Apple'S Healthkit: Upgrading To Stay Competitive

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Apple’s HealthKit
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Upgrading to Stay Competitive
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Apple’s HealthKit: Upgrading to Stay Competitive
Authors: Dr. Azmal Hussain and Dr. Suchitra Mohanty
Abstract: In 2014, Apple took the centre stage of digital healthcare landscape through its
announcement of HealthKit, an app with a range of features that would ease out personal
healthcare to a great extent. There had been speculations all around concerning the fate of
HealthKit, given that Apple’s arch rivals had already made entry into the field of healthcare by then.
Still, the company reportedly thrived with its health app on certain fronts even amidst tough
competition. However, it also had to face criticisms for allegedly overlooking certain important

features including period tracking and some other aspects of women’s health. To address such gaps
alongside consolidating its market competitiveness, Apple announced an up-gradation of HealthKit
by adding some features that were missing in its earlier version. Under such circumstances, a
number of questions were expected to surface concerning the fate of Apple’s HealthKit. Could Apple
scale up the degree of consumers’ reliance on its health app following its up-gradation? Would it
help the company in consolidating HealthKit’s demand on women consumers as the new version
would be adding some vital aspects of women’s health? If so, would there be any challenge from the
other players in an increasingly competitive market ecosystem?
Case Study
“The scope of HealthKit is pretty incredible in and of itself. But with so many links to every part of the
health, fitness, and medical industries in place, Apple truly has the ability to disrupt and transform
how we understand our bodies, diseases, and chronic conditions, as well as how doctors treat and
manage our healthcare needs. That may be a good thing for the public, as well as for the healthcare
industry.”1
– Ryan Faas, Author, Business Analyst and Tech Journalist
“It might seem strange to talk about data that is so sensitive and so intimate, yet when we talk about
technology changing lives, this is vital, revealing, and insightful information. It helps women
understand and be more aware of their bodies and to be in control of their health. It helps and has
helped millions of people make informed decisions about their fertility and family planning.”2
– Shannon Tan, Software Engineer, Apple
1
Faas Ryan, “Why Apple's HealthKit could transform health care in very short order”,
http://www.citeworld.com/article/2359460/mobile-byod/why-apples-healthkit-could-transform-health-care-in-very-
th
short-order.html, June 14 2014
2
Dolan Brian, “Apple engineer explains how Apple decides which HealthKit data types to add”,
http://mobihealthnews.com/44413/apple-engineer-explains-how-apple-decides-which-healthkit-data-types-to-add/,
th
June 16 2015
“© 2015, Amity Research Centers HQ, Bangalore. All rights reserved.”
Page – 1
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C onsumer-led digital health set a new trend in healthcare industry. Analysts estimated that by
2015 around 500 million smartphone users would use healthcare app to supervise or improve
their health. And by 2018 around 50% of the huge 3.4 billion gadget users (i.e., smartphone and
tablet) would download mobile app to monitor their health. Besides, consumers were set to play a
greater role in the digital healthcare market ecosystem characterised by Business-to-Consumer (B2C)
model. This was in turn made possible by the development of various new healthcare technologies3
such as health apps, wearable devices, diagnostic devices, artificial intelligence and so on.4
The wide gap between the expectation of the consumers and the available medical infrastructure
further created a favourable environment for the new players to enter in to the burgeoning
healthcare market of the world. 5 Meanwhile, global spending on healthcare was estimated to reach
at $9.3 trillion during 2014-18.6 By visualising the growing healthcare market many technology based
companies such as Apple, Samsung, Google, Philips7 etc. gradually started entering into the market.
These tech based companies were trying to offer smart solution in healthcare sector by developing
various digital technologies.8
In 2014, Apple launched HealthKit, a key feature of iOS8 that created a revolution in the global

