On Monday, Apple announced Carekit, the latest addition to their burgeoning healthcare software toolbox. It’s similar to the Researchkit platform, with one major difference: Carekit will focus on enabling developers to build self-management apps for patients to use in their day-to-day care. Think digital health tools for care planning, monitoring, tracking, and the like.
CareKit goes live in April, so expect more details to emerge over the next few weeks. The basic idea is pretty clear: The “kit” consist of a set of “modules” that serve as partially configured, pre-set tools that developers can then plug into their own apps:
- Care Card: This module looks like a care plan builder, with a simple progress-based list of activities (meds, exercises, etc.) that can be checked off
- Insight Dashboard: A rollup display similar to its HealthKit counterpart that offers a quick look at a patient’s self-reported symptoms or outcomes over time (e.g. pain, mood)
- Connect: An information sharing app for patients, doctors, and researchers (and potentially caregivers, pharmacists, care managers, coaches….)
- Tracking: A set of modules include basic tracking tools: mood trackers, pain trackers, medication trackers, and so on
There may be more – it’s too early to know. It’s not hard to imagine what these modules look like in practice, because these use cases have been around for years (more on that below). Apple’s featured examples include a post-surgery app being developed in partnership with Texas Medical Center to “let you easily keep track of your postsurgical needs — like monitoring pain levels, temperature, range of mobility, and medication – and help you stay more connected with your doctor.”
Similar apps were announced for chronic condition management in partnership with Beth Israel Deaconess, with some specific apps for diabetes care (One Drop) and mental health (Iodine.)
Some old questions and some new ones
Privacy and Security
Given Apple’s other headlines of late, questions around the privacy and security of PHI are sure to emerge in media coverage. Apple’s status as a covered entity under HIPAA still has lawyers and HealthIT executives debating. However, whether we’re talking about the security of information stored on a phone, data transmitted through the cloud, or data zipping around the internet of things, the unique question raised with CareKit is a simple one: When Apple lowers the barrier to entry for developers new to healthcare, how will we ensure that the new apps being built are up to snuff? Security for small research pilots is one thing, scaling out for thousands of patients using their phones in the real world is another.
More practical questions for the digital health industry
How will ResearchKit and CareKit overlap? Will we see the applications and features move from the former into the latter?
CareKit does seem to be focused more generally on real-world applicability, on chronic diseases rather than rare ones, and tools and features that the market has already embraced and validated.
Will lowering the barrier to entry to develop and deploy these apps flood the app store with hundreds more tracking tools with varying levels of clinical validation?
On the one hand, we want doctors to be prescribing apps to patients; we’ve been talking up this concept for years. On the other hand, if patients want to download a self-management tool and there are hundreds of similarly built options out there without a guide, is that a good thing?
Does this really matter to patients?
There’s a tendency in media to get excited when Apple shows up to the digital health party; we succumb to a Steve-Jobsian Reality Distortion Field in which we imagine eager patients becoming addicted to health management tools on their phone. Let’s do a reality check now and remember patients tend not to think about their health unless they have to (and rightfully so.) Can CareKit really help to change that?
“Tough to say,” notes Todd Johnson, CEO of HealthLoop, a care management startup. “I think that having individuals track their care plans is great, but without physician oversight [use will] be limited.”
I always wonder how many of the new iOS apps built will have Android counterparts. My personal experience over the last five years says not many. At the individual level this might not matter, but when thinking about populations (and markets) it’s not a trivial issue. Apple’s biggest mHealth competitor in the U.S. market has seemingly gone sideways. The Korean giant has been involved in some investments and partnerships, but has not walked the walk the same way Apple is doing.
Market implications: Will CareKit matter?
As a disclaimer: I am not a fan of needless industry hype and I don’t believe that Apple has invented anything groundbreaking with CareKit. However, given their brand’s cachet among consumers and physicians, as well as their influence and footprint in the technology industry (software, hardware, wearables), it’s certain this move will have some impact on the status quo.
Below are some segment-by-segment musings. This is by no means a complete analysis – please leave your own thoughts in the comments section below!
Care management startups: Is Apple eating my lunch?
If you’ve been paying attention to digital health, you know that the examples, features, and general ethos of CareKit are by no means new. Startups have been building digital care plans for self-management for the last four years (e.g. Patient IO, HealthLoop, CareSync, Twine, Wellframe, and many, many others). After years of product development, should these companies be nervous?
When Apple released Healthkit in 2014, a similar hubbub quickly subsided when one thing became clear: Apple is simply trying to attract more builders to their sandbox. Carekit is just another step in the same direction: By automating the development of some common features that the market has validated (trackers, dashboards, care plans), Apple hopes to make it easier to bring in new developers to build customized apps – by disease, by surgical procedure, etc.
