Excited to share Apple Health Records with a doctor? Thank data interoperability standards like SMART and FHIR

Back in early 2018, Apple entered the personal health record (PHR) space with its Apple Health Records platform.

Built directly into the iPhone’s operating system, the tool was designed to help consumers manage their health information by downloading health data directly from participating providers with compatible electronic medical records systems—a list that today includes more than 700 health organizations.

Now more than three years on, the tech company has announced plans to tackle the other side of the coin with a new data-sharing feature for Apple Health Records.

The feature will allow users to choose a participating organization and select which metrics they would want to share with their doctor—a list that ranges from device-collected daily activity and vitals to immunization histories and clinical lab results. From there, the platform will begin periodically collecting a snapshot of the user’s health information that doctors can open within a patient's health record.

Apple said the sharing feature’s fall launch will be supported by six EHR vendors: Cerner, DrChrono, Athenahealth, Allscripts, CPSI and Meditech Expanse. Health organizations using those vendors’ platforms will be able to choose whether or not to support Apple Health Records and its sharing features for patients.

“Access to this information helps give your doctor a more complete view of your everyday health outside of the clinic,” Apple Health Vice President Sumbul Desai, M.D., said during the announcement. “We’re so excited about this new capability to share your data from the health app directly with your doctor … and we look forward to expanding availability even more in the coming months.”

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Leaders from three of the supporting EHR vendors echoed Desai’s enthusiasm for the data sharing feature to Fierce Healthcare and characterized it as part of a broader trend to incorporate patient data into care.

But they also highlighted the ease with which their respective EHRs were able to integrate with Apple’s PHR platform.

The key, they said, was Apple’s decision prior to 2018 to design its platform around standard application programming interfaces (APIs) — namely, SMART on FHIR (Fast Healthcare Interoperability Resources).

“No integrations are ever identical, but their integration approach is standards-driven and therefore fairly common to the industry,” Michael Palantoni, vice president of platform services at Athenahealth, told Fierce Healthcare. “I wouldn’t say there’s anything outside of implementing those standards that are unique to it. It’s as robust implementation of those standards as we would expect of other PHRs.”

After years of proprietary data formats and health information siloed between different organizations, industry standards have increasingly picked up support from leading health data vendors and government policymakers alike.

The eventual adoption of these standards by numerous EHR vendors, as well as a company with the massive consumer reach of Apple, were clear victories for those in the industry advocating for these data formats.

The ease with which EHR vendors said they were able to integrate Apple’s platform and begin supporting a major feature update like data sharing are the latest examples of how those decisions are beginning to bear fruit.

“There’s a revolution happening that I’ve never seen before in healthcare,” Daniel Kivatinos, chief operating officer and cofounder of DrChrono, told Fierce Healthcare. “People are agreeing on standards way more than ever. … It’s really exciting, and it’s a new thing that’s happening between us and other companies.”

‘A very easy project to work on’

Across the board, EHR vendors said that Apple’s team generally followed the same path other third-party groups would take to integrate their health apps.

Take Athenahealth, which offers a single API to all of its partners that supports a number of different industry standards including SMART and FHIR. Palantoni said that third parties who utilize the API can wrap up their integration “in as short a period of time as a weekend,” and that most of the timeline will come down to how quickly the partner builds and how often they want to test the process.

By taking this approach, Palantoni said Apple’s integration didn’t require “any special effort” from either party outside of one additional process for PHRs that opt to use Ahenahealth’s ecosystem-wide patient identification authentication system.

“But that’s, again, a process that’s repeatable, doesn’t require any special effort other than reading our documentation, implementing the documentation and going as fast as the integrated app can go,” he said.

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Jessica Oveys, a director at Cerner in charge of product management, said her company had a similarly streamlined experience bringing Apple’s PHR into their ecosystem and supporting the sharing update.

She also noted that Apple was particularly meticulous when it came to testing the feature prior to making any public announcements and that her team needed to be “respectful” of the tech giant’s desire to keep its work under wraps so it could make the big reveal at its annual developer’s conference.

“We obviously feel very fortunate to be in a position to take advantage of this with investments Cerner has made, and certainly appreciate that Apple’s willing to come to the table and work with us on that,” she said. “At the end of the day, we’ve made the right investments in the right places, which has made this a very easy project to work on. I think we’re in a great spot because of that broader strategy.”

“Both teams, working relatively independently, were able to develop their pieces and use a standard definition of how the data will flow and interact securely in order to support the experience,” added Sam Lambson, vice president of interoperability at Cerner.

Integration driving the future of consumer-facing tools

Committing to and supporting standards like SMART and FHIR doesn’t just lighten the load on an organization’s tech team—it can open the door to new integrations that flesh out a platform and increase its appeal to potential customers.

For Athenahealth, that strategy takes the form of its Marketplace app ecosystem. Available to the vendor’s practice and health system customers, it currently supports more than 260 third-party app integrations (including three non-Apple PHRs) and handles, on average, more than 2 billion API calls per month.

“We certainly think having a thriving ecosystem of application partners, local integrations, integrations with payers and other parts of the healthcare data supply chain is not just critical, but a core component of our value proposition at Athena,” Palantoni said. “The fact that … we can extend and augment their capabilities in a way that other platforms may not be able to is, we think, a definite area of focus for us and something that we want to continue to invest in.”

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The integrations are also a chance for tech companies to compensate for the areas in which their platforms may not excel, Kivatinos said.

From its early days, DrChrono’s mobile-friendly EHR was designed around an open API so that the company could bring in partners that specialize in different healthcare services, he said. While DrChrono is proud of certain in-house capabilities like its claims system or cloud-based practice management tools for scheduling, it also knows that it’s not an expert on things like telehealth or remote patient monitoring.

“We want to make sure that patients are getting the best experience possible from the providers, and if there’s a company out there that partners with us to give a better experience … why not allow that partnership to flourish and allow that partner to get access to that data?” Kivatinos said.

Although the race for a well-rounded product is a strong motivator on its own, the EHR vendors also stressed a couple of larger trends that have spurred greater support for API standards and data sharing across the industry.

“As a response to a specific piece of regulation called the 21st Century Cures Act, we have to provide access. It’s not a choice,” Palantoni said. “If somebody wants to bring an application, we have an open policy to allow those applications to onboard, … so from that perspective we want to make that process as easy and fast as possible for our clients so we can support their needs, so they, in turn, can support their obligations for patient data access.”

Accompanying that is the explosion of consumer health products and services heralded by larger names, like Apple and Amazon, and other digital health companies tackling other day-to-day health issues such as diabetes management, company executives said.

As patients turn up the heat on their providers to begin supporting more of these consumer-facing health tools, EHR platforms that facilitate integrations with these products will be in a better position to “serve our clients in their desire to serve their patients,” Lambson said.

“We see that through high-deductible health plans, right? Patients have to spend thousands of dollars of their money upfront before insurance kicks in, so they’re taking more ownership for the choices they make in their care,” he said. “They may even navigate the health system in unique ways, and they’re also incentivized to stay healthy to avoid those incursions of expense. As a result, their interest in both acquiring and sharing health information has gone up and will continue to be a theme.

“As data becomes more available and patients take more interest in their information and want to get it back to their doc, what is Cerner’s role here? It is to simply and objectively provide standards-based approaches to those workflows. That’s what you’re seeing here," Lambson said.