apple's COO since Tim Cook left the job.

IBM 9y ago
Jeff Williams has been the pointman on Health stuff at Apple for a while now and he's definitely spoken on-the-record about it before [1]. [1] https://www.cnbc.com/2017/11/30/apple-ceo-jeff-williams-talks-to-cnbc-complete-transcript.html https://www.cnbc.com/2017/11/30/apple-ceo-jeff-williams-talk...
- sah2ed 9y ago
  The "ceo" typo in the "apple-ceo-jeff-williams" fragment from your URL initially threw me off. For a moment I thought there had been a change of guard at the CEO level.

pjungwir 9y ago

It seems like Apple's interest in health data is an important part of their unusual concern for user privacy. The less secure the phone, the more problems they'll have with something like HIPAA.

craftyguy 9y ago
Does HIPAA motivate hospitals to take security seriously? The recent outbreaks in cryto-ransomware seem to suggest the answer is 'no.'
- lliw 9y ago
  Yes--HIPAA provides a mechanism for fines to be levied against (most) healthcare organizations that suffer data breaches through the office of civil rights (OCR), with a public reporting of organizations that have been penalized. https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/data/index.html https://www.hhs.gov/hipaa/for-professionals/compliance-enfor...
  - chimeracoder 9y ago
    > Yes--HIPAA provides a mechanism for fines to be levied against (most) healthcare organizations that suffer data breaches through the office of civil rights (OCR), with a public reporting of organizations that have been penalized. Unfortunately, HIPAA is an incredibly rigid, incredibly broad law, and it's applied to a field in which security practices are incredibly inconsistent. As a result, HIPAA violations are pretty commonplace, and the vast majority are never reported to HHS, let alone penalized.
- ef4 9y ago
  They take HIPAA seriously (because there are fines), but that is definitely not the same thing as taking security seriously.
  - freehunter 9y ago
    That's a big thing that many don't seem to understand: there is a massive gulf between compliance and security.

davisr 9y ago

I think this touches upon one of the most important things Apple has done for its users: a convenient way to encrypt things. In every iPhone shipped today is a key and hardware to perform en/decryption. It's the dream that was never consumer-viable with smart cards. Shipping medical records to users is only one application.

jrs95 9y ago
Smart cards made for a cool plot device in 24 though.
gcbw2 9y ago
it is the same as having an all powerful application with saved credentials on your 90's PC, protected by a BIOS password. All fine and convenient until it is compromised by some other application.
- gruez 9y ago
  iOS has a sandbox. my 90s PC doesn't.
  - fooker 9y ago
    JVM?
    - ams6110 9y ago
      It's not iOS that has the sandbox it's the iPhone hardware. The encryption key management is performed in a hardware sandbox. iOS and apps running on the phone cannot access it. I think that's the gist of it anyway. I'm too frugal for an iPhone so I haven't read up on it in detail.
      - ggg9990 9y ago
        iPhones are perfect for the frugal. They are usable and get security updates for about 5 years rather than the ~2 of most Android devices.

lliw 9y ago

Two particularly exciting aspects of this announcement: (1) Hospitals include more than one EHR vendor (both Epic and Cerner), which shows multi-vendor interoperability. (2) Apple is using a leading healthcare standards organization (HL7)'s clinical data specification (FHIR, or Fast Healthcare Interoperability Resources), which is a huge win, and will hopefully increase adoption and usage of this open standard by provider organizations.

