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Over the last few decades the “digital age” has enabled many garage-based startups to transform into sustained successes by targeting problems that begged to be solved digitally.  Sometimes their leaders identified and resolved needs we never knew we had. The largest, like Google, Amazon and Apple, grabbed consumers and have sealed relationships with them via irresistible technology-enabled solutions across a bewildering range of industries.

In the first early days, Apple decided we needed cool-looking, fast computers that were easy to use, essentially because they were what its engineers wanted to have. Google decided to provide Internet users with a search engine that would be instantly gratifying: faster, better and prettier than competitors. And Amazon was certain we would rather buy books online with a convenient click instigated by real readers’ reviews instead of slogging into the local Barnes and Noble — Starbucks coffee or not.

Today these incubating ventures are multi-billion-dollar titans that have amplified their product and service lines across many industries, using similar computer-enabled customer-focused philosophies, and changing the ways business gets done. Think Google mail, Apple iPhones, Amazon cloud, and so much more.

Now they’re here at the healthcare industry’s door; in fact, their feet seem firmly planted in it.  By all appearances, they are ready to do some major disruption in how healthcare is provided and paid for. Here’s Part One of our new blog series on what Apple, Google and Amazon have been up to since our last report in April, 2019. Take a look at the developments, as well as a bit of analysis that goes beyond the news.  Let’s start with:

According to Apple CEO Tim Cook, “If you zoom out into the future, and you look back, and you ask the question, ‘What was Apple’s greatest contribution to mankind?’ It will be about health.”

Collaboration with Major Health Organizations on New Medical Research Studies

Apple has been supporting the medical research community,  starting with its ResearchKit and CareKit, which “expanded the pace and scale of such studies.”  Apple recently used ResearchKit to create the Apple Heart Study, which was the largest study of its kind and illustrated the impact virtual, large-scale studies can have on medical research by examining atrial fibrillation. One intent was to validate the irregular rhythm notification feature on Apple Watch.

In September, Apple announced that it is collaborating with several academic and research institutions on three original medical studies. Apple said, “The studies will be available on the new Research app, which democratizes how medical research is conducted by bringing together academic medical institutions, healthcare organizations and the Apple products customers already make a part of their everyday life.”

Forbes’ reporters noted that only patients who can afford an Apple Watch get to participate; their investment must be a minimum of $400. In other words, the studies’ collection of data doesn’t reflect genuine democratization of research. In fact, the average person who uses Apple’s Cardiogram feature is 41 years old and 79% have health insurance through their employers, suggesting that the gender, age and ethnicity of users may be a significant factor in understanding the studies’ results, because of potential bias towards high-earning, middle- or upper-class Caucasians.

Apple insists that “Participants will contribute to potential medical discoveries and help create the next generation of innovative health products.” Combine this prospect with consumer fascination with digital devices and apps,  and we may well see thousands of people opting in to get their data collected.

Apple Heart and Movement Study:
Apple is partnering with Brigham and Women’s Hospital and the American Heart Association on a comprehensive study of how heart rate and mobility signals — like walking pace and flights of stairs climbed — relate to hospitalizations, falls, heart health and quality of life in order to promote healthy movement and improved cardiovascular health.

Apple Women’s Health Study:
Partnering with Harvard T.H. Chan School of Public Health and the NIH’s National Institute of Environmental Health Sciences (NIEHS), Apple has created the first large-scale long-term study focused on menstrual cycles and gynecological conditions. This study will inform screening and risk assessment of conditions like polycystic ovary syndrome (PCOS), infertility, osteoporosis, pregnancy and menopausal transition.

Apple Hearing Study:
With the University of Michigan, Apple is examining factors that impact hearing health. The Apple Hearing Health Study is the first of its kind to collect data over time in order to understand how everyday sound exposure can impact hearing. The study data will be shared with the World Health Organization (WHO) as a contribution toward its Make Listening Safe initiative.

Commercial EHRs and Apple Initiatives

In August, Allscripts announced that Apple Health Records is now available for Allscripts Sunrise™, TouchWorks® and Professional EHR™ clients and their patients. Similarly, EHR vendor MEDITECH has also started supporting iPhone’s Health Records. Earlier this year, we reported that Apple is also working with other EHR vendors, including athenahealth, Cerner and Epic, to help their users access personal health records on iPhones. This capability directly addresses the challenge of accessing healthcare’s holy grail — interoperability.

