I am not an employee of Apple, although it would be awesome. For 15 years I have consulted and developed companies that seamlessly bridge the gap between technology and human behavior. The deeper I dive into the health and behavior industry; I find one company who continuously shows leadership in an industry they don’t even claim to be in, Apple.
Welcome to Apple Triage
Apple Triage is what I am calling the next evolution of healthcare and what we, as patients, want from our technology. I will demonstrate current problems in the industry and how Apple is the most capable company to solve them using their current approaches to technology and behavior triggers.
Problem: The healthy 80% pay for the 20% sick in any insurance system.
This situation is a very well-known issue in the health insurance system. Starting two years ago the Patient Protection and Affordable Care Act (ACA) requires all US citizens to have health insurance. This is a problem for healthy people, like me. I don’t want to pay $1200 or more a year for something I am never or rarely going to use.
I am healthy. I eat fairly well and I exercise on a regular basis. I rarely get sick. When I get sick, like almost everyone with a cell phone or a computer, I look up what is wrong with me. I know what my symptoms are. I have a fever, the chills, my snot is green and I have lumps in my throat. I enter these symptoms into my Google search and am easily able to look up what is wrong with me.
Medical Definition: the act of assigning degrees of urgency to wounds or illnesses
Patient Definition: Am I going to die?
What am I doing when I look online? I am triaging myself. I want to know how bad is it. Do I need to see a doctor? Worse, am I going to die? I did not diagnose myself; I triaged. I compared what I know to what I don’t. Then, I made an assessment. This is how many people use the health system already.
Emergency departments were designed for emergencies, yet the majority of patients use this system as the next phase in their triage. Prior to going to the emergency room patients consult their current resources, mothers, relative or online posts to access their situation.
A – Airway – B – Breathing – C – Circulation
The ABCs taught in every CPR and first responder training course. This helps the first responder determine the level of severity (triage) and respond accordingly. As a practicing and licensed Athletic Trainer I was told by an EMT to say, “I/the patient is having difficulty breathing” in order to expedite help from emergency responders as this puts the situation higher on the list of priorities.
We need physicians to make a final diagnosis as triage is based on symptoms. The same symptoms for a nonlife-threatening issue can be exactly the same as those that are life threating. For example, A 20-year-old female complaining of sharp pain in her calf after a long tennis match could be suffering from a simple muscle tear or a deep vein thrombosis (DVT) caused by birth control. The Same symptoms result in a drastically different diagnosis and outcome, the muscle strain will heal in a few weeks and the DVT could lead to a pulmonary embolism. Given this type of information allows the patient to be more informed and decide how severe they think their situation is.
Solution: Build an ecosystem that gives people the tools to triage themselves.
Apple already did this. Well, they did it with music. Napster basically created our current music consumption industry. Napster understood what we wanted, cheap (i.e. free) and easy access to music, downloaded from the internet.
ITunes was created to bridge the gap between “cheap and easy” and the music industry giants. ITunes was a “healthy” option for consuming the media we wanted. With iTunes, I could now buy the song I really wanted and didn’t have to risk getting in trouble with the music industry. Apple understood what we wanted and built it. Apple has already begun dipping its hand into building what we want from a health care improvement perspective.
Health App is a fitness tracking app, which comes preloaded on all new Apple devices (phones and watches). If you are an Apple product user, you are already carrying around the first version of a very well designed non-medical device. Apple chose not to add more robust medical grade technology to their newest devices because Apple did not want to make a classified medical device. If Apple would have added this technology, the FDA would have required approval for the devices as they would have had the ability to “diagnose.”
But, if Health App was designed to be a triage center, this would change everything. I can already check my heart rate, my blood pressure and do many other basic medical assessments with my phone. In the future, I will be able to take a blood or swab sample, Theranos or iTest, and run a lab on my mobile device in my home. I will be able to reference numbers on a reliable website / app and triage myself.
Doctors do this! As Sports Medicine intern, a doctor and I left a patient’s room to consult WebMD. After the doctor found what he was looking for, we went back into the room to share our newly-gained wisdom with the patient.
Doctors don’t know everything; they can’t. Vinod Khosla at the Health2con Winter Conference said, “The average cancer patient in the US does not get cancer care at the level at which it is taught to a medical student.” Current practicing physicians don’t have time or access to the newest standard of care taught in schools. This problem is again demonstrated by pharmaceutical companies. Pharma companies advertise their medications via media outlets, nightly news broadcast, Hulu, and billboards. Doctors almost require patients to tell them what is new, because they don’t have the time to look up what is new – even with continued education requirements.
So why not give me the ability to triage myself? Let me put in my symptoms, run some tests and then send me a list of items to compare. Let me make the choice if I should do something about my condition.
Problem: Medical devices don’t talk with one another.
Fitness trackers, Fitbit, Moov, Basis, Up, your phone and the 100s of other devices, are the beginning of the self-triage or ther-ables (therapeutic wearables) industry. However, these devices suffer greatly from the lack of a simple connected ecosystem. Android has over 24,000 different devices a developer can choose to code for. Connecting all of the fitness trackers to all 24,0000 phones is nearly impossible.
