Health Records Firm Epic and About 60 Client Hospitals Object to Data Sharing Rules Supported by Apple

Health records firm Epic Systems and some 60 client hospitals are objecting to a proposed U.S. government policy that would make it easier for patients to share medical records data with apps, an initiative supported by Apple and other tech companies (via CNBC).


Proposed by the Department of Health and Human Services (HHS) in 2019, the modified data sharing rules would allow patients to share private clinical data from their healthcare providers and make it more accessible to health apps via APIs.

Currently, patients often have difficulty trying to obtain their information, with clinical data stored on physical media and processed through medical record software marketed to hospitals by the likes of Epic. According to one report, an Epic installation can cost upwards of $1 billion for a major health system to implement.

Yet in a letter to the HHS Secretary Alex Azar, Epic and signatories argue that the pending initiative on interoperability will be "overly burdensome on our health system and will endanger patient privacy."

Instead, Epic's letter recommends changes to the proposed rules, including extra clarity around health information related to family members and a longer timeline for the "development of new technology required by the rule," up from 1 year to 3 years.
"While we support HHS' goal of empowering patients with their health data and reducing costs through the 21st Century Cures Act, we are concerned that ONC's Proposed Rule on interoperability will be overly burdensome on our health system and will endanger patient privacy. Specifically, the scope of regulated data, the timeline for compliance, and the significant costs and penalties will make it extraordinarily difficult for us to comply."
A spokesperson for HHS told CNBC that it had received the letter. "We appreciate all stakeholder feedback as we continue to finalize the rules," they said. "Our ultimate goal is to ensure that patients are able to easily access their electronic medical records."

Some health IT experts told the news outlet that the letter has not been signed by some of the largest health systems in the Epic ecosystem, and called their absence "significant."
"Their absence represents a thundering silence," said David Brailer, the first National Health Information Technology Coordinator, appointed by George W. Bush. "Many health systems are quietly discussing how the data access and data fluidity actually benefits them in the long-run."
Apple, Microsoft and Google recently joined a call with non-profit Carin Alliance to discuss ways to get the rule finalized. As noted by CNBC, the tech firms favor the rules, partly because greater interoperability between systems that store medical records could help them move into the $3.5 trillion health care sector.

Apple has progressively worked to break into the health industry in recent years. At the beginning of 2018, the company launched a Health Records service to increase the portability of health records and make them available across participating hospitals and clinics. The idea was to allow patients to download their health records to iOS devices and then easily share them with other practitioners.

By August of the same year, Apple's Health Records feature allowed iOS users to access their medical records from more than 75 different hospitals and medical providers in the United States.


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Patent Describes Apple Watch Feature for Improving Treatment of Parkinson’s Disease Symptoms

A newly unearthed patent reveals that Apple is exploring how a future Apple Watch could help doctors monitor the symptoms of Parkinson's patients.


Spotted by AppleInsider, "Passive Tracking of Dyskinesia/Tremor Symptoms" describes the use of special sensors in a proposed ‌Apple Watch‌ medical feature and the reasoning behind it.
"There are an estimated 600,000 to 1 million cases of Parkinson's Disease in the United States and 60,000 new cases are diagnosed each year," reads the filing, which goes on to describe the symptoms sufferers have to live with. "Symptoms of PD include... tremor and dyskinesia. Dyskinesia is an uncontrollable and involuntary movement that can resemble twitching, fidgeting, swaying or bobbing."
The patent states that dyskinesia and tremors can occur when all of the other features of Parkinson's Disease are being managed through medication. Unfortunately, the dopamine replacement therapy can also cause more pronounced side effects, and doctors have to rely on in-clinic tests and patient reports to regulate their treatment effectively.
"A patient's quality of life is largely dependent on how precisely clinicians titrate and schedule the patient's medications to minimize the patient's symptoms. This is a challenge for clinicians because each patient has a different combination of symptoms that can change and become more severe over time. Also, in any given day the symptoms may fluctuate based on medications, food intake, sleep, stress, exercise, etc."
The feature uses motion sensors to monitor the wearer's movement and the data gathered is analyzed on the device using the Unified Parkinson's Disease Rating Scale (UPDRS). According to Apple, this allows the data to be collected more reliably and means the sufferer doesn't need to keep close track of their symptoms and can better plan activities around symptom patterns.