The concept is that Apple Health Records will bring together hospitals, clinics and consumers to make it easy for iPhone users to see their health data from multiple providers whenever they choose. Apple worked with the health care community to create its “customer-friendly” Health Records based on the Fast Healthcare Interoperability Resources (FHIR) standard for transferring electronic medical records, which many believe offers great promise to achieving healthcare’s goal of EHR data interoperability.

that Apple Health Records is now available for Allscripts Sunrise™, TouchWorks® and Professional EHR™ clients and their patients. Similarly, EHR vendor MEDITECH has also started supporting iPhone’s Health Records. Earlier this year, we reported that Apple is also working with other EHR vendors, including athenahealth, Cerner and Epic, to help their users access personal health records on iPhones. This capability directly addresses the challenge of accessing healthcare’s holy grail — interoperability.

The concept is that Apple Health Records will bring together hospitals, clinics and consumers to make it easy for iPhone users to see their health data from multiple providers whenever they choose. Apple worked with the health care community to create its “customer-friendly” Health Records based on the Fast Healthcare Interoperability Resources (FHIR) standard for transferring electronic medical records, which many believe offers great promise to achieving healthcare’s goal of EHR data interoperability.

Individuals will have medical information from participating institutions organized into one home page view, covering allergies, conditions, immunizations, lab results, medications, procedures and vitals, and will be notified of information updates.

Apple claims that Apple Health Records is already reshaping the health records market, and is currently at 16% penetration in US health systems. In theory, with each new data integration Apple lands, the AHR app becomes a more powerful tool for healthcare research and informing treatment options, making it increasingly attractive to growth via potential health system partners.

Apple and Senior Health

Apple’s new device and app features are the latest signs that it’s investing in the senior healthcare market, destined to grow extensively in the coming decades.

Apple is integrating the iPhone with hearing aid support and a “hearing health” section, to make the device more attractive to seniors, half of whom will get disabling hearing losses, according to the NIH. The Watch is also incorporating a new medication adherence app that will remind patients to take their pills as instructed. Over half of all seniors don’t take their medication on time, according to Aging Care.

Apple hopes that bolstering its devices with more senior-focused health features will attract more provider and payer partnerships including agreements that could include subsidizing the Apple watch. Reportedly, Apple is already in talks with private US insurance companies about subsidizing the Apple Watch for millions of Medicare Advantage members.

Healthcare-related Apple Systems Updates

During the Worldwide Developers Conference in June,  Apple announced updates to the operating systems for its several devices — iPhone, iPad, Mac, Apple Watch, and Apple TV — to enhance their health tracking capabilities. A revamped Health app with a new homepage will better outline consumers’ daily activity from the day. There will be a section for “hearing health,” which will show us how loud we are playing music on our headphones and even the loudness of the external environment. The upgraded app includes more comprehensive menstrual cycle tracking, a new system-wide Sleep Mode that lets users input the time they fall asleep and when they want to wake up, and better track sleep patterns.

Meanwhile, authorized developers continue to work with the development kits Apple shares with them to build apps for the iPhone and Apple Watch in the areas of health information exchange between apps, medical research and clinical trials, and connecting providers with patients.

AC Wellness: Apple’s Clinics

Apple continues to ramp up its primary care group subsidiary, AC Wellness, to provide care to Apple employees at its headquarters in Cupertino, California. According to CNBC, many of the company’s physicians were hired in part for their experience in alternative management or wellness. AC Wellness has hired more than 40 nurse practitioners, nutritionists, exercise specialists, and other wellness experts to provide on-site care to employees. Go to Google, look up AC Wellness employment, and you will see many more current job openings!

Reportedly, recent tensions within the healthcare team over conflicting ideas about its long-term direction have caused at least eight key people to leave. AC Wellness’ products and services are mostly confined to wellness and prevention, but some employees feel the company should be taking on more ambitious projects and generally doing more in health. It’s worth noting that wellness initiatives, although of value,  are responsible for few costs in the health care system. Almost 90 percent of U.S. health care expenditures are for people with chronic diseases, according to the CDC.

Internal issues include disagreements over whether AC Wellness health clinics should expand into medical software to produce products for clinicians, or remain focused on Apple employees. Also, some staffers wanted to introduce a telemedicine service and move into health payments to simplify insurance billing, but they were unable to drive these initiatives forward.

It remains to be seen when — or if — Apple will be able to translate AC Wellness into a profitable service that would benefit a large audience than its own employees and potentially reduce some of our healthcare costs. As the company is already seeing and (one would hope) expected, the business of providing healthcare to patients is anything but simple or straightforward. Even as we publish this report, Walgreens is announcing that it is closing its 160+ in-store clinics, which have barely broken even.

Stay tuned for Part 2 of this report during the week of November 18, where we will review the latest healthcare initiatives of Amazon.