lostlogin 9y ago
HL7 is such a monstrosity. Once you have used it you are forever sadder and that this became the default spec for everything in health is really disappointing. Edit: for the uninitiated. Excuse the readable line breaks, this isn’t defined in the spec (or at least is done differently by all vendors). You won’t have to suffer long though as you’ll go blind reading the ||| and ^^ when debugging. MSH|^~\&|EPIC|EPICADT|SMS|SMSADT|199912271408|CHARRIS|ADT^A04|1817457|D|2.5| PID||0493575^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^|19480203|M||B|254 MYSTREET AVE^^MYTOWN^OH^44123^USA||(216)123-4567|||M|NON|400003403~1129086| NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC||||||||||||||||||||||||||| PV1||O|168 ~219~C~PMA^^^^^^^^^||||277^ALLEN MYLASTNAME^BONNIE^^^^|||||||||| ||2688684|||||||||||||||||||||||||199912271408||||||002376853
- midhunsezhi 9y ago
  This! If there is one thing to fix health data communications, its coming up with better spec than HL7. Nothing makes me more sad than dealing with HL7 messages.
  - nradov 9y ago
    HL7 operates under a very open standards development process. If you have ideas for improvement then get involved and submit formal change proposals.
    - cmiles74 9y ago
      I have worked in the field and I strongly disagree with this statement. The implication is that one can submit suggestions to the HL7 organization and hope to see improvement or changes in the spec. I would contend this is only the case for the larger vendors who are already established in the field, and quite happy with the current state of the (pretty much entirely non-interoperable) specification.

innagadadavida 9y ago

Does making the hardware HIPPA compliant give any special protections agains FBI requests unlock phone or other government regulations and requests? May be I'm connecting too many dots but Apple might be killing two birds with one stone here.

chimeracoder 9y ago
> Does making the hardware HIPPA compliant give any special protections agains FBI requests unlock phone or other government regulations and requests? Not in the least, and it's sort of a category error to say "make the hardware HIPAA-compliant". Apple doesn't really have to do anything to make the hardware HIPAA-compliant. In fact, pretty much any phone that's on the market today could be used for accessing protected health information in full compliance with HIPAA. What happens at the software level is more relevant.

thomasruns 9y ago

This is great news if you or someone in your family has ever: - Moved and had to come up with child vaccination records from another state (or multiple states) from 5+ years ago. - Seen doctors across multiple health organizations who all want to run the same tests, or fill out a records request form that gets faxed and delays treatment by another month. - Applied for disability or anything else that requires medical records and had to fax 10 different records request forms, wait a month or more, then pay printing fees for each.

nwhatt 9y ago
It looks to be read-only at the moment, meaning you can't necessarily walk into one of those few health care systems with your iPhone and have the data sync with the EHR.
- thomasruns 9y ago
  Syncing would be nice, but just being able to show that a test was already done and was negative means the doctor can move on to whatever is next instead of having to request that record and wait for it. I think there are already benefits like that, plus the potential for much more if syncing and printing of records can be added.
ams6110 9y ago
How so? What organization demanding immunization records is going to accept a screenshot from your phone?
- thomasruns 9y ago
  They currently accept a printout from Walgreens, so you'd probably be surprised what they would accept. But at the very least this is a great first step that will hopefully lead to a printout or some method of providing records that others will accept as valid.
- prepend 9y ago
  I was really surprised by this. When I moved to the state I had to get immunization records for my kid’s school. My pediatrician was able to pull up some automatically, but it was missing some. She asked me about it, I told her that the kid got the shots didn’t know the exact day. The doc added that to the form that I gave to my school. I was shocked that there was no real data checks. What’s even crazier is that I once had to travel on official business to some travel restricted regions that required a ton of vaccinations. My proof that was checked by immigration in lots of 1st World and 3rd world countries? A little yellow folded up piece of paper with checkboxes and initials from a doctor.

mikeymop 9y ago

I see this on Android 8.1 as well. If on the lock screen tap emergency, double tap emergency. Below emergency contacts there is medical information.

prepend 9y ago
It’s not direct from healthcare and it’s not device encrypted.
nkozyra 9y ago
Is it imported via electronic health records, though, or just something you enter in case somebody needs to access it?
dwighttk 9y ago
that is not the same thing.

prepend 9y ago

This is great that data are encrypted and solely accessible by user and sharing by user. This does two things- puts patient in control of their health data as they are the only only able to pull together medical data from all their sources (try getting 5 hospitals to share data with each other) and it’s a sustainable business model since the device manages storage/backup/whatever. There have been personal health records for a decade (remember Google Health) but they never made money and/or were oriented around research needs or clinical needs; not patient needs. So they shriveled up a bit because they lost money (eg, Google Health) or are hard to use (eg, HealthVault).