The image above shows a patient wearing an ‌Apple Watch‌, but the patient doesn't specify that the feature would be limited to a wrist-based device, suggesting it could make its way into an iPhone, or perhaps even an electronic finger ring.

Related Roundups: Apple Watch, watchOS 6
Tags: patent, health
Buyer's Guide: Apple Watch (Buy Now)

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Stanford Medicine Publishes Results of Apple Heart Study

Stanford Medicine today published results from the Apple Heart Study that kicked off in 2017, marking the third time data from the study has been shared (via Reuters and CNBC).

The aim of the study, conducted by Stanford and Apple, was to determine whether the Apple Watch is able to detect atrial fibrillation, which can be an indicator of serious heart health problems. Researchers wanted to determine how well the ‌Apple Watch‌ worked and whether it was safe to use.


A total of 419,297 people in the United States participated in the study, and 0.52 percent of participants (2,161 people) received an irregular heart rhythm notification over 117 days of monitoring. People who received a notification were sent ECG patches to further monitor for heart problems, but quite a few of those went unreturned.

Of the 450 people who returned the patches with data that could be analyzed, atrial fibrillation was present in 34 percent overall and 35 percent of participants age 65 or older. Of those who had an irregular reading and returned a patch, 84 percent of subsequent notifications were determined to be atrial fibrillation.
Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram. Of 1376 notified participants who returned a 90-day survey, 57% contacted health care providers outside the study. There were no reports of serious app-related adverse events.
According to researchers, the low number of warnings in the study indicates that the device does not cause an excess of false notifications in healthy people who wear the watch.

In some cases, atrial fibrillation detected by the ‌Apple Watch‌ was in the early stages of development, and it didn't happen frequently enough for the patch testing to detect it, something that was more prevalent in younger participants.

The study did ultimately determine that the ‌Apple Watch‌ can detect atrial fibrillation. Stanford cardiologist and co-author of the study Dr. Mintu Turakhia said that the trial was overall a success, especially when it came to determining how many people are going to get heart-related notifications from ‌Apple Watch‌ and what those types of notifications mean for patients, doctors, insurers, and more.

Dr. Daniel Cantillon, a Cleveland cardiologist who was not involved, told Reuters that the technology was promising, but more than half of participants were under 40, a group at low risk for atrial fibrillation, leading to concerns about scaring healthy people.

Separately, a New York cardiologist told CNBC that there's a risk of the ‌Apple Watch‌ finding young people who have early signs of atrial fibrillation that the medical community doesn't know how to treat. "We just don't understand atrial fibrillation well in the 35-year-old, otherwise healthy person," he said.

Wessler treats patients who have visited him based on data gathered from the ‌Apple Watch‌, and he expects those kind of visits to pick up in the future. Should Apple's research continue, Wessler believes it's important to find the right population that's most at risk to use these tools rather than delivering them to a mainstream audience.

The study was overall beneficial, demonstrating the potential for large-scale studies that use a variety of technologies to monitor patients remotely without requiring on-site visits. Since this study kicked off in 2017, it did not use the new ‌Apple Watch‌ models that are able to take ECG readings, instead relying on the standard heart rate sensor.

The full Apple Heart Study published by Stanford Medicine can be read in The New England Journal of Medicine.


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Amazon’s Alexa to Offer NHS-Verified Health Advice to Britons

From this week, users of Alexa devices in the United Kingdom will be able to get expert health advice from the voice-activated smart speakers, thanks to a partnership between Amazon and the National Health Service.


When health-related queries such as "Alexa, how do I treat a migraine?" or "what are the symptoms of flu?" are put to the devices, Amazon's algorithm will use information from the NHS website to provide answers.

