Apple Health Records: A Potential Tool for Electronic Health Record Platform

This study analyzes Apple Health Records as a potential tool for the electronic health record platform. It discusses the strategy and application of Apple Health Record Technology, bridging the existing gap, management of diabetes, advantages, and disadvantages of Apple Health Records.

Running head: ADVANCED HEALTHCARE SOFTWARE AND SYSTEMS
Advanced healthcare software and systems
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Abstract
EHRs consists of diversified sets of information that are shared among the public health
academicians, medical researchers and the healthcare providers due to the potentiality of the
data. The Apple health records are easy for the users to visualize and at the same time secure
their health record data. The patients feel empowered and can bring together the patient-
generated data and the health records data from the several health organizations and this will
create a holistic view of health. The Apple health records help the patient to have all their health-
related records on their iPhone and thus it is easy for the patients to participate in help and health
drive with a bit of awareness of the patient portal. Apple health records have the inbuilt features
of medical research, nutrition planning, disease management, medication tracking.

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Table of Contents
Introduction......................................................................................................................................3
Electronic Health Records and the present status............................................................................3
Strategy and application of Apple Health Record Technology.......................................................3
Apple Health Records and bridging of the existing gap..................................................................5
Apple health record and management of diabetes...........................................................................6
Advantages of Apple health records................................................................................................7
Disadvantages of Apple Health Records.........................................................................................9
Conclusion.......................................................................................................................................9
Reference.......................................................................................................................................10

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Introduction
Electronic health record (EHR) can be described as the patient’s chart in a digital format.
EHR is the patient-centric records and data that are in real time made available and accessible to
the authorized users and in a secure way. EHR contains the treatment history of a patient and this
dataset includes the clinical data that are provided by the care provider and are in relation to the
patient care. The EHRs have the potential to streamline and automate the workflow of the
provider; providers can use the evidence of the evidence-based tools that can be used to make
patient centred care; EHRs, in general, contain the test results, laboratory results, radiology
images, allergies immunization dates, treatment plans, medications, diagnose, patient's medical
history (Fernández-Alemán et al. 2013). One of the major benefits that arise from the usage of
the Electronic health records is that it is created in a digital format and managed by the
authorized providers that can share the information with the other health care providers or
organizations. EHRs are built with one motive of sharing the information with the other
organizations and providers such as the workplace clinics, school, emergency facilities,
pharmacies, medical imaging facilities, specialists, laboratories. EHRs thus contain information
regarding the clinicians that are involved in the care of a patient (Jensen, Jensen and Brunak
2012). This study will be based on the Apple Health Records and its analysis as a potential tool
for the electronic health record platform.
Electronic Health Records and the present status
EHRs consists of diversified sets of information that are shared among the public health
academicians, medical researchers and the healthcare providers due to the potentiality of the
data. It is, however, important to note that the fields in the records are inconsistent and the field
values are not supplied consistently. Additionally, the data sets do not contain information that is
easily readable by the machines and thus lacks interoperability (Ajami and Bagheri-Tadi 2013).
Interoperability here means that the information related to the EHR is shared across a variety of
EHR storage solutions and medical systems. EHR data are the ones that are ones that are
provided in the descriptive form. The several issues that are associated with the interoperability
of data and metadata quality are data coherency/consistency, correctness, completeness. It is seen
that if the data, fields are standardized and applied subsequently then the data can be put to
greater use and also in better clinical decision making. Additionally, the coherence of data leads
to timely detection and intervention of the dangerous diseases, increased safety of patients
(Fildes et al. 2015). EHRs consist of the medical records in the electronic format sourced from
the different providers such as the transactional data consisting of the information on
prescription, qualitative data based on the clinical notes, quantitative data based on vital signs
and laboratory test results. The medical histories of the patients can also be included within the
electronic medical record and this includes data on past medical diagnoses and treatments. EHR
contains both the unstructured and the structured data and majority of the structured data can be
entered into the fields of the medical records promoting data interoperability (Rind et al. 2013).
Strategy and application of Apple Health Record Technology
On June 4th 2018, Apple announced that it has opened to the developers its Health records
API. This will the developers to create apps that will facilitate the users to manage their
medication, nutrition and others. The app will deliver on the following key categories:

