Provider vs. third-party commercial apps
One of the interesting things about CareKit is that apps will be created by two broad categories of organizations. The first is healthcare providers themselves -- hospitals, medical groups, insurance companies, physician practices, etc. Texas Medical Center's Postsurgical care app is an excellent example (as is that discharge app concept I discussed early on). And then there are third-party developers, companies that produce health-related apps for the general public but aren't associated with a specific provider. Both will provide value, but there will be some notable differences.
Apps developed by a provider will more likely allow a user to share data with and receive updates from a care team. Since these apps will be designed to work with a specific hospital, medical group or practice, they will tie into the backend systems used by those providers (including, but not limited to, electronic health records, patient portals and internal communications systems). The shared data will also likely be mapped to a provider's clinical workflows, meaning that doctors, nurses and others will be expecting to receive the data, have processes in place to review it and have a plan for how to respond if needed.
These apps will prove to be immensely valuable to users and clinicians because they will be tailored to a provider's processes, specialties and the needs of patients. And healthcare interactions will be richer and more useful because the apps are more tailored to specific needs based on patient conditions or the specialties of the providers.
They will, however, have a narrower focus because the data and interactions will be centered around specific health issues. Sharing data with other providers (such as a primary care physician) may not be as easy as with the hospital-based care team or specialty practice. The audience for these apps will also be limited to the patients of a specific provider.
Apps developed for more general use will obviously have a broader audience since they're designed for a mass market, available to anyone that needs or wants to track a given condition. This makes them more accessible, but it also means that more user setup will be needed to customize the app for specific needs and treatment plans. There will likely also be less direct interaction with a provider or care team, meaning it will be up to users to get more involved in their own care. That could involve simply printing out the data generated by an app; some existing health-tracking apps that are planning to integrate CareKit already rely on this method for sharing data.
This won't make these apps any less useful. In fact, broad availability could be an advantage since individual medical practices or doctors in smaller healthcare groups will be able to suggest apps to a range of patients and may even be able to walk them through initial setup during an office visit. The mass market could also allow apps to be tailored tightly to specific conditions, particularly rarer ones, than provider-generated apps.
Obviously, broad availability also means that individuals will be able to select and use the apps without input from any healthcare provider while still offering useful data and insights that can be shared as needed (and with any/all healthcare professionals rather than just a subset). That process, however, will likely be less automated and directed more by the user than by a physician or care team.
CareKit's challenge -- making use of the data
Without a doubt, CareKit provides a lot of insight into a user's health and conditions, particularly those that are chronic or progressive. It offers a simple way to take a wide swath of information from a variety of sources, correlate it and present it in easy-to-digest formats. In short, it makes all this data meaningful. The trick is making it actionable. That's where the ability to share data and discuss it with clinicians is key.
The challenge here is that physicians and other providers need to be ready and willing to go over these insights with patients. For apps developed by a healthcare provider, this is pretty much assumed. For mass-market apps, this may not be the case. There remains a debate in the healthcare community about the value of patient-generated data as well as concerns about being able to absorb and analyze large sets of data.
The brilliance of CareKit is that it is designed to ensure accuracy by relying on sensors and connected devices to record data and to make that data meaningful by correlating multiple sets of information, including subjective information like how a patient feels. This provides more useful information than multiple separate sets of raw data.
An overall challenge will be getting healthcare providers to actually use those insights beyond simply looking at the data itself. This may very well be an area where patients need to educate healthcare professionals about what CareKit is, the apps available related to their specific needs and the insights these apps can provide. Sharing the information from an app's Insight Dashboard during an office visit would be a very good starting point.
Why CareKit is revolutionary
One of the remarkable things about CareKit is that it provides a consistent, template-based approach to creating apps that eases the development process and offers users an extremely shallow learning curve -- figure out how to use one CareKit app, and you'll likely find others familiar and accessible.
Another is that the framework allows for immense versatility. Some of the apps already announced use the framework to track a wide range of health issues, from postsurgical care to depression (focusing on the effectiveness of various treatments), pregnancy, diabetes, Parkinson's Disease and other chronic conditions. It's hard to imagine any physical or mental healthcare issue that CareKit couldn't help monitor and manage.
A third important point is that CareKit, like HealthKit and ResearchKit, isn't limited to just patient responses to questions or reminders. It has access to the various sensors of an iPhone as well as connected devices and additional apps that are HealthKit-enabled. That provides a great range of objective data as well as subjective data. By being able to track and correlate this data over time, CareKit apps provide a unique living view of a person's health, progress and issues that impact a given condition.
Ultimately CareKit is one of the most revolutionary technologies introduced for the overall health ecosystem because it enables developers to connect so many sources of information and make sense of them. Broadly adopted, it will allow many people greater understanding of their unique health issues and needs, particularly those with chronic or difficult-to-treat conditions. It offers an accessible path to more personalized medicine by building on Apple's existing health initiatives and the work of a disparate range of developers, device makers and healthcare providers.