Britain's NHS says the technology will help patients the elderly, blind and those who cannot access the internet through traditional means, to get professional NHS-verified health information in seconds, potentially reducing the pressure on the NHS and GPs, specifically when it comes to providing information for common illnesses.

Currently, Alexa gets its answers to health-related questions from a number of sources, including the Mayo Clinic and WebMD. As a point of contrast, Apple's Siri currently retrieves answers to health-related queries from Wolfram Alpha and Wikipedia.

Secretary of State for Health and Social Care Matt Hancock offered the following comments on the new Amazon-NHS partnership:
We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.

Through the NHS Long Term Plan, we want to embrace the advances in technology to build a health and care system that is fit for the future and NHSX will drive this revolution to bring the benefits to every patient, clinician and carer.
In addition, Hancock told Sky News there are "privacy rules" in place to prevent peoples' information being sold on, and that the government was "up for doing this sort of collaboration with other tech companies".

The Royal College of GPs welcomed the move, but warned that independent research will be needed to ensure the advice given out is safe.

Professor Helen Stokes-Lampard, chairwoman of the RCGP, told Sky News:
"This idea is certainly interesting and it has the potential to help some patients work out what kind of care they need before considering whether to seek face-to-face medical help, especially for minor ailments that rarely need a GP appointment, such as coughs and colds that can be safely treated at home.

"However, it is vital that independent research is done to ensure that the advice given is safe, otherwise it could prevent people seeking proper medical help and create even more pressure on our overstretched GP service."
NHS experts believe half of all health-related searches will be made through voice-assisted technology by 2020. The U.K. government has set up a unit called NHSX to boost the use of digital technologies in the health service over the next few years. Measures already being pursued include an expansion of electronic prescribing and the use of artificial intelligence to analyze scans.


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Health Insurer Anthem Poaches Several Apple Health Employees

A CNBC report on Tuesday brought attention to a slew of recent hires away from Apple's Health team to health insurer Anthem, which is trying to improve the user-friendliness of its consumer technology.

According to the report, Anthem has hired half a dozen current or former Apple employees over the last few months, including veteran Apple staff as well as relative newcomers to the company.


Among the new hires are senior machine learning researcher Stefanos Giampanis, and Apple Health's Toni Trujillo Vian, an Apple veteran of 24 years.
The health insurer also hired Ted Goldstein, a former Apple vice president from 2002 to 2007, to run its AI and health data efforts, about six months ago, and some lower-level folks like Berick Bacani, a former Apple operations specialist, as a UX designer on the digital team.
CNBC notes that the health insurer's Apple pedigree actually dates back a few years: Anthem's vice president of commercial, Aneesh Kumar, started his career in the 1990s as a product manager at Apple.

In addition to the Apple staff migration, the insurer has gained another high-profile recruit from the tech world: Udi Manber, who headed Google's search team, is now a technical advisor at Anthem.

Apple's staff departures are particularly notable given that the company is supposed to be redoubling efforts to improve its health-related tech. For example, Apple in 2018 acquired Tueo Health, a startup working on an app to help parents monitor asthma symptoms in sleeping children.

At WWDC 2019, Apple also announced that new health and fitness capabilities are coming to the Apple Watch in watchOS 6, due to be released in the fall. New features include Activity Trends, a new Noise app uses the Apple Watch microphone to monitor environmental noise, and a Cycle Tracking app for tracking menstrual cycles.

Apple CEO Tim Cook has previously said that health is a major focus of Apple, and that health may actually end up being "Apple's greatest contribution to mankind."

Tag: health

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Apple Hires Obstetrician for Health Team to Bolster Women’s Health Efforts

Apple recently added obstetrician Dr. Christine Curry to its health team, reports CNBC. With this hiring, Apple is said to be looking in to how to bolster its efforts in women's health.

Curry comes to Apple from a stint at Kaiser Permanente in Redwood City, California, which is located not too far from Apple's Cupertino campuses.


