October 2015

It's All on the Wrist
By Dava Stewart
For The Record
Vol. 27 No. 10 P. 8

Although the Apple Watch is new to the health care scene, it holds great promise for improving patient engagement. Toward that end, Epic and Nebraska Medicine are taking steps to integrate the technology into the patient experience.

The Partnership and the App
In June, Nebraska Medicine released an Epic app that allows patients and clinicians to access MyChart through the Apple Watch. The app is interesting for several reasons, not the least of which is its potential to boost patient engagement.

Epic's MyChart service, which can be accessed online, or on any iOS or Android device via a free app, is available to all Nebraska Medicine patients. Integrating the app for the Apple Watch adds a layer of convenience.

Through MyChart, patients can securely access billing, scheduling, and other administrative data as well as portions of their medical records. Those patients and clinicians who use the MyChart app on an iPhone automatically have the functionality to integrate the Apple Watch, according to Michael Ash, MD, chief transformation officer at Nebraska Medicine.

Although the Apple Watch has only been on the market since April, Ash is excited about its potential. "[Apple CEO] Tim Cook specifically called out Nebraska Medicine as a leader. We are all learning," he says.

According to Ash, there are three areas where the technology can be a game-changer: viewing information, incorporating the data into daily life, and using the watch to take action. "That last step is the one we are really excited about taking with Epic."

Who's Using the App?
It's difficult to tell exactly how many people are using the watch to access MyChart on either the clinician or the patient side. "The Apple Watch app is built into the MyChart app for iOS devices. There isn't a way to run a report and see how many people are using the watch," Ash says, adding that approximately 800 clinicians use the MyChart app.

Nebraska Medicine doesn't supply the hardware. Devices are purchased individually, and then Nebraska Medicine installs the necessary security software. "Right now we aren't looking to provide watches to all of our providers. We've purchased a few for testing and piloting," Ash says.

Although the cost of the Apple Watch may be viewed as a barrier, there's reason to believe its price tag actually will help improve outcomes for patients who take the plunge, says Nilesh Chandra, a health care expert at PA Consulting Group who believes when a device is more expensive, it tends to get used more consistently. For example, he notes that although fitness trackers are popular, interest tends to wane. "The problem is stickiness. People wear them for two or three months, then they lose the habit," Chandra says.

Ash cites studies that have found patients are more likely to maintain activity and lose weight if they use a pedometer. "The mental investment and the physical reminder make people more active," he says while pointing out that the differences between a pedometer and a smartwatch are significant. "The watch is a much more flexible device. Satisfaction rates among those already using it are incredibly high."

Optimizing for Size
When a patient accesses the MyChart app through an Apple Watch, the functions are necessarily limited. "The watch is really a subset [of their entire record]," Ash says. The watch's "screen" limits the device's functionality. For example, typing is difficult, so using it to initiate a message to your doctor would be cumbersome.

Given the small screen size, Epic is working to optimize what can be done within the app. One such optimization is what Ash calls "canned responses." When patients receive a message from their provider on the watch, the app provides a set of responses. Users can click the appropriate response without needing to launch the text messenger.

The questions and canned responses may be the key to helping people manage chronic conditions. "Epic and Nebraska Medicine want to get smarter on those questions and answers, and make them very targeted," Ash says. For example, if a person with diabetes receives a higher than usual blood sugar reading, the clinician can send a message: "Your blood sugar is high. Are you feeling OK?" The watch would provide a set of answers and, based on the patient's response, the provider can decide what action to take, if any.

Security Still a Concern
Through the MyChart app on the Apple Watch clinicians can view their schedule, a list of hospitalized patients, and some clinical summaries. Although a dictation feature exists, it's not currently being used. "Privacy and security are above everything else," Ash says. "We need to do more testing to make sure the information is fully encrypted."

"There are some genuine concerns with security," Chandra says, pointing out that allowing patients to upload data could be risky. "But there are ways to address that. I think it's an opportunity," he says, noting that the potential benefits far outweigh prospective hazards as long as security issues are addressed.

The Big Step Forward
Considering the number of health care apps being launched for the Apple Watch and the level of hoopla that seems to accompany each release, it's becoming a tool with great promise, capable of helping solve some of the industry's most pressing problems. One reason for the optimism is Apple's HealthKit, which allows all the various health and fitness apps to work together.

"Interoperability within health care is absolutely critical in terms of patient engagement. [HealthKit] is a step in the right direction because it provides a platform," Chandra says.

Without a consistent platform, providers face an ever-growing jungle of systems that don't work together. "If you're a provider or a vendor, you have to integrate with all the different systems. The complexity of integration is just too much," Chandra says.

HealthKit and GoogleFit are the two most promising platforms being developed, Chandra says. "In the future, they won't have to choose a product to recommend. They will only have to say 'Track your steps,' then decide how to accept the data. That is the potential of these platforms," he says.

Looking Forward
Those looking for the Apple Watch to take the industry by storm need to exercise patience, Chandra says. "This is the first version of a product. Think about the very first iPhone—it was a phenomenal product, but compared to what we have today?" he says.

The future of smartwatches in health care is intriguing, Ash says, noting the next frontier will be adding sensors to the devices. "I think smartwatches with integrated sensors provide some of the biggest breakthroughs we have seen in the management of chronic conditions," he says. "Seamless monitoring of your chronic condition and easy communicating with your care team give additional benefits. If you are healthy, the devices are helpful, but if you have a chronic condition, it could help achieve optimal control of your disease."

On the provider side, the technology will advance as the security issues associated with the dictation feature are addressed, Ash says.

The partnership between Epic and Nebraska Medicine is a byproduct of the facility's patient-focused approach, "From a care perspective, we are absolutely committed to providing the best patient experience," Ash says. "Patients want more access and more control. We are committed to exploring all the options for our patients. We want it to be a safe and overall great experience."

— Dava Stewart is a freelance writer based in Tennessee.