Have they commoditized a swath of digital health product development? Sure. But we should know by now that building an app doesn’t guarantee you anything in the health IT market. Any company worth its salt that already built their trackers and dashboards have also pitched, fundraised, piloted, and closed customer deals. Apple’s Carekit will not wipe out that work, but rather serve as a starter kit for the next wave of startups to (try to) enter the digital health market.
An anonymous health IT executive I e-mailed with added that smart companies would rush to leverage CareKit as an opportunity, rather than treat it as a threat (See ‘Healthcare Orgs’ below.)
I’d fully expect all of the familiar startup brands out there – Twine, Propeller, Omada, Ginger, and so on – to get on this train soon. For most, the attitude here is “C’mon, it’s Apple – get on board or get left behind.”
EHR and other enterprise health IT vendors: Meh.
On the opposite end of the spectrum, the enterprise health IT segment will be either the most promising, or the most disappointing one to watch. Epic turned some heads announcing an app for Apple Watch, but their target market there is physician users. Several vendors, from Epic and Cerner down the chain, have dabbled with Healthkit, but we haven’t seen much product maturation beyond pilots.
Will CareKit finally lead EHRs, who have long floundered on patient-facing tools (especially mobile), to quickly and affordably build out their own tools for monitoring, task management, and engagement?
Given how reactive this segment has been with consumer tools, it’s doubtful we’ll see a “meaningful” amount of activity here. Look for some nifty stuff from the smaller, specialized players out there – players like Influence Health, Get Real Health, or MedFusion.
Healthcare Orgs: I get by with a little help from my vendor
Carekit could ostensibly lower the barrier for healthcare organizations to develop and pilot their own apps for patient self-management. Provider partnerships have been a clear and growing focus for Apple ever since Healthkit’s launch. Duke, Cedars-Sinai, Ochsner, and over a dozen others have been busy imagineering how to transform care delivery with iPhones. With so many innovation centers around the country, we can definitely expect to see more provider-built apps rolling out over the next couple of years…but will they ever make it to market?
I posed the question to Jason Bornhorst, the founder and CEO of Patient IO, and he wasn’t so sure Carekit will extend beyond the pilot phase: “CareKit still requires health systems to have an IT team supporting a one-off app. Ultimately, health systems will need to do interactive care planning at scale. This is where the opportunity is for enterprise solutions.”
Lizza Miller, CEO of Datstat, agreed. DatStat leveraged ResearchKit to push an app-building framework to their customers, who were then able to partner with the vendor to turn research protocols and questionnaires into patient-facing tools.
“CareKit’s open-source framework will be part of our overall strategy to help providers leverage connected technology to more fully engage patients in tracking and managing chronic disease between visits.” She added she anticipates CareKit will “allow our customers to more quickly roll out healthcare apps, more easily modify apps when needed, and leverage our backend data platform and API to integrate app data with provider systems.”
All other digital health companies: Your time is now
CareKit could be a boon to the telehealth industry, which has not done a great job of establishing continuity between the world they operate in (rental networks of doctors, non-interoperable medical records) and the rest of the delivery system. Using a smartphone-tethered care plan to connect the dots through the patient would be a use case worth trying. Same goes for Pharma, who is aiming to move beyond the pill through companion apps, med adherence tools, and outcomes tracking. Carekit might be their next up to bat.
It’s almost inconceivable that Walgreens doesn’t do something cool with this platform. Will they come up with a compelling role for the pharmacist to assist in self-care? Finally – and this is next to impossible – I like to daydream occasionally about a world in which TelCos like Verizon decide that they can package a caregiver app together with a family plan, pre-install it on their phones, and enable virtual digital caregiving at the touch of a screen. If Apple is doing so much of the legwork, all Verizon would need to do is―yeah, never going to happen.
Big picture: What’s good for consumers is good for digital health
It’s important to realize that none of the above opportunities are “new” or intrinsic to Apple’s announcement. These are simply the unrealized promises of mHealth. The question is whether CareKit will help the industry realize some of this opportunity.
All ruminations aside, one thing is clear: The digital health industry is in great shape. One of the most enthusiastic reactions to CareKit has come from mental health care reformers, who are thrilled to see important tools like mood tracking featured on the largest tech stage in the business. So while CareKit is not really an innovative or original development in terms of technology, it can serve to ease the pain points for incorporating mobile health for patients and to increase awareness of the importance of digital consumer engagement around the industry. Perhaps too, this will finally drive some patient-oriented use cases for FHIR.
“It’s a positive sign for the future of digital health that Apple and other consumer electronics companies continue to invest in the space,” says Drew Schiller, CTO at Validic. I couldn’t agree more.
While I don’t view Apple as a white knight for chronic disease, their presence, energy, and effort in this space are as important as the popularity of their products. Looking at the hiccups of the patient engagement segment over the last decade, it’s clear that we’ve got to try something new to get patients, family members, and their supporting clinicians and caregivers the 21st century tools they all deserve.
What do you think about Apple’s announcement? Do you work on a product, or treat patients, and have ideas for how this might play out? Leave your ideas and comments below.