healthcare market.9 However, after Apple’s health app was released, the company had to face ample
criticisms owing to ‘ignoring women’s health issues’. Besides, UV exposure, water intake and
sedentary state of the users were some of the other key aspects not covered by Apple in its
HealthKit. In 2015 Apple was planning to upgrade its HealthKit by adding few more features
including the women health issues.10 Meanwhile, rivals like Samsung and Google were also planning
their strategies cautiously to throw tough challenges to the iPhone maker.11 With this background,
would Apple be able to make it big in the growing healthcare market in the world by upgrading its
HealthKit, particularly when fierce competition came from both established and new entrants?
HealthKit: Apple’s Healthcare Extravaganza
On June 2nd 2014, the iPhone maker Apple announced its arguably biggest venture into mHealth
with the unveiling of ‘HealthKit’ (Annexure I). It was claimed to be a virtual service framework that
would promote sharing of data between patients and health practitioners, and third-party devices
like FuelBand wearables of Nike and medical institutions. Along with this, Apple announced of
striking a partnership with the Mayo Clinic12 aiming at improved doctor-patient communication
3
“Digital Disruption Who will Unlock the Power of Consumer-Led Digital Health?”,
http://www.atkearney.in/documents/10192/4685218/Battle+of+Digital+Titans-
+Who+Will+Unlock+the+Power+of+Consumer-Led+Digital+Health.pdf/242ffd85-b298-4689-b0c2-2a4b336265b4, 2014
4
Deloitte, “2015 Global Healthcare Outlook Common Goals, Competing Priorities”,
https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-
care-outlook-global.pdf, 2015
5
“Global health’s new entrants: Meeting the world’s consumer”,
http://www.pwc.com/en_GX/gx/healthcare/publications/assets/pwc-global-new-entrants-healthcare-chart_pack.pdf
6
“2015 Global Healthcare Outlook Common Goals, Competing Priorities”, op.cit.
7
Sikka Puneet, “Salesforce partners with Philips to enter the healthcare cloud”,
http://marketrealist.com/2014/07/salesforce-partners-philips-enter-health-care-cloud-market/, July 2nd 2014
8
Perras Stephanie, “Record Number of mHealth Devices to Ship in Next 5 Years”,
th
http://mhealthwatch.com/record-number-of-mhealth-devices-to-ship-in-next-5-years-24028/, September 17 2014
9
Williams Rhiannon, “What is Apple’s Healthkit”,
th
http://www.telegraph.co.uk/technology/apple/11395073/What-is-Apples-HealthKit.html, February 6 2015
10
Perez Sara, “Apple Stops Ignoring Women’s Health With iOS 9 HealthKit Update, Now Featuring Period Tracking”,
http://techcrunch.com/2015/06/09/apple-stops-ignoring-womens-health-with-ios-9-healthkit-update-now-featuring-
period-tracking/#.nthhvl:Etw8, June 9th 2015
11
“What is Apple’s Healthkit”, op.cit.
12
Founded in 1889, Mayo Clinic was one of the leading medical practice and medical research group in the world.
Page – 2
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while offering consumers greater control of their health activities as well as decisions. The HealthKit
was reportedly a facet of Apple’s iOS813 SDK. When unveiled, it was the company’s latest developer
operating system for iPads and iPhones. “We believe Apple’s HealthKit will revolutionize how the
health industry interacts with people”, commented Mayo Clinic’s President and CEO, John
Noseworthy, who was further quoted as saying, “We are proud to be at the forefront of this
innovative technology with the Mayo Clinic app.”14 While going public with HealthKit, the iPhone
maker also announced its collaboration with Epic Systems, a provider of hospital information, which
was being considered more important in the long run. In the hospital atmosphere, Apple was
expected to get ample credibility through this alliance.15
Pilot programme of Apple’s Healthkit was introduced in fourteen major hospitals in USA. The
Healthkit helped the doctors to monitor patients by providing key information on blood sugar, blood
pressure, heart rate and weight etc. With minimum cost, Healthkit assisted the hospitals to check
repeated admission of the patient in accordance with the new rule of the US Government. Apple
further noted that more than 600 developers were already collaborating Apple’s Healthkit with their
fitness and health apps. While in 2015, the healthcare market size in USA was estimated at $3
trillion16 and the global spending on healthcare was anticipated at $9.3 trillion during 2014-18.17 By

