iOS8 + Healthkit = Pandoras box
How much should we know about our patients?
As many of you may have heard Apple have recently announced the magical wonder that is this year iOS update along with many improvement I can’t wait to try out and although split screen multitasking is going to be the best thing since sliced bread; healthkit and the health app may become a double edge sword.
Anybody who has been following healthcare tech over the past couple of years knows that the rate of adoption of non-invasive monitoring is on the rise. What’s interesting is that these “sensors” are actually being developed for use by consumers, not necessarily healthcare workers.
The implications of this may seem minor at first sight but the fact that a major company has managed to put a 24 hour healthcare monitor into every single one of it’s phones means that from hence forth your patient should in be an open book. But how useful is that data?
First we need to decide how valid it is, currently the fitbit I wear every day is a consumer electronic device, this means it isn’t really validated or approved by the FDA necessarily. So how accurate is it really? and how do we decide on a defacto standard when using these to gauge our patients health or blood sugar levels for example.
Next, we need to decide what it means, at first sight knowing how much your patient walks, or what her heart rate is when she does walk or go up stairs seems useful, but how many studies have been conducted to see if walking 10'000 steps a day helps control blood pressure and most 24 hour blood sugar models are based on acutely ill patients or animal models, rendering random 24 hour blood sugar reading useless. It’s probably more useful as a lie detector in the bigger scheme of things. Patients can no longer say they walk everyday for an hour when they barely make 2 miles but then again they could give it to one of their kids to run around in and trick you.
Then there’s patients rights, who owns this data? Is it the patients or Apple, inc? and how are you supposed to access it? I’ve yet to look at the healthkit API but I’d imagine that apple would need some pretty good security if they expect me to trust them with my last blood test ,especially consdiering that someone can actually look it up at random.
Plus, how many of you would like your employers or insurance companies to have access to your data? Like it or not, around the world insurance providers have become part of our healthcare family and it’s only a matter of time before it comes to Kuwait.
Lastly, how ethical is it to publish data taken off the healthkit API? How will institutional review boards and ethical committees approve or even validate this data? If they can it’ll actually be a fantastic thing and may even been as revolutionary as evidence based medicine. (1000's of patients across 1000 of locals with unbound variables to do stats on ….. heavenly ….)
And believe me Apple have a plan to bring all these things to fruition, the recent meeting between key Apple execs and their FDA counterparts it further proof that this is something that will be part of your clinical practice in five years, just like the electronic patient record systems we used today were considered “neat toys” in their infancy by many of our more senior colleagues in the 90's.
I’m not saying it’s a bad thing, I’m just saying it’s something that like many things Apple the implications are far more reaching than at first glance and this like the iPhone and iPad it’ll probably make us think different when patients come in with their iWatches next fall.
P.S. I write mainly in English because I’m basically trying to foster discussion amoung us as hospital workers, you all have alot to say and I think we should try and comment on it. Feel free to do so. To access comments on medium all you have to do is sign in with a twitter account (every Kuwaiti gets one as part of their pre school registration these days so there no excuse …. ) If you would prefer you can email me instead.
