HealthKit is finally live: Here's how it (really) works

Apple’s HealthKit consumer health platform and ecosystem is officially out. After a couple of false starts, HealthKit and the “Health” app are live in iOS 8.

Much has been said about HealthKit, bad and good, hopeful and doubtful. And Apple itself has done very little to promote or educate the public about how its HealthKit data platform will work, not only for consumers but also for the healthcare industry.

Essentially, the HealthKit platform will allow users to store data (like weight or steps or heart rate) from multiple devices in one place. These metrics can be displayed in the Health app in iOS 8, a sort of “wallet” for you personal health data.

This is important because health data becomes more meaningful, and potentially actionable, when it is brought out of its own little silo when combined with data from other health apps or devices. At the simplest level, this might create the ability to understand how weight fluctuations are driven by diet, exercise habits, sleep habits, and stress levels.

Right now a handful of large health providers — such as Mayo Clinic and Johns Hopkins — are working on ways to use HealthKit to collect data from especially costly patient populations, such as those with like congestive heart failure and diabetics. But as Malay Gandhi of the Rock Health accelerator tells me, health providers will eventually understand how to collect, analyze, and display consumer health data in ways that help doctors care for patients of all kinds.

I asked Gandhi, who is familiar with the HealthKit platform, to explain how it will manage health data from the time it collects personal details from the consumer to the time it presents this information to the consumer’s doctor.

How HealthKit Works

The iPhone owner (“consumer”) assigns data sources for each physiological metric tracked within the Health app (e.g., weight, blood pressure, sleep, Vitamin A, etc.)

• These data points can either come from any piece of hardware/software that chooses to integrate with Health app (the Apple Watch for example), or they can be inputted manually.
• The consumer controls this at the individual metric level. The consumer can also assign priority to data sources if there are multiple inputs for any one metric (for example, FitBit counts the steps you take).

For each metric stored within Health, the consumer chooses whether to share that data or not

• Apps will request access to data in the Health app at that metric level (how many pounds you weigh, how many steps you take, etc.), and consumers will then see a familiar permissions screen (the same one used for access to contacts, location, etc.) where they can provision (or decide not to provision) that specific health metric to that specific app.
• This data is transferred from the Health app to the app that requests that data (e.g., Epic’s MyChart) through the HealthKit API.

The app that has received the data can then further transport the data, e.g., send it to an electronic health record (EHR), based on the final endpoint allowing access. (In the case of an EHR push, that would require permission from the healthcare provider that owns the medical record.)

The Health app (and the associated consumer who owns the iPhone) is truly the center of all of this, Gandhi tells VentureBeat. “The Health app is fundamentally a data aggregation and provisioning app disguised under very thin visualization: The consumer controls what data goes in, and what goes out, at a reasonably deep level (it would be like if when an app asked for access to your contacts, you specified access at the individual contact level),” he says.

“While Apple will never mirror your Health data to iCloud (or allow another app to do that), once you provision access to another app, they may transport it elsewhere (e.g., to your provider’s electronic health record system), but only if that particular endpoint allows access,” Gandhi says.

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HealthKit and the EHR

When Apple launched HealthKit last spring, the largest EHR vendor in the U.S., Epic Systems, was there. This was a bit surprising to some, because the Wisconsin-based company has been hesitant to integrate and share data with systems or networks outside the firewall of its hospital or medical group customers.

But Apple has worked with Epic to find a way to get personal data collected through HealthKit into the patient record.

Epic is also known for being media shy, but it did share some information with VentureBeat about how its medical record might pull in data from HealthKit.

Epic spokesman Brian Spranger explains that consumer health data from the Health app doesn’t go directly from HealthKit into the EHR, but routes through Epic’s MyChart personal patient record app.

“If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit ‘wakes up’ the MyChart app and tells it there’s new data,” Spranger said. “The MyChart app on the phone then transmits that weight back to the EpicCare EHR system, where it can be used appropriately as part of the patient’s medical care,” Spranger said.

Health data moves mainstream, because Apple says so

In the broader sense, Apple sees health data as the content at the center of a new kind of ecosystem. It’s the beginning of a long story in the same way Apple’s first step into music was. Apple will spend billions next year on the development of HealthKit and the Apple Watch, the Apple device that will act as one of its inputs. (The true power and importance of HealthKit will begin to emerge in 2015 when Apple Watch becomes available.)

As the health data ecosystem grows, consumers will become more interested in their own health data. Some might wonder about the privacy of their data as more of it is sent into HealthKit platform. But by then, app developers and the healthcare system will have become much better at making sense of it, and taking action on it in ways that obviously benefit uses.