visualising the rising healthcare market, analysts highlighted that around 70% of the healthcare
organisations across the world would invest in various technologies such as wearables, virtual care,
apps etc. by 2018.18
While HealthKit stole the limelight the moment it went public, Apple had not been the maiden
vendor of such products into the market. Just a week before its announcement concerning
HealthKit, its arch rival Samsung made its manoeuvre into a digital health venture boasting open
hardware as well as software podium for mHealth technology. Still, Apple’s platform commitment
alongside developer focus was being cited as a game-changer. It was believed to be capable of
pushing apps out of the unique type besides augmenting consumer adoption. It was also being
claimed that applications taken forward through HealthKit could share information with other apps
for an increasingly comprehensive health management. Capability of this nature was viewed as a
breakthrough technology. “For the past year mHealth has been on the verge of crossing the chasm
between early adopters and the early majority,” noted President of Payer+Provider Syndicate, Adam
Powell (Powell) following HealthKit’s announcement. “Apple’s announcement is evidence to me that
it has finally done so,” Powell added.19
Analysts foresaw two key implications of Apple’s foray into the mHealth market. Firstly, with
HealthKit’s standardisation of the user experience, quantified self-device makers could concentrate
more on hardware-oriented product differentiation. Secondly, value of all integrated mHealth apps
as well as devices were expected to go up with the existing potential for secured data sharing with
healthcare institutions. “In the past, there has been no organized way for clinicians to access their
13
An advanced operating system of Apple released in 2014 with more than 4,000 APIs.
14
Mottle Judy, “Apple HealthKit viewed as a major market changer”,
rd
http://www.fiercemobilehealthcare.com/story/apple-healthkit-viewed-major-market-changer/2014-06-02, June 3
2014
15
Shaughnessy Haydn, “In Healthcare, Apple Will Struggle To Match Huge Samsung Ambitions”,
http://www.forbes.com/sites/haydnshaughnessy/2014/06/11/in-healthcare-apple-must-square-up-to-huge-samsung-
ambitions/, June 11th 2014
16
Farr Christina, “Exclusive: Apple's health tech takes early lead among top hospitals”,
http://www.reuters.com/article/2015/02/05/us-apple-hospitals-exclusive-idUSKBN0L90G920150205, February 5th 2015
17
“2015 Global Healthcare Outlook Common Goals, Competing Priorities”, op.cit.
18
“Exclusive: Apple's health tech takes early lead among top hospitals”, op.cit.
19
“Apple HealthKit viewed as a major market changer”, op.cit.
Page – 3
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patients’ app data,” noted Powell. “If clinicians can access mHealth app data, apps can transform
from tools for personal enlightenment to an integral part of healthcare,” he explained.20
Given the nature of market competitiveness, Apple was expected to go all out towards projecting its
HealthKit as a unique piece. As business analyst Neil Hughes commented, “Many Apple watchers
expect the company to show off new features in iOS 8 geared toward the same goal of collating and
displaying health data from a variety of ‘quantified self’ devices. The company is also thought to be
deep into the development of a so-called ‘iWatch’ that would sport an array of biometric sensors for
personal health and fitness tracking and integrate closely with existing iOS devices.”21
Once Apple’s HealthKit got announced, it generated a lot of pointers and concerns from healthcare
as well as industry analysts concerning privacy, the sharing of secret data and use of medical jargons.
Some experts urged that while data on the phone of a user might not fall under the Health Insurance
Portability and Accountability Act, after transmission to a hospital, physician, provider or pharmacy,
the data could come under the purview of the privacy rules. Some even expressed deep concerns
over the absence of any common infrastructure existing between healthcare apps and the
software’s capacity to integrate on the professional as well as consumer side. Apple’s move was in