EamonnMR 9y ago
I think the biggest adoption factor here might be a giant like apple forcing smaller companies to take notice.

hitgeek 9y ago

Microsoft and Google both failed with forays into medical records, so I'm skeptical apple will see much success. Most people do not want to manage their own health records, or only become interested for short periods of time after illness. For those who do want this service, I'm hopeful Apple will improve user experience such that its easy but provides value. EHR vendors do not make data sharing easy so having an even larger player in the space, pushing innovation, is welcomed.

prepend 9y ago
This is a lot cheaper for Apple since there’s no site and database to maintain. And this is a bit of a differentiator since Google is not interested in having encrypted user data they can’t analyze.
- r00fus 9y ago
  Bingo. It's all about incentives. Google's customers are the advertisers. Microsoft's customers are largely OEMs and Corporations. Apple's are consumers for the main part. Consumers benefit could from this feature, and they will buy more product (or stay more loyal).
robbiemitchell 9y ago
> Most people do not want to manage their own health records How do you know? This isn't a capability right now. I suspect that once people have their record and can plug it in wherever they want, they'll like having it.
- hitgeek 9y ago
  I was previously the administrator of a "patient portal" that was connected to our health record system. we had a hard time getting people interested in using it and signing up. and those who did sign up rarely used it after the first few weeks. when talking to people, the primary reason seemed to be that they wanted to communicate with a person for most healthcare related needs b/c they had questions or wanted clarification/re-enforcement. They used the online portal so infrequently that they never felt confident they could quickly get what they needed accomplished. The notable exception is parents managing the records of their children, which I don't think will be a feature of this v1 health records app. its all about user experience though. i'm hopeful Apple can delivery something that is better than what is available and has come before. i'm worried b/c I don't see it as a v1 and done feature. It will take consistent interaction and improvement as health record systems change and capabilities increase. hopefully apple is committed to it.

wehadfun 9y ago

I feel the correct solution to this problem is for legislation that forces hospitals to quickly, easily, and cheaply share patient information. If you go to one hospital and then go to another hospital up the street even though they probably both use epic they have to fax or mail records. Not for technical reasons but bureaucratic ones.

toomuchtodo 9y ago
You would be correct. The fix is to have the Department of Health and Human Services administer health records [1], and use Medicare funding as the stick to require its use. [1] This requires public policy implementation, US Digital Service/18F levels of technical competency, along with ruthless transparency and governance.
- ams6110 9y ago
  After the OPM debacle with security clearance records, I would not trust the government to do this properly. https://www.cnn.com/2015/07/09/politics/office-of-personnel-management-data-breach-20-million/index.html https://www.cnn.com/2015/07/09/politics/office-of-personnel-...
  - toomuchtodo 9y ago
    But you would trust a single hospital (or hospital network) to run Epic securely (and all that entails from a security and risk management perspective)? As someone affected by the OPM breach, I agree that it is bad. You can't paint the entire government with a broad brush though.
    - ams6110 9y ago
      Absolutely not. I'd like to opt out of all of it. But there's really no way.
      - toomuchtodo 9y ago

mc32 9y ago

IIRC, hospitals have been looking for something akin to encrypted "digital dogtags" which can be accessible by qualified medical personnel. Obviously a tricky proposition to both keep data secure while also accessible to those to whom this data should be accessible. Perh their reputation for privacy combined with their market share can enable a viable solution to this dilemma.

minimaxir 9y ago

Given the centralization of the data in the Health app, I would like to see Apple make it easier to get Health data out of the iPhone for personal analysis. The Export feature in the Health app currently exports all data as a large XML blob, which is not easy to load up into a spreadsheet. (for reference, I wrote a script to extract heart rate data from the XML and get it into a CSV: https://github.com/minimaxir/get-heart-rate-csv https://github.com/minimaxir/get-heart-rate-csv) The workaround is to use a 3rd party app, which complicates privacy.

