I informally polled a cross section of physician friends of mine about it - ranging from direct primary care physicians, family practitioners, concierge physicians and so on to get some feedback on it. And it was very illuminating:
- The direct primary care and concierge physicians were all for it. Why? Because most of their patients (and they themselves) were iPhone users. They could also see how this would allow them to provide a higher level of service to their clients.
- Almost every other physician felt it would have almost zero impact on their patient population.
What is challenging to me is how to say what I want to say without getting into a flamewar. So let me set the baseline - I have an iPhone (have had every alternate year’s model), own a Mac or two, own an iPad or two. So I do like Apple products. This post is not about Apple or its products. This post is about trying to provide some opinions on the likely impact of Healthkit and the quantified self movement in general.
So here are a few facts:
1. The majority of healthcare costs are due to chronic diseases
This has been written up about quite a bit. We all know this so I won’t belabor the point. However, the key point to note here is that….
2. The majority of these patients are not quantified self-ers
People with chronic diseases do track some of their activity per this Pew report. A closer look at the data, shows this set of data.
Basically indicating that the populations most in need of tracking health don’t do it as much nor do they use electronic means to do so.
Let’s add one more factoid to this set of data - the distribution of iPhone and Android across income levels.
Put all that together and we realize that the population most in need of tracking tools are barely using or impacted by Healthkit. My physician friends were right - Healthkit is likely to have little to no impact on actually addressing the key challenges around chronic disease.
3. Physicians are constrained on time, payments
Physicians are already strapped for time and have traditionally been very leery of the quality and reliability of patient generated data and making clinical decisions on the basis of that information. Travis wrote about this and I quote, “I have personal experiences with family that have wanted to share their own data and been blown off by physicians. An example is my dad. We got him an iPhone-connected glucometer a couple years ago and, in his excitement, he emailed his endocrinologist his data ahead of an appointment. The endocrinologist flat out told him that he couldn’t really use the data. My dad now sends me his weekly reports of blood sugars, which is helpful because I can encourage him but it would be great if his physician supported and encouraged his enthusiasm for self-care.”
Sharing should be encouraged so perhaps the move to present a default way to access and view summaries of the data could be welcomed. The concern that the physicians I talked to had was that, while patients being more interested in their health is always welcome, more available data implies more time, more correlation, and potentially more liability.
Great journeys begin with a single step. I’m a big fan of the quantified self movement as it is my hope that this will extend soon to folks who are likely to benefit the most from it. Perhaps Apple putting its considerable weight behind it will just be the impetus it needs to make it more widespread.
Great journeys also begin with a destination in mind - and that is what I want to call attention to. The destination for us, if we’re serious about impacting healthcare costs, is figuring out how to engage the low income, 60 year old with COPD and diabetes or preventing the 40 year old smoker with poor diet and exercise habits from turning into that 60 year old. Is the answer to that a $600 phone with an additional couple of hundred on additional devices? If you’re really serious about this, focus on the lower end of the market - dumb phones, cheap smartphones. This has proved very profitable for some and my contention is that because it was not focused just on one platform - Whatsapp is available on “The client software is available for Google Android, BlackBerry OS, Apple iOS, selected Nokia Series 40, Symbian, selected Nokia Asha platform, and BlackBerry 10.”
So, to answer the question I posed in the title, “What does HealthKit mean for healthcare?” - not much in the in the immediate term.