fact being considered as the initial sign of a definite network. “Having centralized support for
healthcare data makes applications more interoperable and useful,” noted Henry Feldman
(Feldman), Chief Information Architect at Boston’s Beth Israel Deaconess Medical Center. “This will
raise all the healthcare apps to a new level, and greatly increase utility and innovation around these
apps,” he added. While pointing out that managing vast data piles would be yet another cause of
concern, Feldman said, “This is a 1.0 release, and undoubtedly it will grow over time, and we will see
creative uses, which will inspire all of us to grow with it.”22
Stronger competition was also considered likely to spark development in the mobile healthcare
landscape thereby creating fresh opportunities in the bigger healthcare industry worth $1.6 trillion
as of 2014. “The potential of this type of technology has not yet been tapped,” said Kumar Nandigam
(Nandigam), CEO of Plano, a healthcare-centric solution provider. “This is going to be a huge
industry, and I would say this is going to grow exponentially down the line,” Nandigam added.23
Subsequent developments, however spoke of scenarios in favour of HealthKit compared to rival
products like ‘Google Fit’ and Samsung’s ‘S Health’. As suggested by an update in early 2015, more
hospitals preferred to trial with Apple’s HealthKit for monitoring chronic illnesses like diabetes and
hypertension.24
According to some analysts, Apple’s sheer focus on its tie ups with hospitals and research
institutions such as mayo Clinic came in handy. “A large part of Apple’s success is driven by the
ability to forge lasting partnerships with major players in every space the company enters,” said
MicroMass Communications’ Senior Digital Strategist, Kyle Sutton (Sutton). “iTunes was successful
because Apple formed partnerships with record labels that held all the cards on [legal] digital music
20
“Apple HealthKit viewed as a major market changer”, op.cit.
21
Hughes Neil, “Samsung announces open health care platform with modular hardware, cloud-based software”,
http://appleinsider.com/articles/14/05/28/samsung-announces-open-health-care-platform-with-modular-hardware-
th
cloud-based-software, May 28 2014
22
Mott Judy, “Apple HealthKit draws concerns about data security, privacy and medical accuracy”,
http://www.fiercemobilehealthcare.com/story/apple-healthkit-draws-concerns-about-data-security-privacy-and-
medical-accu/2014-06-10, June 10th 2014
23
Edmond Ramin, “Partners See Opportunity As Samsung, Apple Tune In To Mobile Health Technology”,
http://www.crn.com/news/mobility/300072719/partners-see-opportunity-as-samsung-apple-tune-in-to-mobile-health-
th
technology.htm?itc=refresh, May 5 2014
24
Vincent James, “More hospitals are trying Apple HealthKit than Google Fit”,
http://www.theverge.com/2015/2/5/7983707/apple-healthkit-hospitals-google-samsung, February 5th 2015
Page – 4
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distribution but struggled to navigate online music sales. Health will be successful because Apple
collaborated with the FDA to get clarity on regulation, Epic Systems to ensure integration with the
largest vendor in the EHR space and Mayo Clinic to guide the process of making the data actionable,”
Sutton added.25 Notwithstanding, it was also warned that significant hurdles still remained ahead in
the presence of issues concerning security and data selection. “Apple has made the first move, but
there's still plenty of time for its rival to catch up”, noted The Verge reporter, James Vincent.26
Though Apple’s HealthKit was claimed to accommodate an amazing assortment of health indicators,
it allegedly missed out on certain vital features at the first go. This reportedly caused a fair amount
of dissatisfaction among customers. For instance, after HealthKit’s introduction in 2014, it was
criticised for overlooking certain health needs of women.27
Upgrading HealthKit: A Move to Stay Competitive?
During Apple’s 2015 WWDC (Worldwide Developers Conference) keynote address, Craig Federighi,
the Senior Vice President of Software Engineering at Apple indicated an expansion of support for