killerdhmo 9y ago
Would you have to do something similar to aggregate all my steps for the year (or miles running) for example?
- minimaxir 9y ago
  For my quick example, you'd have to change the key in the regex appropriately, and there may be other various metadata involved that has to be handled (i.e. whether the steps are from running or from walking). Again, there are 3rd party tools, but I do not want to use them. The actual data filtering/aggregation/visualization is a different story, and beyond the scope of getting the data. (here's why I was getting the heart rate data in the first place: https://twitter.com/minimaxir/status/949306256874913792 https://twitter.com/minimaxir/status/949306256874913792)
  - killerdhmo 9y ago
    Thanks for your response! Even just an aggregation would be useful (outside of 3P apps). Congrats on your new gig! Looks a little more exciting than your previous one ;)
  - mercutio2 9y ago
    Why are you using regular expressions to parse XML? Python has excellent XML libraries.
    - 9y ago

rambossa 9y ago

This is essentially what all "blockchain for healthcare" idealists are trying to advocate/accomplish. With buzzwords like "security" & "interoperability" ... Apple is really pushing for both here (though it would be centralized). I think the absolute key is to win the users first, and force the industry to adopt a strategy that is best for users vs what is best for Hostpitals/EHRs/Health-Networks. Interoperability is a beast of a problem to solve for healthcare, and it'll be interesting to see how far Apple is willing to push or disrupt (i.e. standardizing & forcing the adoption of their chosen data formats & integration) ------- shameless plug about healthcare & blockchain: https://hackernoon.com/developing-blockchain-for-healthcare-primer-d23004de7aed https://hackernoon.com/developing-blockchain-for-healthcare-...

saosebastiao 9y ago
I really do not know why a blockchain is necessary. If people have ownership over their own data, all that is really needed is a place to store it and some kind OAuth scheme to access and manage it. I mean, sure, smart contracts on a blockchain could do that, but so could hundreds of other architectures.
- JAFTEM 9y ago
  It's not a matter of what's possible but rather a matter of who has control and access to that data. Do you want a decentralized platform or Apple to protect your records. Fwiw I'm not advocating one way or the other.
- rambossa 9y ago
  Agreed -- I don't think blockchain introduces anything _entirely_ new to any type of application. Blockchain in healthcare goes a lot further than user control/convenience though, and a "holy grail" success would mean complete interoperability across the industry in terms of security and data & knowledge sharing. Also the whole "centralization" bit was already mentioned.

rs86 9y ago

this is going to fail because blockchains solve this much better.

CabSauce 9y ago
I agree. As long as thousands of hospitals and clinics agree on, and use, a standard. Edit: Which is a pretty big caveat.
prepend 9y ago
This is the blockchain solution. Just wait, my guess is that this is the beginning of all the blockchain nodes with every phone serving it’s part to process transactions and store data. It’s probably something like in addition to your own record, you’ll store 10 other patients in an encrypted manner. And 10 other phones will store yours.
pat2man 9y ago
No one wants their data on a public blockchain. A private blockchain doesn't solve this any better.

jacksmith21006 9y ago

Apple who had root able to use on a Mac with just hitting enter a few times is not very encouraging to protect my health data.

madeofpalk 9y ago
On the other hand, Apple vs FBI has shown that this is something they do take seriously.

