IEEE Spectrum June, 2015 - 54

business

58%

47%

43%

26%
Check for ear
infection
using device
on phone

Use an at-home
strep test
at a store

47%

42%

44%

Do urinalysis
test at home
with device
on phone

32%

Have ECG at
home using
device attached
to phone

Consumers likely to
choose DIY over
traditional option

Clinicians comfortable
relying on DIY diagnostics
test to prescribe medication

Do try tHis at HoME: smartphone health
apps tend to appeal more to patients than to
doctors (and perhaps more to both than to
regulatory agencies).

$300 Apple watch," says Sean Wieland,
who follows stocks in the health information industry for the brokerage firm
Piper Jaffrey.
A second issue is that doctors don't
share the tech industry's "more is better" approach to data. "There is a big
concern that health care providers will
be getting a huge amount of new information that they don't want," says Bill
Hanson, chief medical information
officer for the health care system at
the University of Pennsylvania. This
would include, he said, hour-by-hour
readouts of weight, pulse, blood pressure, and the like.
One of the problems with at-home
data, Hanson adds, is that doctors have
no context for the information. "When
I have a patient in front of me, I can
look and see that blood pressure has
increased because the patient is nervous.
But I don't have that sort of knowledge
about data from outside a medical setting. Someone might have had a weight
54

jun 2015

north american

gain simply because they ate food with
a lot of salt and retained fluids."
Another problem with data-hungry
diagnostics is that they're based on
the assumptions of preventive medicine, some of which have recently been
upended. The conventional wisdom
used to be that frequent screenings
for diseases allowed doctors to catch
and treat pathologies like prostate
and breast cancer while they were still
nascent. Instead, medical researchers
have discovered that overscreening can
cause more trouble than it solves by
inflicting risky procedures on "false
positives"-patients who test positive
for an ailment they don't have.
There's also a liability issue, Hanson
says. Plaintiff's attorneys in medical
malpractice suits routinely subpoena
all of a patient's health records. Should
those records include copious real-time
data involving heart rate, for example, a
lawyer could zero in on a single anomalous reading and attempt to blow it out
of proportion. "They're getting increasingly sophisticated about using medical
records," says Hanson.
companies like samsung and

Apple may also struggle with the
software technologies used in connection with electronic medical records
(EMR), which are produced with different corporate cultures and customer
relationships than those that consumer
companies are used to.
An EMR system replaces the racks of
bulging charts that were once a familiar
sight in doctors' offices; each patient's
record contains clinical notes, lab
results, and other information. The EMR
market is highly regulated, not only for
privacy reasons but also because the U.S.
federal government is now spending billions of dollars subsidizing what it hopes
will be an industry-wide transition to
EMR-based record keeping and is trying
to make sure the money is well spent.

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The EMR market, at least for big
hospitals and health clinics, is highly
concentrated, with a few companies
controlling most of the business. These
big EMR providers tend to maintain a
much lower profile than the Apples
and Googles of the world. Ever heard
of Epic Systems Corp., of Verona, Wis.?
It's the biggest of the lot, and it's not
even a public company.
When they discuss their coming role
in health care, Apple and the others tend
to talk of complementing the technology provided by big EMR vendors rather
than replacing it. Consider what Apple
is doing with the Mayo Clinic, one of
HealthKit's premier customers.
Mayo designed a smartphone app
based on software from Epic, of which
Mayo is a customer. Patients use the
app to e-mail their doctors, schedule appointments, and check on test
results. When Mayo patients first sign
up for the app, they can allow Mayo to
access their Apple HealthKit data-if
they have it-and present it alongside
their Epic data. As the app is still in
its early days, few people have signed
up, according to Ommen, the Mayo
medical professor.
Analysts who follow the multibilliondollar-a-year EMR market say the consumer companies have little chance of
making a major impact on it. "Health
care requires a tremendous amount
of domain expertise," said Wieland,
of Piper Jaffrey. While consumer companies tend to be closely followed in
the media, meaning their health care
announcements usually get a great deal
of coverage in the general interest press,
"they actually don't have a very strong
track record. It's still the Epics of the
world that end up the winners."
The final issue is regulatory. The U.S.
Food and Drug Administration recently
clarified the extent to which it will regulate digital devices. It said that, in general, fitness-oriented devices that record

StatiSticS Source: Pwc'S health reSearch inStitute

Part 2: Analyzing the Code

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Table of Contents for the Digital Edition of IEEE Spectrum June, 2015