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 Medical research- in order to determine the conditions that are pre-existing in a
patient, researchers previously used to use the survey questionnaires. This
traditional method used put a lot of pressure on the patient and would bound them
to remember 100 percent of the health condition. Now, the story is different, the
researchers can access with prior permission of the user their health-related data
to conduct a comprehensive research (iMore 2018).
 Nutrition planning- The API which emphasises the health records allows the app
developers to completely customize the nutritional programs that will be based on
the cholesterol results and the blood pressure results.
 Disease management- Apple has announced that there is a diabetes app that will
access the lab results and the health records along with the exercise details and the
diet details that are existing within the iOS HealthKit integration and it will help a
patient to stay on track (figure 1).
 Medication tracking- there is an app called Medisafe. This particular app is
capable of managing medications and this after getting linked with the health
records data can track the medications that are being taken up by a patient (figure
2). The app is potential enough to tell which medicine after reacting with another
can have drug interaction issues (iMore 2018).
Figure 1: patients of more than 500 clinics and hospitals are able to access the medical records in
a single view [source: apple.com 2018c]

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Figure 2: The Medisafe app integrates along with the API of Apple Health Records and this
helps the users to learn even about the harmful drug interactions [source: apple.com 2018c]
Apple Health Records and bridging of the existing gap
The Apple health records are easy for the users to visualize and at the same time secure
their health record data. The patients feel empowered and can bring together the patient-
generated data and the health records data from the several health organizations and this will
create a holistic view of health. The Apple health records help the patient to have all their health-
related records on their iPhone and thus it is easy for the patients to participate in help and health
drive with a bit of awareness of the patient portal (apple.com 2018a).
Apple has facilitated the ecosystem to be a convenient one with the transfer of the EHR
from the servers of the health organizations or institutes directly to the iPhone. Apple has worked
with Athenahealth, Cerner and Epic and the other healthcare organizations and communities to
make it easy for the users to enable this feature. Apple health records have tried to bridge the
gaps that are already existing in the world of EHR.
 Apple health records are built with the industry standards- A connection is
established between the users of the health app and electronic health record. This
connectivity utilizes the Fast Healthcare Interoperability Recourses (FHIR) API
which is defined by the project Argonaut. The data types that are supported by

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such a connectivity are vitals. Procedures medications, lab results, immunizations,
conditions, allergies.
 Seamless connectivity- a system of connection called the OAuth 2.0 and this sort
of connection allows the users to just authenticate for once and have a continued
connectivity with the EHR APIs. If a new data arrives in the new health records,
then the app will occasionally pull the data and periodically notify the users of the
app (apple.com 2018a).
 Secure and encrypted throughout- Every time the health records get transferred
from the health care institutions to the health app, the data is transferred in an
encrypted form. However, due to security and privacy purposes, none of the data
is passed through the Apple's network. The health data is iPhone gets locked with
Face ID, Touch ID or passcode and this stays as an encrypted data. Even if a user
chooses to sync the data present on the phone with the cloud server then also the
transfer and the rest part stays encrypted.
 Designed for protection of privacy- Apple provides its user with the ability to
request and subsequently download the information related to the health records.
This whole process employs an encrypted connection between the APIs that are
provided by the clinic or the health system and the user's iPhone. Thus, Apple on
their part is not transmitting, maintaining and receiving and creating the protected
information on health on or behalf or for the healthcare institutes (apple.com
2018a).
Figure 3: Apple Health Record app [source: apple.com 2018a]
Apple health record and management of diabetes
Apple health records are a novel app that helps to fetch patient's health data present in the
servers of the healthcare institutes and organizations. A patient that is already having diabetes
and is undergoing diabetic medications and other treatment procedures can have his or her

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diabetes data directly into their iPhone. The Apple health record app will allow that patient to
directly access the treatment data and test reports for a handy purpose. Apple currently uses
CareKit in partnership with the Health Gorilla. Health Gorilla can be described as a platform that
is exclusively made for the clinicians so that the clinicians can coordinate the patient care. The
CareKit is a strong interface that brings all the stakeholders associated with the medical care of
the patients into a single platform (El-Gayar et al. 2013).
At the same time, Apple watch can be used to keep a track on the blood sugar levels and
the with the other several parameters. A user or a patient can keep a track of his or her activity
and the present glucose levels with the active implementation of the prescribed medicine by the
physicians (El-Gayar et al. 2013).
Figure 4: Apple health app integration with apple watch for easy health tracking [Source: CB
Insights Research 2018]
Advantages of Apple health records
A survey conducted by a research firm called KLAS revealed that the considering the
broad customer base of iPhone, Apple health record has the potential that will effectively impact
the lives of the millions of users. Early participants that have participated in the survey have
stated that the Apple health records have both the short term benefit as well as the long-term
potential for the users of the Apple health records and this directly impacts the way patients
manage their health and the way organizations interact with their patients. Sixty percent of the
early participants have mentioned that the Apple health records will empower the patients and
the interoperability issue will directly act to solve the previous problematic issues and this is
indicated by the fifty-eight percent of the patients. 50 percent of the respondents have revealed
that the Apple health records will solve the issue related to change and innovation. While 30
percent of the respondents have revealed that the Apple health records would facilitate the app

