Garry James, 60, is perched on the edge of his hospital bed, temporarily unhooked from monitors that track his vital signs. It’s his third week waiting for a heart transplant, a nerve-wracking process that can stretch out months or even years, but he greets me with a wide smile.
“I’m an Android guy,” says James, while clutching the iPad that Cedars Sinai Medical Center in Los Angeles gave him when he was admitted into the hospital. Unlike some of the more senior patients on the ward, he got up to speed with the technology in no time. “My son, who is 10, knew exactly what to do,” James says. These days, James uses the iPad to message his nurses, order magazines, make notes, browse medication side effects, reserve lodging for his family when they visit from Las Vegas, and review his medical record.
The device has helped him feel more in control of his own care. “I want to have an intelligent conversation with my doctor,” James says. “Just enough to be guided on the right path.”
An iPad might not seem revolutionary in the internet age, but it’s actually a big step forward for patients to have digital health information at their fingertips. Many doctors, like Cedars Sinai’s Shaun Miller, remember a time even five years ago, when many processes were still paper-based and medical information sat in silos. It took a $35 billion investment from the federal government back in 2009 with the HITECH Act to kick-start the process to digitize health data. Even today, many patients still receive their health data on a USB stick or CD-ROM, making the shift to mobile at some hospitals truly cutting-edge.
A major reason that hospitals across the United States have been notoriously slow to adopt mobile and consumer technologies relative to other sectors, like finance and retail, is that many are still tied to on-premises enterprise software. “Health care has been the last bastion for (apps with) design principles, mobility, and a clean, compelling consumer experience to infiltrate,” says Sterling Lanier, CEO of Tonic Health, an app that collects medical data. It has also been a challenge to get doctors and other health professionals on the same page. As the associate chief medical officer, it’s Miller’s job to help convince doctors to change their processes. It’s only recently that the majority of fellow physicians have fully adapted to the shift away from clipboards, fax machines, and pagers. “A lot of it has been resistance to change,” Miller tells me. Changing the way their work is done “can feel scary” to some medical professionals, Miller says.
Meanwhile, patients seem to have adapted quickly to the changes, as many already use mobile devices in their daily lives. James pulls up a page with all of his prescriptions, and clicks on each to review possible side effects. If he has any concerns, he can send a direct message to a specific person on his specific care team and get a response in minutes, rather than pressing a button for any on-call nurse to show up. “I’ve never seen anything like this,” he says.
For Apple, the $3 trillion health care sector offers a lot of potential for growth for its iPad. The company is likely to restate its commitment to the tablet device as early as next week, with the rumored announcement of the 9.7-Inch “iPad Pro 2.” From an enterprise sales perspective–a priority for the iPhone maker in the wake of recent partnerships with Cisco and IBM–large hospitals and health systems that shift to iOS tend to buy devices in bulk. “We now have hundreds of iPads for patients to use,” says Miller, who uses a compliant iPhone app called Voalte to text with other providers. “As we expand to more wards, it’ll be thousands.”
iPhones and iPads have been used by some hospitals for more than five years, but it’s only recently that the company went public about its interest in health care. “Leading hospitals and health systems are using Apple products to transform all aspects of health care inside the hospital and beyond,” says an Apple spokesperson, emphasizing the “privacy and security of iOS” as a key factor for its growing popularity among hospitals for remote patient monitoring and in-patient care.
For Apple, health care is one of the largest sectors it is tackling as part of its enterprise efforts. It isn’t alone. Rival phone makers Samsung and Alphabet also see huge potential to bring mobile technologies to patients and clinicians. “There’s still some transitions that have to take place in the industry,” explains Ben Bajarin, a technology analyst with Creative Strategies, who has been tracking Apple’s move into health care. Some of these challenges include the lack of reimbursement from insurance companies for new technologies that are shown to improve patient outcomes and cultural resistance among some doctors.
Apple’s interest in health care was also initially surprising to many outside observers, given the complexities and regulatory constraints that many tech companies shy away from. “Health is a sensitive area, and it’s not consumer-oriented,” says Bajarin, who suggests that it wasn’t an obvious target for Apple. “You don’t just have to pass the Federal Communications Commission,” he says. “You have to go through a lot of regulatory protocols,” including the FDA. But Bajarin says the move was a long time coming: The late Apple CEO Steve Jobs realized how “broken and bad” many health care processes were, such as the poor user experience, after he got sick with cancer.
After consulting with dozens of experts and building a team, Apple opted to “look at themselves as a platform,” Bajarin adds. Rather than making its own apps for hospitals, the company is working with top developers who are already building apps for health–as it does in other industries–by taking feedback from experts, like developers and hospital executives, and connecting them to its developer relations team to answer ongoing questions from top app makers.
In response to conversations with industry experts, Apple introduced a slew of software services–CareKit, ResearchKit, and HealthKit–that are all designed to make it easier for mobile developers and consumers to pull together disparate health information such as steps, sleep, and heart rate in one place. HealthKit, which was introduced first, is designed to make it easier for developers to gather health data–with the user’s consent. ResearchKit, already in use by developers at major academic hospitals and universities like Mount Sinai, Stanford Children’s Hospital, and Harvard University, helps researchers recruit participants for their studies on mobile. CareKit is geared at helping patients with chronic conditions share data with their care team.