Tuesday, September 13, 2016

Today, C-CDA Goes Mainstream at Duke Health with HealthKit in iOS 10

Back in June I broke the news that support for HL7s C-CDA was coming to Apple's HealthKit, giving consumers more control over their health information. This is a major step forward for patient empowerment, and also - of particular interest to me - standards-based interoperability.

But this cool new feature is meaningless if patients can't get access to their health information!

So, I'm very happy to report that today, with the launch of Apple's iOS 10, Duke Health is ready to allow patients to download their C-CDA from our Duke MyChart portal and import it into the Health app, ready for sharing with other compatible apps! This process currently requires accessing the Duke MyChart website, but we hope to add the same functionality to the MyChart iOS app in a future release.

To start, simply log into the Duke MyChart portal from the Safari browser on your iPhone or iPod touch (the iPad doesn't currently support HealthKit). Tap on the My Medical Record tab along the top, then on the Download My Record option. This will take you to a page fitting called Download your Continuity of Care Document. Simply tap the green Download button here (Note: if you choose the option to encrypt the document, you will not be able to open it in the Health app).

The document will then download, and you'll be presented with a screen asking you what you'd like to do with it. If it doesn't say "Open in Health," tap the "More..." button and then select "Add to Health" from the top list. It'll be the icon with the heart on a white background as shown below:

You'll then be shown a preview of the record:


Including a searchable view of the C-CDA itself (some information here redacted):

If you're happy with this information, simply tap "Save" (see left screenshot above), and the record will be imported into the Health app.

To view this record later, simply open the Health app and select Health Records, where you will be able to view all imported records:


If you tap on the individual record from here, you will be able to view it as well as share it with other apps that can accept C-CDAs.

Also note that you are not prevented from importing documents from other individuals. I was able to import my daughters' C-CDAs and view them all from the Health app.

As I've mentioned previously, on import into the Health app there is very little parsing going on - just enough to identify the individual. If you share this document with another app, it will need to handle document parsing itself in order to make use of the structured content. Fortunately, there are already some open source tools popping up to handle such tasks, such as this one written by Alex Nolasco as part of HL7's C-CDA Rendering Tool Challenge, which contains a C-CDA parser as well as an iOS viewer written in Objective-C.

This is a great step forward in our march towards greater patient empowerment and health system transparency. I can't wait to see where the next steps take us!

Friday, September 9, 2016

iPhone 7 and the Case of the Frustrated Consumer

So you've probably heard by now that the iPhone 7 was announced on Wednesday. According to most outlets (and Apple themselves), it's an evolutionary upgrade. Yet, there has been palpable disappointment from many corners of the internet that this version bump didn't follow the traditional "tick tock" cycle of "major upgrade" (i.e., when the version number changed) followed by "speed upgrade" (with the addition of the "S," a tradition harking back to the iPhone 3GS introduced in 2009).

Something has been bothering me about this disappointment, and not in an "Apple Fanboy (or girl)" kind of way. I usually get my best insights while monotonously swimming laps in the mornings, and today was no exception. I was struck by this obvious thought: the majority of consumers (and the media, and Wall Street) - perhaps unconsciously - judge the novelty of new products primarily based on its aesthetic appearance. Beauty is only skin deep. Perhaps there's a greater lesson there for society, but that's not the point of this post ...

But that's not all. The problem with that thought as it relates to the iPhone (and smartphones in general) has to do with Apple's general design philosophy of "form follows function." In other words, the product will be designed with the singular purpose of enabling it to function at the highest level for its intended use.

When it comes to the iPhone, this largely seems to be a solved problem. How much has the iPhone design truly changed since its introduction in 2007?

There's a screen, a home button, speaker(s), volume buttons, a power button, a mute switch. It's obvious that despite the marketing and the version numbers and the minor cosmetic tweaks, the most significant changes have always been related to internal components. Every time. Just take a look at the major advertised features of each release:

  • iPhone (first release, need I say more?)
  • iPhone 3G: 3G, GPS
  • iPhone 3GS: speed, better camera with video recording
  • iPhone 4: Retina display, custom A4 chip, front-facing camera
  • iPhone 4s: Siri, custom A5 chip, 1080p video recording
  • iPhone 5: larger display, LTE, Lightning connector, custom A6 chip
  • iPhone 5s: TouchID, dual-LED flash, A7 (first 64-bit mobile chip with M7 motion coprocessor)
  • iPhone 6: larger (higher resolution) displays, Apple Pay, custom A8 chip
  • iPhone 6s: custom A9 chip, 3D Touch, LTE Advanced
  • iPhone 7: custom A10 Fusion chip (quad-core), dual-cameras, water resistance, stereo speakers (no audio jack!)

Throughout all those upgrades, has the design truly changed? If you count moving from rounded edges to squared edges (then chamfered edges) to rounded edges again, yeah, a bit. I guess (if I squint).

So why hasn't there been the revolutionary design change the people are clamoring for (and constantly disappointed when it doesn't materialize)?

Because it's not necessary.

The minor design updates have had no noticeable impact on how people use the phone. Changes in usage have all been driven by the internal upgrades noted above (I count the screen and buttons as internal - the design is the same).

The basic design is already nearly optimal for the device's intended usage. For more proof, look no further than the competition. Since the original iPhone was released in 2007, smartphone designs in general have converged on the standard Apple pioneered: a screen and a button.

So should Apple change the design of the iPhone simply for the sake of change? This seems to be what the public is expecting. Hence their disappointment.

Yet Apple, through Jony Ive's disembodied voice, continues to make it clear that the design evolution (rather than revolution) is quite intentional:
"We have created a product that is the most deliberate evolution of our original founding design." "Our obsession remains to continuously simplify and improve." "iPhone 7 is the most singular, the most evolved representation of this design."
Understanding this is the key to unlocking the future of the iPhone. Do I expect the next iPhone to be the big design revolution people are expecting? Of course not. Do I expect some pretty cool internal changes that might cause me to rethink how I use the device? Absolutely.

In the end, Apple's courage to challenge these consumer expectations is probably the most revolutionary thing of all.

The views contained within this post are my own and do not reflect the views of my employer. Furthermore, I have no financial interest in Apple whatsoever.