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development for the consumers. Furthermore, 25 percent of the respondents have indicated that
this will open up the healthcare sector to the outside vendors (Hickman 2018).
The health records are meant to manage the issues that were previously thought to be
challenging with respect to the interoperability. This allows the iPhone users to get a hold of the
health data on a device which is already used by them regularly. Around 70 percent of the
respondents have said that they are planning to be able to access their health records data. Only
70 percent of the respondents have mentioned that they will actively use the service. While 50
percent considered the Apple health record as an additional option of patient engagement
strategy (healthcareitnews.com 2018).
Figure 5: Survey carried out by KLAS on Apple health records [source: Klasresearch.com 2018]
Figure 6: Impact of Apple Health records on the healthcare industry [source: Klasresearch.com
2018]
 Healthcare providers provide the best care when they have intuitive and powerful
tools. Apple Health records have the potential to connect with the patients
remotely and work effectively within the hospitals and thus promoting research in
the medical fields. Therefore, the care delivered becomes more humane,
personalized and more efficient (apple.com 2018b).

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 The product will transform the way patients will interact with each other and with
the patients. Apps that are present on the iOS devices work efficiently and the
clinicians can access the data whenever they need them. Nurses at the same time
can ensure better medication for the patients and the nurses stay engaged and
informed about the patients and the other care provider teams (apple.com 2018b).
 The iOS devices enable the patients to receive care at their home and the app also
helps the user to stay connected with their care team. The healthcare organisations
can use the CareKit to make health apps and at the same time the HealthKit
enabled medical devices and the apps make enables patients to record their health
data (apple.com 2018b).
Disadvantages of Apple Health Records
Apple Health Records is an enhancement over the existing Electronic health records and
it takes into account the various positive aspect of patient benefits. However, there are certain
negatives or the downsides of the initiative taken up Apple.
 The cost of maintenance and set up- the cost associated with the setup of the EHR can
actually act as a deterrent. The hospital organizations and the institutes will have to
consider the cost of making applications that will be compatible with the way Apple
health records works. The cost of the set up will be setting up of systems for a system
update, IT support, training, maintenance. Lower cash flow and the smaller practices
alone with act as a detriment for the proper implementation and maintenance of the
system (Baldwin et al. 2017).
 Delays in the documentation process- the whole concept of EHR and the interoperability
will add an extra burden on the physicians. Previously documentation and the notes were
the two most time-saving approaches that were brief and straight to point. However, with
the EHR the documentation process in lengthy and they have to work before and after
each patient visit (Baldwin et al. 2017).
 E-messaging between the providers- While the approach taken up by the Apple health
records adds convenience for the patients and the users. The remote access of the patient
health data will reduce the face to face communication and there will be less of the
question and answer scenarios.
 Lack of accountability and the continuous need of updates- For each and every single
process of prescription, treatment, procedure, diagnosis and wellness visit, the EHR along
with Apple health record will undergo an update. The constant updates will also lack the
scope of accountability, which otherwise will require clear and communicated
information from the nurse’s, doctor’s and patient’s end (Baldwin et al. 2017).
Conclusion
From the above discussion, it can be concluded that the Electronic health record (EHR)
can be described as the patient's chart in a digital format. EHR is the patient-centric records and
data that are in real time made available and accessible to the authorized users and in a secure
way. EHRs are built with one motive of sharing the information with the other organizations and
providers such as the workplace clinics, school, emergency facilities, pharmacies, medical
imaging facilities, specialists, laboratories. Apple has facilitated the ecosystem to be a
convenient one with the transfer of the EHR from the servers of the health organizations or
institutes directly to the iPhone. Apple has worked with Athenahealth, Cerner and Epic and the

10ADVANCED HEALTHCARE SOFTWARE AND SYSTEMS
other healthcare organizations and communities to make it easy for the users to enable this
feature.

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