Apple CareKit: Are Consumers Ready for Tech-Enabled Home Health?

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Harry Greenspun, MDDeloitte’s Harry Greenspun talks about what research is revealing when it comes to consumers and caregivers plugging into tech-enabled home health.

What about the doctor-patient relationship? This is the question that many whisper yet few ask directly as technology gives greater rise to remote treatment methods. Take CareKit, released from Apple, Inc. in March, which allows users to collect medical data and share with physicians. Will what’s achievable on screen disrupt the crucial care that needs to happen behind it?

Recent research from Deloitte Life Sciences and Health Care shows that while consumers and caregivers are open to using home health technology, they are concerned about how the technology will impact the relationships they have with doctors.

This report has no direct connection to Apple Inc.’s CareKit release. However, the findings revealed from Deloitte may shed light on how consumers will respond to Apple’s Inc. third medical framework (following HealthKit and ResearchKit) when it comes to sharing more medical information remotely—as well as how they may feel about incorporating data-monitoring technologies into their lifestyles—in the pursuit of managing or improving their lifestyles.

We spoke to Deloitte’s Director of the Deloitte Center for Health Solutions Dr. Harry Greenspun, for his insights on CareKit and on the findings from the report:


We are seeing a lot of development in technology right now circulating around telehealth services and technologies. Apple Inc.’s CareKit certainly falls within that realm, with the promise of providing tools and apps to help patients and their physicians track illnesses and monitor chronic conditions remotely. Going into conducting this research, did you have any preconceived notions as what the research would find?

While we try to avoid preconceived notions, we did have a few hypotheses. Health care has often lagged other industries in its adoption of technology. With so many tools and apps available for consumers in other aspects of their lives, such as retail, travel, and finance, we wondered if those experiences would drive acceptance or expectations.


Did anything that the report revealed surprise you?

There were a number of interesting surprises. Overall the biggest surprise, or even relief, was the overall embracing of technology, particularly among older participants.


In the report it’s stated: “Technology-enabled solutions that are perceived to intrude on people’s privacy, such as sensors that monitor an individual’s sleep quality or motion patterns at home, face resistance.” Were you surprised by this type of reluctance? Why or why not?

 We expected privacy to be a big deal, and it was. What was somewhat surprising about this was that many people already share some of this data willingly as part of their fitness and wellness goals. However, when put into a “health” context, reluctance grows.


The study emerged some interesting findings regarding remote monitoring, including that control and choice are important: e.g., consumers want the ability to scale up or down the level of physical environment and biometric monitoring. Does this mean that consumers may not be ready for some of the more invasive technologies, even if they could more automatically monitor and help manage their health?

Ultimately, people are concerned about privacy and being able to control the level of monitoring based upon need. When someone perceives they are getting a lot of value out of sharing data, they are willing to give up a lot of privacy. However, as that need diminishes, the balance shifts.


Do you think developers will have to consider that consumers are not ready for some of the more invasive technologies, especially in terms of wearables, implantables or home-monitoring devices?

Again, this is really about value to the individual. If they need it, they will want it. However, just because something can be monitored, doesn’t mean that people will want it monitored. This is especially true regarding data that has implications that may be of concern or could potentially result in some form of discrimination.


One participant said the following: “As a society, I don’t want us to get to where everything we are doing is not human-based anymore and is all automated and monitored and ‘big brother’.” What are your thoughts on such a comment? Is this type of sentiment really going to slow the pace or change the application of health technologies?

As a doctor, and having been a patient myself, I never lose sight of that fact that health care is intensely personal. It is about caring. Technology plays an important role, and consumers really do like innovation. However, they also want to know that whoever is on the other end of that data stream cares about them and has their best interests at heart.  While this again raises issues of privacy, it also reflects how much we value the human touch.


From the findings, it looks like the millennial population may one day be ready for more invasive health-tech solutions. But do you think these types of solutions (such as remote wearables and monitoring) will not be as effective in treating the large aging, baby-boomer population as developers and providers may have hoped?

This is a bit of a conundrum in the sense that the question is a bit hypothetical for millennials, but quite real for baby-boomers who may already have a range of health issues. In addition, adoption of technology by baby-boomers is more variable than among millennials. Developers should appreciate that to get the most out of technology, they should consider scenarios in which the person with the devices is not the person managing them.


It seemed like video-enabled health-tech solutions were highly embraced by the older study participants (ages 45-65). This seems to play nicely into the telehealth movement that is now taking place in healthcare. Still, there were negatives to using such technologies mentioned (including lack of touch, impersonal, social isolation, usability, hacking, loss of privacy). Do you think that as technology further evolves, the need for these concerns will erode, or will technology only shift the perspective of healthcare delivery so much?

The barriers to telehealth are less about technology than they are about incentives. As providers become incented to utilize it and consumers find it a more convenient way to access care on their terms, adoption will accelerate.


A major stumbling block for many developers, health providers and the like remains the issue of interoperability. There has recently been a push from the FDA to have app-developers create interoperable devices from the blueprint. Similarly, we have seen HHS ask the major EHR vendors to pledge to more open ways of data sharing. Do you think either of these efforts will make a difference at all when we talk about achieving interoperability to take telehealth technology to the next level? Will this issue of interoperability stunt consumer embracement of such technology?

Much of the focus of interoperability has been on EHRs. However, to really transform health care, interoperability will have to extend to medical devices in the hospital, in the home, and in the body. The government is working on this, as are EHR vendors. It is great to see providers pushing this through the Center for Medical Interoperability. As consumers get direct access to more devices, they will start to demand seamless connections.


The report also points to the many data siloes that currently exist in technology, both for medical providers and patients. These siloes upset physician workflows and complicate and disengage patients. With that being said, does this make the issue of interoperability the most crucial as to when and how tech-enabled home health will evolve?

Other studies have shown that if the providers have to move from one application to another to accomplish something, they are unlikely to do it. I have seen many great ideas from innovative companies that I know are doomed to failure because they create a standalone system. For many of them, silo is an overly generous term. Drive by any farm, and you’ll see that silos are enormous and can hold a tremendous amount of grain. Many technologies are more like cereal bowls.


The overall conclusion of the focus group results suggest that consumers are open to adopting new technology that enables home health care and their concerns and reservations do not pose insurmountable barriers. If the challenges are not insurmountable, any insight on how some of the current reluctances or barriers that now exist will or should be dealt with?

Probably the most important thing is to focus on needs over capabilities. As we demonstrated, when consumers need something, they are willing to do a lot to satisfy it. Heaping on unwanted or unnecessary functionality only breeds confusion and resistance.


As a result of this study in conjunction with your own perspective, where is tech-enabled home health really headed say in the next five to 10 years?

It’s heading home!  I think we will continue to see accelerated adoption as we solve the various issues highlighted here. Another thing to bear in mind that is that as time moves on, the population changes. Younger, more tech-savvy and tech-accepting people become older and will embrace innovation in their care as they do in all other aspects of their lives. The same goes for their doctors (and other caregivers).


Any closing thoughts to share with our readers?

The big driver for adoption of these technologies is the shift toward value-based care. That will focus our industry on population health, prevention, and wellness. Doing so will require us to share information, coordinate care, engage consumers, and analyze data in profoundly new ways. This creates tremendous opportunity for innovation.