troyastorino 9y ago

Hopefully Apple entering the space will move things forward in terms of interoperability, but so far, this announcement doesn't really change the status quo. It seems like it's is coming out of Apple's participation in the Argonaut Project [1], which has been around for a few years and is (currently) the strongest vehicle for push FHIR and SMART on FHIR, but hasn't really seen wide participation. They have 12 hospitals participating right now [2], which is in line with the ~10 systems that interoperability plays typically get on board. Apple has been moving on health records for a while, with their acquisition of Gliimpse [3] a couple years ago a clear indication, and I had hoped that Apple would have been able to get more systems participating before they made an announcement. 12 systems is a far cry from the 5,500 hospitals [4] and 230,000 practices [5] in the US. In order to make medical records really useful for people, they needs to have all of their records. That means records from whatever system they've been seen at, and all of the information in those records. Every purely electronic approach to aggregating records that I've seen doesn't get doctors notes, procedure reports, pathology reports, radiology reports or medical imaging (x-rays, MRIs, CTs, etc). Sadly, it looks like Apple's attempt also won't address those issues. Collecting medical records is an extremely hard problem. Technical integration is not only expensive and annoying (see many other comments about the shittiness of HL7, which FHIR is the latest, least-bad iteration of), but health systems don't have strong incentives to push interoperability. Health systems have way bigger IT problems facing them than aligning with interoperability standards (e.g., update the failing, 10-year-old software in the pediatric ICU), releasing records automatically could open them up to a lot ill-defined of legal risk (is a health system liable for what happens to information it releases to third parties?), and interoperability is kinda against business incentives (more interoperability => easier to lose patients). It doesn't look like Apple is taking a fundamentally different approach than Google Health did to any of these incentive problems (if we build, it they will come). disclosure: I'm one of the founders of PicnicHealth (YC S14), and follow these things pretty closely. If you want to chat about the space, feel free to email me: troy{at}picnichealth{dot}com [1]: http://argonautwiki.hl7.org/index.php?title=Main_Page http://argonautwiki.hl7.org/index.php?title=Main_Page [2]: https://www.apple.com/newsroom/2018/01/apple-announces-effortless-solution-bringing-health-records-to-iPhone/ https://www.apple.com/newsroom/2018/01/apple-announces-effor... [3]: https://techcrunch.com/2016/08/22/apple-acquired-gliimpse-a-personal-health-data-startup/ https://techcrunch.com/2016/08/22/apple-acquired-gliimpse-a-... [4]: https://www.aha.org/statistics/fast-facts-us-hospitals https://www.aha.org/statistics/fast-facts-us-hospitals [5]: https://en.wikipedia.org/wiki/Group_medical_practice_in_the_United_States https://en.wikipedia.org/wiki/Group_medical_practice_in_the_...

EamonnMR 9y ago

I'd be elated to see healthcare companies forced to adopt this. Fax machines and paper records are a hazard to patient health.

jlarsson89 9y ago

So basically what we've had[1] for ages in Sweden but an app shipping to one platform and vendor? [1]: https://www.gemalto.com/govt/customer-cases/digital-doctors https://www.gemalto.com/govt/customer-cases/digital-doctors

extrememacaroni 9y ago
Well if Sweden doesn't want to bring it outside Sweden, someone else will, right?

m3kw9 9y ago

Google shuttered their HealthVault service. Who in their right mind would let google who openly sells and uses your data..

jrowley 9y ago

I guess I just submitted this too early. Dupe (which should be deleted I guess?): https://news.ycombinator.com/item?id=16222839 https://news.ycombinator.com/item?id=16222839

Sonnol53 9y ago

We're already cyborgs

blackflame7000 9y ago

After conquering the difficult feat of integrating LTE and GPS into the Apple Watch 3, the question is what's next? I personally love the iwatch3 for its ability to allow you to stay connected even when disconnected. (ie take a business call in the middle of an outdoor jog without your phone) Nevertheless, I'm still not sure if there's anything else they can do that will be as groundbreaking as the watch3 is. Obviously, Apple feels there is a lot of potential for the watch and health, however.

throwawazqq 9y ago

At some point we need to stop calling it a phone.

therealdrag0 9y ago
I've always liked the sound of "mobile".

dawhizkid 9y ago

The entity with the most complete information about you is not the doctor with the EMR, it's the health insurance company that has every claim (i.e. drug prescription, hospital admission, doctor visit, specialist visit across all providers) with all your diagnosis/procedure codes on each claim.

im3w1l 9y ago

Tech companies are eating the world.

YTGRK 9y ago

https://youtu.be/VIoEpU7GUoE https://youtu.be/VIoEpU7GUoE

nabeards 9y ago

If I can't add medical records manually myself, this is a useless feature. I'm seldom in the same country for very long, so get medical records from a motley collection of sources. I just want a single place to save all my records for easy access wherever I go.

WhyNotHugo 9y ago

The big issue with Apple Health is that you can't really back it up. The only way to backup Health data is to do a full iPhone backup -- which might include a bunch of garbage you don't want. So if you want to move onto a new, clean phone, your Health data is tied to all the other junk you might want to get rid of. I really wish that backing up Health was really possible.