How Apple becomes the operating system for health

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

Apple health operating systemFrom Rob Litterst and Nathan Baschez’ “healthOS” posted Friday in Divinations:

On one hand, we’re seeing a proliferation of health sensors that will only continue to accelerate… On the other hand, we have a healthcare system that isn’t making use of any of this data and isn’t exposing any of the data they generate in any sort of structured or portable way.

Apple’s goal is to connect these dots by becoming a trusted broker that stands in the middle…

Before Apple Health came along this data was closely guarded by healthcare vendors that have restrictive privacy needs. Further, healthcare companies have historically shut down attempts to integrate EHR into mobile devices, partially because it’s complicated, but also because they have a big disincentive to allow a new data layer to form that allows patients to switch between providers more easily. Both Google and Microsoft have tried in the past, and both got shut down. So why Apple?

Put simply, it’s the combination of scale and privacy. Apple’s focus on privacy got them in the door with healthcare companies, and their scale allows healthcare providers to tap into their customer base for large scale research studies that make the relationship mutually beneficial.

Apple health operating systemThis relationship creates a feedback loop: the more users Apple can get in their Health ecosystem, the more likely new healthcare companies are to partner with them. The more healthcare companies partner with them, the more compelling Apple’s health ecosystem becomes for users who aren’t on it. Growing each side of this marketplace deepens the trenches of Apple’s health data moat, and since this moat is so uniquely theirs, it’s become their biggest priority.

The goal is to become a non-negotiable integration point everyone can rely on.

My take: Good plan. Smart piece.

10 Comments

  1. David Emery said:
    I see no incentive for anyone to cooperate with Apple. I have a FreeStyle blood sugar sensor in my arm, that I read with the associated app on my iPhone. Why would Abbott want to give up the data they get from that app to Apple?

    HIPAA is a significant impediment to user friendly health applications. If Abbott wants to communicate with me about my monitor, they send me a message telling me to log onto their website, which of course is a closed system that they can certify to HIPAA standards. Other health providers/insurance companies have similar -closed- systems built around the often onerous HIPAA requirements. Now that they’ve paid for that stuff, why would they give it up? Would using Apple infrastructure relieve them of legal liability under HIPAA?

    Apple’s stuff works pretty much only with Apple devices (with the exception of iTunes for managing iDevices). For many, that’s both a philosophical and a business point of failure.

    Now if Apple had success with Home automation, a much less difficult domain to integrate, I might be more encouraged. But for now, I’m expecting Health to be 2 or 3 ‘bridges too far’. (I’d write more, but I’m out of characters…)

    1
    June 14, 2020
    • David Emery said:
      Let me expand a bit on why ‘Home’ is like ‘Health’ from this perspective. Both depend on 3rd parties for the majority of the devices and a lot of the value proposition. The big problem with Home is the lack of much to control at an affordable price. Apple has not incentivized companies to produce lots of Home compatible items at low prices, it’s at best a niche market. There are affordable ‘smart controllable devices’ out there, they’re just not Home-compatible, and there’s certainly not enough to make Home ubiquitous.

      Health will have a similar problem. There’ll need to be a critical mass of compatible devices and apps to generate the groundswell to overcome the Big Pharma/Big Insurance business obstructions and investments. .

      1
      June 14, 2020
    • David Emery said:
      Oh, and I would Very Much like to see both Home and Health become successful! In previous posts here, I’ve proposed that Apple needs to financially incentivize investments in Home-compatible products. Apple needs a similar approach to get over the critical mass for Health products.

      1
      June 14, 2020
    • Bart Yee said:
      I always ask myself “why do people get concerned when Apple stuff only works on Apple devices? Is that really a “business failure”?”

      I haven’t seen much pitch for health devices or healthcare integration to the vast installed Android user base, you know, that huge group that dominates variously 83-88% of the smartphone market. One would think there would be huge incentive (and revenues and profits) to partner with Android (or even Microsoft Windows) and all those tens, if not hundreds of makers, and leverage that for their users’ benefit. Ah, but is data protection and privacy a major premise of those operating systems and manufacturers?