Apple employs dozens of doctors at its "AC Wellness clinics" designed for Apple employees. Sources that spoke to CNBC said that while Curry has an interest in women's health, she will be working on "various health issues across the health teams."

When Apple first launched its Health app and HealthKit service, there was no section for reproductive health, but it was later added. There is now a full Reproductive Health section available within the Health app that integrates with period and fertility trackers.

Apple CEO Tim Cook recently said that he believes Apple's ultimate contribution to mankind will be its improvements to the health field.

Tag: health

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NHS Unveils Mobile App to Let Patients Book GP Visits Online

The British government has announced plans to launch a new NHS mobile app that will let patients in England make appointments with their doctor.

The app will also allow users to order repeat prescriptions, manage their long-term healthcare, see their medical records, and quickly access 111 for urgent queries.


In addition, users will have access to patient preferences related to data sharing, organ donation, and end-of-life care.

Health Secretary Jeremy Hunt described the app as a "birthday present from the NHS to the British people", 70 years after the service was founded.
The NHS app is a world-first which will put patients firmly in the driving seat and revolutionize the way we access health services.

I want this innovation to mark the death-knell of the 8am scramble for GP appointments that infuriates so many patients.

Technology has transformed everyday life when it comes to banking, travel and shopping. Health matters much more to all of us, and the prize of that same digital revolution in healthcare isn't just convenience but lives improved, extended and saved.

As the NHS turns 70 and we draw up a long-term plan for the NHS on the back of our £394 million a week funding boost, it's time to catch up and unleash the power of technology to transform everyday life for patients.
"The new app will put the NHS into the pocket of everyone in England but it is just one step on the journey," said Matthew Swindells, NHS England National Director of Operations and Information. "We are also developing an NHS Apps Library and putting free NHS Wi-Fi in GP surgeries and hospitals."


Developed by NHS Digital and NHS England, the app will enter its testing phase in September and then roll out officially in December. It will be available on iOS devices through the App Store, as well as on Android phones via Google Play.


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Health Startup ‘Notable’ Announces Apple Watch App to Automatically Record Doctor Visits

A new health-focused startup called Notable today announced its first app for Apple Watch, which aims to automatically record and digitize visits to the doctor as well as "eliminate the vast majority of clinical administrative work." Using deep learning algorithms, AI, and natural language processing to identify voices, Notable records interactions between doctors and patients so that specific information can be revisited by physicians, healthcare providers, and patients.

The company says that its technology not only helps busy doctors cut down on paperwork and other administrative tasks, but also lowers the stress of visits for patients. Notable's Apple Watch app captures a visit's duration, location, and more, then compiles the data from the doctor's Apple Watch to add labs, prescriptions, referrals, and more to the patient's medical records. The doctor then looks over all of this information for accuracy before submitting it to the patient's electronic health records.



To accomplish these tasks, the app uses voice wake features that make it possible for doctors to complete an encounter "with just one tap." The app automatically structures conversations, dictations, orders, and recommends the appropriate billing codes. Since Notable's beta launch, the company says it has earned an approval rating of more than 98.5 percent by doctors using the service.
"Notable frees me to spend more quality time with my patients at work, and more quality time with my family when I get home. I now complete almost 100% of my notes immediately after the patient visit is completed. I've worked with typing entry, iPhone transcription services and a scribe. None of them compare to Notable and I can't imagine going back.” — Dr. Dolan, Orthopedist

"The thing that I like the most about this product is that it combines two very unusual characteristics: it is simultaneously the most faithful and least intrusive means of recording what happened. A wrist watch doesn’t take up the same kind of space as a computer, a tablet, or a even a dictaphone, and … it encourages face to face contact during speech." — Dr. Gollogly, Orthopedist
On its website, Notable says that the app is compliant with the Health Insurance Portability and Accountability Act, ensuring that the medical data of every patient is secure and private. "Security & HIPAA compliance are essential to everything we do, and we are proud to exceed the industry standard in protecting your organization."