Samsung took the Android platform a step further and developed Tizen and their own line of wearable fitness trackers including their own ecosystem. Interestingly, their own products don’t communicate with one another, which again is a problem.
The current solution to a connected health ecosystem is open APIs. Every day a new API is added to the ecosystem, which requires new products to spend valuable dev time connecting to the millions of other open APIs and building their own. Even with the help of API curators, it is still not a viable option for this industry.
Solution: Build a platform that talks to itself.
Continual upgrade and improvement are critical for the development of a connected health ecosystem. Older products need a shelf life so new products can build the necessary infrastructure.
I started a health company, Random Breakfast. We built a nudge based fitness system through the mobile game platform. One of the first issues we ran into in the development of our first game, StepPets, was the lack of a connected system.
We looked into going native for Android, but this proved problematic. We would have to build for thousands of Android variations. We also looked into using current apps on the market. Users would have to download two applications just to play our game, this would never happen. Then we decided we should only connect with the most popular fitness trackers, FitBit, Moov, Basis, Up, connecting all of these would have segregated the Android market and limited our capabilities to gain users.
We were left with only one choice, Apple. Every single Apple iPhone device (5s and above) has Health App pre-loaded. Apple uses the same code base and the applications run identically. No new downloads. No additional steps. Seamless integration. Because Apple focuses on the future and “the next big thing”, older phones have an issue with many new Health App features. The reason: Apple wants you to upgrade.
What we need is not just a connected fitness tracker system, but a connected Health System. Becoming a connected health system can only be accomplished by an organization or a system that is designed to remove the old and outdated and continually push to update the established infrastructure. My belief: Apple has this nailed and it won’t be going away anytime soon, which is perfect for a health revolution.
Problem: Privacy is broken and HIPAA doesn’t help
We have all seen the checkbox that says “Allow Access to Your Personal Information” when we sign up for websites with a Facebook or Google account. Privacy has come a long way and now we know what we are agreeing to (assuming you read the agreement) and what information the application is taking from us. This is called a “Wrapper Agreement.” Other places we see this is when we download software or buy a DVD, once the wrapper or the download has been performed we are bound to the agreement.
Healthcare is a bit different. We still sign the agreement with the healthcare provider stating they will not share our health information except with those that need it, but as patients we tend to hide behind this privacy act stating,”No one can know my ‘personal’ information”, yet we share information socially about where we are, what we are doing, the food we eat, and our height and weight. This information is public, yet if it is in my medical record then for some reason we believe this same information is protected by HIPAA and should not be shared.
Solution: Treat ourselves as numbers for the greater community.
We need to share our “personal” data. When it comes to sharing this type of data we really are just a bunch of numbers. Let’s take an imaginary person: Male, 36, 5’9”, 175 lbs., BP 120/80. Let’s assume he has a rare form of cancer and there is a small group of other cancer patients in a similar situation. Jane McGonigal calls these people our “allies” in her book Super Better. Our patient needs allies and they need him.
We need to talk and share information openly. What if our patient is cured, because of something he ate, did or because of due to some DNA gene that everyone else doesn’t have? The only way to know is to share.
There are many websites that have groups that do openly share their successes and struggles. In one case, I recently spoke with the author of Nail It Then Scale It, Paul Ahlstrom, about an experiment he did with cancer patients and their willingness to share everything. They share not only what they ate and their exercises but also share their treatment protocols. Treatments are supposed to be HIPAA protected, but this community sees a bigger picture. If a member of the community is cured of an ailment, they want everyone else to know what they did and be cured too! This action of sharing treatments and results is no different from a person who lost 100 pounds on a paleo diet sharing. They believe their story can help others. What is missing is the organized approach to researching these communities.
While HIPAA and sharing information isn’t directly solved by Apple, having a single place to share this information and store it in a way that is trusted and accessible by the research community is something that Apple Triage would easily be able to do.
Apple already has one of the best-performing fitness tracking apps loaded on millions people’s phones. Health App is the only fitness tracking app that is shared by many, without the need for an extra download, which allows new companies easy access to many people with limited extra work. Apple updates their technology and forces people to remove the old, thus updating a broken non-connect ecosystem. Health App is on the verge of becoming the next greatest tool to help me and so many other better understand their health. By organizing my collected data and connecting me to “Allies”, allowing my information to be shared between devices and by giving me a tool to self-access my situation, Apple will dominate personalized mobile health in the next few years. Welcome to Apple Triage.
I have a Masters in Sports Medicine and an MBA from the University of Utah. I worked in Athletics for a number of years and I grew up the son of a physician. I worked as a consultant for a number of companies in the health industry including telemedicine, analytics and health and wellness. I have started two companies that focused on behavior change and I am an avid follower of the trends in this industry. I am fascinated by the evolution of healthcare and excited by what my role will become in changing the future of how we are diagnosed and treated.