      0
      June 15, 2020
  2. Steven Philips said:
    It also seems that when a company partners with one of the tech companies they usually end up partnering with the others so any exclusive “feedback loop” is lost. Witness the health companies teaming up with Fitbit for example.

    1
    June 14, 2020
  3. Joe Murphy said:
    I understand the hurdles named above. Yes, they’re significant. However, I have confidence in Tim being fully aware of them and being committed to working through them.

    We won’t know until we’re looking back at what was accomplished.

    2
    June 14, 2020
  4. Fred Stein said:
    Pretentious writers (Straussian reading??) do raise good points and miss some.

    They see the OS as platform for integration – correct. They miss the Watch as THE winner (more in a later post.). They miss clinical trials, a $64B cost, that reduces drug development ROI to low single digits.

    0
    June 14, 2020
  5. Fred Stein said:
    More on the Watch: (I’ve ranted on this before, but not specific to health)

    The rest of the Smart Watch and the narrow function wrist devices are a fragmented mess. This presents an ROI challenge 3rd party health product and services developers who choose anything other than Apple Watch. The authors the issue of fairness and equity. Again, Apple Watch offers the payers (however politics shake out) the best deal. The actual cost of the device will be small compared to nearly every other healthcare cost (sadly). Case by base, the Watch will become paid by providers.

    Another way to think about the Watch is “Uber”. Who thought in 2007 that Uber would up-end the taxi business? We’ll find other “Ubers” in health. No need to guess.

    3
    June 14, 2020
  6. Jerry Doyle said:
    Tim C is on record that health care is a wide-open field where he believes Apple can make significant contributions.

    Apple kicked off its entry into the trillion-dollar industry at the 2014 WWDC with the intro of iOS 8. Health care is the biggest industry in the US worth $24.5B in 2016 according to the Inc. 5000, an annual list of the fastest-growing private US companies.

    Apple has the Health app combined with the HealthKit framework. Apple’s intent is to construct a comprehensive health view of our life, which should empower us to take care of ourselves over time. It also affords us to deliver certain health data to our doctors and get help from them.

    Tim views Apple Watch as a comprehensive health and fitness device. He sees the Watch as a major new category in health care and, this is Apple’s trajectory for the Watch. It was the very first product category launched under Tim C. Jony Ive is on record saying the Apple Watch was the first major product with no input from Steve Jobs.

    Very few Apple products are instant hits out-of-the-gate. The Watch will become (if not already) a significant historical Apple product hit. I don’t know the specifics, but with HealthKit and ResearchKit Apple is laying the foundation for a wrist-worn computer that facilitates and assists wearers in monitoring and improving their health and fitness. The Apple Watch is the platform for Apple’s ambitions in the Health & Wellness industry.

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    June 14, 2020
  7. Bart Yee said:
    As a retired physician who worked both sides of healthcare, the biggest obstacle to managing healthcare for the welfare of the patients is the healthcare system itself. Everyone is proprietary, everyone is in a silo, everyone wants to control their own (patients, doctors, insurance, pharma, etc.), and none will share except when it truly benefits them.

    Apple’s approach, IMO, is to give some of that monitoring and management back to the user / patient. Apple proposes to provide a common platform for personal and medical information to benefit the patient, and then the purveyor. Healthcare has never had a forte in protecting or sharing information – too much old school thinking dating back from the 80’s and 90’s.

    When Apple builds out its health related devices, OS and Apps, users will see, adopt, use and then clamor for their providers (and insurances) to do the same. Like Apple Pay, once a few critical dominoes fall and accept, there will be a steady migration. Oh, there will be a few resistors (like MCX / Current-C was) and competitors, but they will have years less experience and capital.

    2
    June 15, 2020

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