HealthKit.28 Tracking the users’ level of water intake was one of the features in the upgraded version
of the HealthKit. While explaining its significance, software engineer Shannon Tan (Tan) said, “I’m
sure we all know someone who lugs around a gigantic water bottle, and, when asked, explains that
daily hydration is important to wellbeing and it’s probably bad for you to be thirsty all the time.
There are a lot of apps in the AppStore that gently nudge you to increase your water intake and even
some use things like Bluetooth sensors to track your water intake.” A new data field for UV exposure
was another upgraded feature. The UV exposure feature would have an UV index ranging from 0 to
12, where 0 would indicate least dangerous. As part of this, Apple would ask its HealthKit user to
identify the type of her/his skin for tailoring of UV exposure tracking.29
As claimed, reproductive health data would as well be one of the major additions targeting female
consumers.30 In iOS 9, the app would hold up women’s capability to track their own reproductive
health. Some analysts tended to relate Apple’s latest move with the company’s internal workforce
structure. “Apple today is a company where only 30 percent of its employees are female, and only
20 percent of those in engineering positions are female. And while Apple has been attempting to
make amends for its lack of diversity .., the issue with the Health app is a perfect example of how not
having the right balance internally can actually impact innovations and technology developments,”
commented Sara Parez, an industry analyst representing TechCrunch.31
Tan explained, “We think about HealthKit syncing your workouts or your food diary automatically
logging your nutrition. But reproductive health is also a major component of health. For many
women who track their health data, nothing has been as exciting or revealing as tracking their
menstrual cycles. And for many couples who are trying to conceive, and many couples who are
25
Matthius Andrew, “7 Ways Apple’s HealthKit Will Make Marketers’ Jobs Easier”,
http://www.pm360online.com/seven-ways-apples-healthkit-will-make-marketers-jobs-easier/?GTTabs=0, July 30th 2014
26
“More hospitals are trying Apple HealthKit than Google Fit”, op.cit.
27
Hill Kashmir, “Apple has a lady problem: the new version of HealthKit still doesn’t track periods”,
http://fusion.net/story/100781/apple-ios-update-new-version-of-healthkit-still-doesnt-track-periods/, March 19th 2015
28
Garun Natt, “It’s okay Apple, I understand why you felt weird talking reproductive health at WWDC”,
http://thenextweb.com/opinion/2015/06/10/its-okay-apple-i-understand-why-you-felt-weird-talking-reproductive-
health-at-wwdc/, June 11th 2015
29
“Apple engineer explains how Apple decides which HealthKit data types to add”, op.cit.
30
“It’s okay Apple, I understand why you felt weird talking reproductive health at WWDC”, op.cit.
31
“Apple Stops Ignoring Women’s Health With iOS 9 HealthKit Update, Now Featuring Period Tracking”, op.cit.
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trying not to conceive, monitoring fertile times and understanding hormonal changes or
irregularities, is critical information.”32
In view of the erstwhile uproar over Apple's initial failure to incorporate any tool for tracking
reproductive health in HealthKit, some analysts were impressed at the additions that happened
of late.
However, there had been a seeming uncertainty in the presence of other fertility apps providing
insight into relevant data as well as tips to improve fertility. “We still don't know what the user
experience will be like for Apple's Health app,” noted Selena Larson representing The Daily Dot.33
Even when the addition of reproductive health features was declared, it was quite uncertain as to
what functionality would exactly be available. As an analyst commented while citing an example,
“although if ovulation tracking turned out to be inaccurate in any way, there could be potential
ramifications that Apple would want to avoid here.” Nonetheless, analysts also gave ample
importance to the other new metrics to be added to HealthKit. For instance, an ability to tell the
length of time a user sat down, which was considered especially important owing to the long term
health consequences of sitting down at a desk throughout the day. Likewise, UV light exposure was

another thing of similar implication, which would also be tracked by the new version of HealthKit.34
However, contention regarding accuracy issues could still remain. “App-generated data varies
markedly in accuracy, and so must be handled carefully,” said Matthew Godfrey-Faussett.35 “Not
only is it right that health-related data is only shared with third parties in appropriate circumstances
for ethical reasons, there is also every chance that that data might be flawed or incomplete”, he
added.36
32
“Apple engineer explains how Apple decides which HealthKit data types to add”, op.cit.
33
Larson Selena, “Everything that Apple's 'reproductive health' options will actually track”,
http://www.dailydot.com/technology/apple-healthkit-women/, June 10th 2015
34
Darren Allan, “Apple announces new HealthKit features coming with iOS 9”,
http://www.itproportal.com/2015/06/09/apple-announces-new-healthkit-features-coming-with-ios-9/, June 9th 2015
35
A technology law and digital health expert, Pinsent Masons law firm.
36
“Apple sets out privacy safeguards for developers of health and fitness apps”,
http://www.out-law.com/en/articles/2014/august/apple-sets-out-privacy-safeguards-for-developers-of-health-and-
fitness-apps/, August 29th 2014
Page – 6
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Annexure I
Glimpse of Apple Healthkit
Apple’s Healthkit
Apple’s Healthkit Monitoring High Risk Patients with High Blood Pressure
Source: 1) Williams Rhiannon, “What is Apple’s Healthkit?”,

http://www.telegraph.co.uk/technology/apple/11395073/What-is-Apples-HealthKit.html, February 6th 2015
and 2) Leswing Kif, “Apple Healthkit is already finding a home in U.S. Hospital”,
th
https://gigaom.com/2015/02/05/apple-healthkit-is-already-finding-a-home-in-u-s-hospitals/, February 5
2015
Page – 7

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Purchased for use by Saahithya Seenivasan on 03-Apr-2022. Order ref F444414.

© 2015, Amity Research Centers Headquarter, Bangalore.

To order copies, send an e mail to [email protected]. / [email protected].

Distributed by The Case Centre North America Rest of the world

Authors: Dr. Azmal Hussain and Dr. Suchitra Mohanty