Dear Apple: An Open Letter Regarding Healthcare from a Practicing Physician

Dear Apple,

As a practicing Orthopedic Surgeon, I am fascinated by the rise of digital health and the unrealized potential of technology to address the myriad problems facing American medicine. We are in an unprecedented era of innovation with record amounts of money flowing into healthcare related startups and tech ventures. Some of your biggest competitors have accelerated their efforts to enter this space. Even your CEO Tim Cook has stated that health will be your company’s “greatest contribution to mankind.” This is certainly a bold statement and one that seems a little less likely given some recent high-profile departures from your health team. Your level of secrecy (more on this later) makes it difficult to know exactly where your healthcare efforts stand, how much impact these departures will have, and how much dissention there is within your assembled team of health experts. 

Undoubtedly, there are many different approaches technology companies can take to bring innovation and change to healthcare. Google has generated buzz with its recent successes in utilizing artificial intelligence, deep learning, and algorithms to improve cancer detection and predict acute kidney injury. Microsoft is leveraging its strengths in cloud services and data analytics as well as its unique Hololens augmented reality platform to further position itself as a player in medical innovation. Even Amazon has taken bold steps to disrupt healthcare by partnering with financial giants JP Morgan and Berkshire Hathaway, buying PillPack, and positioning its Alexa device as a tool to access medical information. 

Cloud services and artificial intelligence aren’t necessarily your company’s strong suits. A partnership with IBM was meant to address some of these shortcomings, but Watson’s own failures in healthcare may represent a blow to those efforts. Your work in making healthcare records more accessible for patients with FHIR is commendable. HealthKit has provided a platform for medical app developers to leverage the 1.3 billion iOS (and WatchOS) devices in use to bring health and wellness innovations to the masses. The Apple Watch, initially positioned as a fashion accessory, has successfully evolved into the premier health and fitness wearable with the ability to detect heart arrythmias, detect falls, and (in the near future) track menstrual cycles and monitor environmental noise levels. These innovations are steps in the right direction and represent your usual measured approach.

The problem, of course, is that these efforts may not be enough to reach your lofty goals of radically changing healthcare and making an indelible mark on the American medical system. Wearables and fitness apps have shown limited ability to alter patient behavior and improve health. Data gained from these devices is of dubious clinical utility. To make matters worse, those who could benefit the most from such devices may not be able to afford them. Focusing on wellness and prevention does little to address the larger problems of chronic health conditions, lack of access to care, physician burnout, the cost of medical care and other pressing issues. 

Despite the current challenges of entering the medical space, there may be other ways forward. A large, well-resourced company currently outside the medical establishment could address the shortcomings of our system in a way established entities cannot. Doing so make take you out of your comfort zone. This is a big ask for a company whose naysayers love to predict its demise with every mildly “disappointing” quarterly report. Taking a more aggressive approach to healthcare may make investors nervous, but what’s the point of making bold statements about your contributions to the health of mankind if you aren’t willing to take a risk? With that in mind, here are some suggestions from someone on the frontlines of medicine to help revitalize (pun intended) your health efforts and uniquely position yourself as a trend setter in the healthcare technology revolution.

1.       Be Bold – The Apple Watch is a fine device and centering your healthcare efforts on it makes some sense given your strengths in user experience, design, and consumer-facing solutions. But for the foreseeable future, wearables’ impact on healthcare will be limited. Step outside your comfort zone and focus on bigger efforts. Acquiring an electronic health record company and partnering with physicians to make it a pleasure to use would prove to everyone that you are serious about changing medicine and can solve difficult, meaningful healthcare problems. Partner with or acquire a forward-thinking digital health provider like One Medical to show the healthcare sector you are serious about supporting new approaches to medical care delivery. Work with a company like Muve Health to develop centers of excellence, microhospitals, or freestanding medical centers to bring affordable, high quality, evidence-based, and patient-focused care to the masses devoid of the problems that plague large hospitals and health systems.

2.      Commit to Transparency – Going forward, it will be difficult to be taken seriously in the realm of healthcare without embracing transparency and being open about your intentions and efforts. Secrecy works well in the tech sector when bringing new, innovative products to market and maintaining a competitive edge. However, in medicine, secrecy and obfuscation are rapidly becoming non-starters. Create a true Health Care team, let it be its own entity, and let everyone know who they are and what they do. Doing so will give legitimacy to your efforts and crystallize your intentions.

3.      Let Your Doctors Be Doctors – Doctors are a slightly different sort. Endless meetings, multiple layers of administration, lack of direction and autonomy, and convoluted leadership structures are all factors that drive burnout in real world medicine. Physicians encountering these same issues in corporate life may experience lack of morale, frustration, inability to innovate, and disillusionment with the whole process. Treating your doctors as cogs in the machinery neutralizes the best of what they bring to the table in fixing healthcare.

4.      Privacy, privacy, privacy – Two of the biggest elephants in the room of digital health are protection of health information and commitment to patient privacy. Thankfully, this is one area where you have an advantage over your competitors. Apple has taken a more aggressive stance on protecting its users data and this could easily translate to healthcare. Patients and physicians remain skeptical of Amazon, Microsoft, and Google’s intentions for PHI. This single issue could have the biggest impact on the adoption of healthcare technology solutions, and failure to handle privacy appropriately could sabotage otherwise revolutionary technology. Continue to make privacy a top priority. Commit to never selling PHI to a third-party. Give patients total control over how their information is used. Put pressure on your competitors to do the same.

5.      Capture Your Startup Spirit – Real healthcare innovation is difficult for a large, established company with certain expectations. The tendency is to take what you’re already doing and figure out a way to fit it into the medical puzzle. But retrofitting existing ideas to address a new problem creates limitations in what’s possible. Approach healthcare as a fresh problem with any and all possible solutions discussed, explored, and brainstormed. Capture the hunger, bravado, and innocence of a startup company instead of the measured and restricted approach of the massive behemoth you are. Adopt the Zen concept of “don’t know” mind to break free from the limitations of a walled garden and shareholder expectations.

6.      Don’t Be Afraid to Fail – Failure is usually not an option for one of the world’s largest and most valuable companies. Some of your critics and naysayers wait expectantly for any opportunity to portend your doom and highlight your stumbles. The financial world hangs on your every move and even the slightest dip in device sales is seen as cause for concern. At the same time, medicine is hard. Having a meaningful impact in healthcare will require taking some risks. And with risk often comes failure, failure to a degree that the company probably hasn’t experienced in some time. Remaining within your comfort zone and avoiding the potential for failure will stifle innovation, limit your impact, and prevent you from reaching the goal of revolutionizing the future of mankind’s health.

 Admittedly, the last thing you probably need is advice from some random MD with a keyboard,  subscription to Wired Magazine, and enough knowledge to be dangerous. Wherever your health efforts stand, there will be a need for your involvement in the future of digital health. But disruption can take many different forms. As a practicing doctor, I experience on a daily basis the issues facing our healthcare system and the pain points that need to be addressed. Artificial intelligence, deep learning, and neural networks are exciting innovations that, when successfully applied to medicine, will revolutionize the way we care for and engage with patients. But it will likely be years before these advancements are widely applicable. In addition, they may represent attempts to run before we can crawl. There are many other challenges facing American healthcare that are in desperate need of a fresh approach and outside influence. Your greatest ability to help humankind may lie beyond wearables, HealthKit, and FHIR. Perhaps your current team is frustrated with the inability to realize your company’s vast healthcare potential. Perhaps they see an entity with the means to do something truly special but held back by its own history and expectations. Listen to your doctors, commit to something great, and step outside your comfort zone. American healthcare desperately needs it.