Company CEO Pranay Kapadia got the idea for Notable after his family complained about the many frustrating administrative tasks they had to complete as doctors. Kapadia explained: "We started Notable to leverage powerful technologies such as AI, wearables and voice interface to address these challenges and to give physicians what they really want — a seamless, truly hands-free solution, not another screen to learn or computer application."

Apple Watch has become a major factor in many health-related startups and studies, with a few this year suggesting Apple's wearable device can detect early signs of diabetes, high potassium, and abnormal heart rhythms with 97 percent accuracy. Apple itself runs the Apple Heart Study in partnership with Stanford University, allowing users to contribute their Apple Watch's heart rate sensor data and identify irregular heart rhythms.

Related Roundups: Apple Watch, watchOS 4
Tag: health
Buyer's Guide: Apple Watch (Neutral)

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How to Set Up Medical ID on Your iPhone

Medical ID is a built-in feature of your iPhone's Health app that gives ambulance crews and other emergency first responders fast access to potentially life-saving information about any allergies or medical conditions you have, even if your iPhone is locked.

Even if you don't suffer from any health conditions, it's still worth enabling Medical ID, because it can also provide other vital information about you to emergency services, such as your blood type and who to contact in an emergency. This article shows you how to set up Medical ID in iOS 11.
Continue reading "How to Set Up Medical ID on Your iPhone"

iOS 11.3 Coming This Spring With New Animoji, Vertical ARKit, Health Records, Battery Info, and More

Apple today previewed iOS 11.3, its next major iPhone, iPad, and iPod touch software update. The first beta will be seeded to developers later today, followed by a public beta soon, ahead of an official release this spring.

iOS 11.3 introduces new Animoji on the iPhone X, including a lion, bear, dragon, and skull. There will now be 16 characters to choose from in total, including existing ones like a pig, fox, chicken, pile of poo, and robot.


iOS 11.3 will feature ARKit 1.5. In addition to horizontal surfaces like tables and chairs, Apple's updated augmented reality platform will now be able to recognize and place virtual objects on vertical surfaces like walls and doors, and more accurately map irregularly shaped surfaces like circular tables.


ARKit 1.5 can find and recognize the position of 2D images such as signs, posters, and artwork, and integrate these real-world images into augmented reality experiences, such as bringing a movie poster to life. In addition, the view of the "real world" will now be in 1080p HD, up from 720p currently.

The software update will introduce Business Chat, a new way for users to communicate directly with businesses within the Messages app. This feature will launch in beta following the public release of iOS 11.3 this spring, with support from select businesses, including Discover, Hilton, Lowe's, and Wells Fargo.

With Business Chat, it's easy to have a conversation with a service representative, schedule an appointment or make purchases using Apple Pay in the Messages app. Business Chat doesn’t share the user’s contact information with businesses and gives users the ability to stop chatting at any time.
In the Health app on iOS 11.3, users will be able to view health records, including available medical data from multiple providers like Johns Hopkins and Cedars-Sinai. The data is encrypted and protected with a passcode.


iOS 11.3 will provide users with an iPhone 6 or newer with more information about the health of their device's battery, including a recommendation if it needs to be serviced. In the same menu, it will also be possible to see if Apple's power management feature is active and turn it off if desired.

Apple says the battery and power management features will be coming in a later iOS 11.3 beta release, so they won't be available today.

Other new iOS 11.3 features include more prominent placement of music videos in Apple Music, a new Video section in the "For You" tab of Apple News, and support for Advanced Mobile Location (AML) to automatically send a user's current location when making a call to emergency services where supported.

The first beta of iOS 11.3 will be seeded to developers later today, followed by a public beta soon. The software update will be released to the public this spring for iPhone 5s and newer, all iPad Air and iPad Pro models, the fifth-generation iPad, iPad mini 2 and newer, and the sixth-generation iPod touch.

Related Roundup: iOS 11

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