Apple created a new series of healthcare application development frameworks in early 2016. The new open-source frameworks, CareKit and ResearchKit, provide a standard platform that enables developers to build medically-focused research and care apps with built-in features related to end-to-end data encryption, privacy, and standardized data sharing. CareKit allows users to track their symptoms, activity and medications, while ResearchKit allows medical researchers to gather and analyze health related data from study participants, all in the name of improving health for end users and advancing medical research.
Currently, there are a handful of reputable medical institutions and pharmaceutical companies utilizing the framework to create applications. For example, one success story for Apple is ‘One Drop’ — an app created with CareKit that tracks diabetes metrics, which helps the patient manage his/her symptoms while sharing their health data with their doctors. One Drop enables providers, payers, and pharma companies to capture valuable insight, such as the current course of treatment, medication adherence, and general population health data by monitoring and tracking a patient’s diabetes metric outside of the doctor’s office.
Providers will be able to obtain real-time health data from the patient voluntarily through One Drop which will eliminate redundant repetitive data collection, which increases productivity and provides huge cost savings. Payers on the other hand will have a better understanding of the patient’s quality of care, which will (hopefully) lead to more accurate reimbursement rates. Pharma companies will gain better insight into medical adherence and overall ‘data’, which with better data could lead to new drug developments. One Drop impacts the healthcare industry by making the process and market more efficient, while the data can help drive innovation and increase productivity, and overall will be able to deliver better quality care to the patient.
With all these benefits, why wouldn’t apps like One Drop become more mainstream? For starters, changing to any new system raises many questions and often concerns; How will organizations build the new systems which will require large amounts of capital? Will the apps integrate with incumbent systems? How will organizations engage with patients, and overall how will they align regulations, payers, providers, pharma and finally the consumer to utilize the apps? The lingering question becomes, “Will CareKit or ResearchKit be a mainstream part of the healthcare industry?”
Several experts/individuals have expressed concerns about security measures, as well as effectiveness and adoption of an application to provide care to the patient via their phone. However, if CareKit or ResearchKit can successfully penetrate the healthcare industry, should pharma companies, providers, and payers jump on the bandwagon and become early adopters or wait until the platform is more mature? Will the benefits outweigh the costs and risks?
Approach to CareKit and ResearchKit
Firms that are interested in building apps with CareKit or ResearchKit should be aware of the potential risks, pros, and cons. Firstly, they should understand that CareKit and ResearchKit are only frameworks, rather than fully-fleshed out products themselves. A significant amount of effort and investment may be needed to develop a full-blown mobile app on top of the frameworks, though obviously, the effort and investment scale with the complexity and ambitions of a given mobile application – app development efforts can range from weeks (for simple apps) to months or years for significantly more complex apps. Firms will need to create the main structure of the apps, the visual and navigation components – as well as integrating features required to create questions/surveys and process responses (for ResearchKit apps), integrating access to HealthKit data (for CareKit apps), and integrating the frameworks with their own back-end (HIPAA Compliant) API and data storage to collect and process the data.
Further, the CareKit and ResearchKit frameworks are currently created solely for use on iOS devices – which could prevent more than 55% of users from utilizing such an application (iOS had only 42% of US market share as of January 2017), potentially detrimental to an unbiased research study for all smartphone-using patients. Firms that wish to build a cross-platform research app targeting all smartphone users will need to implement another open-source ResearchKit-compatible framework such as the similar ResearchDroid product or the open-source ResearchStack framework on the Android platform. These Android frameworks are compatible with ResearchKit, but iOS code will need to be re-written for use on the Android platform unless a cross-platform approach is used. Though ResearchKit is covered on the Android side, there is no analogue for CareKit on the Android platform – which may significantly limit the share of patients that would have access to such an application to improve the quality of their care. Fortunately, Apple created CareKit as an open-source project – perhaps someone will eventually port the codebase for use on Android devices. Until then, firms should be aware of this caveat.
Though Apple has implemented these frameworks with data security and encryption at the core, developers must still take steps to protect patient data once it has left the secure mobile device environment. Firms implementing these apps will want to closely review who has access to the data used in these applications, how the data is encrypted, where the data is stored, and the implications of these on HIPAA compliance. Some vendors have stepped up to provide solutions that make it easier to reach compliance and protect patient data, such as Tresorit’s ZeroKit which offers an extension to CareKit that improves patient/worker authentication, end-to-end encryption of health data throughout the lifecycle (on the device, over the wire, and at rest during storage), as well as secure sharing of encrypted patient data to authorized healthcare providers. Firms will need to look closely at these solutions in collaboration with their CSOs to understand where the data is going and where the data is being stored to ensure the firm is meeting compliance standards.
As for any emerging technology, there are risks imposed on new technology and companies that are concerned with unproven technologies. They can choose to avoid the infancy stage of the life cycle, and wait for the early adopters to overcome the hurdles and failures to develop and implement it. Risk-averse companies should observe the market until integration, full accessibility and security measures are compliant, however as a late entrant, it is crucial to fully research and understand the needs in the market and develop a product that will have a competitive advantage.
We normally see disruption in the market place with any new technology, therefore it is critical for players in the healthcare industry to stay abreast of upcoming research and technologies. As pharma companies are shifting to a patient-centric model, and providers to a value-based care model, it appears CareKit and ResearchKit’s goals align with the direction healthcare is heading and the application platform may be the new frontier in healthcare. Our life sciences and mobility consulting professionals have deep experience in all aspects of building successful healthcare-focused mobile applications – from strategy to implementation. Contact us for more information on how we can work with you to build patient-centric apps utilizing CareKit, ResearchKit, and other technologies.