Apple, iOS 8 Health, and the Gordian Knot of convoluted healthcare bureaucracy

“This year I’ve spent a lot of time in doctor’s offices and I see what a giant mess the electronic health records (EHR) industry really is. And I don’t think Apple’s going to solve the problems facing the American healthcare industry,” Peter Cohen writes for iMore. “Apple’s telling us that iOS 8’s Health feature will give us a way of sharing important diagnostic information with our doctors. But it’s predicated on a huge assumption: That our medical providers are affiliated with an institution that’s willing to buy in to this particular data stream.”

“Because of my own health issues and those in my family, I deal with a lot of medical specialists. All of them use electronic health records (EHR) systems, because they’re required to (especially if they expect reimbursement through Medicare and other social insurance programs),” Cohen writes. “But getting these different medical providers to talk to each other is a byzantine process at best, thanks in part to a complete lack of interoperability between different EHR systems, federal and state restrictions, and pure administrative incompetence… A couple of months ago I was seeing another specialist. When I checked in they asked me if I’d brought a medication list with me. I pulled out my phone and showed her the list. ‘Do you think I can put that on the photocopier?’ she said. She was totally serious. She wanted to photocopy the screen of my phone.”

“I’m extremely skeptical that even Apple, with all its marketing acumen, its meetings with the FDA and even wins like the Mayo Clinic, is going to be able to make a dent here with iOS 8 Health,” Cohen writes. “What Apple is facing is nothing less than a Gordian Knot of EHR systems, healthcare IT, defensive corporate culture, administrative ambivalence and incompetence, and government bureaucracy.”

Read more in the full article here.

MacDailyNews Take: In healthcare, especially in administration (doctors’ offices, health insurance workers, etc.), we see people who are faced with an overwhelming morass of stupidity, incompatible overcomplexity, and stifling bureaucratic red tape, who therefore naturally mentally shut down and focus instead merely on eking out ways to deal with their own little job responsibilities. This gets them through the day (usually barely), but only compounds the morass. (It’s also, ironically, one of the most unhealthiest ways to suffer through the day.)

In the U.S., at least, the whole thing needs to be blown up, modernized, unified, and replaced, but, of course, those entities who are currently making tons of money off the “system” will erect considerable roadblocks to at least preserve the status quo or, optimally for them, further increase their cash flow.

Good luck, Apple.


  1. The author used a nice classical analogy, Alexander the Great slicing through the Gordian Knot. I think an even better one would have been Hercules cleaning up the Augean Stables.

        1. If you ever go to Danang go see the interior of Marble Mountain, it’s absolutely gorgeous. It has shrines and temples cut into caves inside the mountain. The only problem was having to be led in by Marines sweeping the road and trail for mines and seeing the area while carrying M-16’s. It’s hard to pay homage to such an ancient site while wondering when you’ll be shot at.

          1. Thanks, I spent an absorbed hour with that, and seeing how they restored it, although one might suppose leaving the bullet holes would have increased tourist interest considerably

    1. While I appreciate your fondness for historical literature references, the main point is the mess the law has created for millions of people.

      We got the change, without the hope for something better.

      1. Righto. What I was thinking was that the two stories (Alexander and Heracles) both represent a difficult problem and its clever solution.

        Journalists like to use the problem part of the story as a metaphor, and leave out the solution part. They aren’t in the business of solving problems, but in magnifying them.

        So, considering them as parables in full, Alexander had little patience with intricate puzzles, and so sliced the knot asunder. Heracles gave it more thought: he tore out the barn wall, diverted two rivers so that the manure washed out onto the fields as fertiliser.

        1. Your indictment of journalists is spot on.

          Not only are they incapable of solving problems they are slaves to the politically correct Democrat party masters.

          Simply put, the party of SOME of the people …

          Ahh, but smart money knows better …

          1. Slaves to who? Oh I know: The 1% who own and dictate the news provided to the peasantry.

            Sorry ‘NeoCon’, but your gang’s buffoonery is obvious, as is their’s.

            “Smart” doesn’t enter into either equation. But lots of money certainly does.

      2. This had NOTHING to do with the ACA. This is what happens when the “free market” takes over an industry without any regulation or centralization. Imagine the internet without standards.

        Meanwhile, the best way to fix our current mess is a “single-payer” system… Like every other civilized country on Earth. If the fight over Onamacare was vicious, imagine what will happen if the insurance industry feels threatened…

        1. Great idea – just swell; a single, monolithic government monopoly over the most important aspect of human existence; our health. Excellent.

          Did you ever consider you may not WANT the government to know about every aspect of your life that can affect your health?

          Your sexual proclivities?
          Your recreational activities?
          Your diet?
          The amount of alcohol you consume?
          Any other vices you have?
          The amount and type of exercise you do?
          Whether you own a gun?

          The ACA is already written to require that health care practitioners log this kind of information. There are numerous codes that relate to factors that may (or may not) relate to your injuries and illness.

          For example, if you have a broken arm, the code is not just that your arm is broken but also HOW it was broken. It’s not a stretch to imagine that once rationing kicks in (as happens with all socialist medicine schemes), that a broken arm occurring while you are working will be treated at a higher priority than a broken arm coming as a result of say, skateboarding or waterskiing.

          So yes, it’s possible that a single payer system might deliver a common, efficient, reliable database (although no where in our current government bureaucracy is there any evidence that this is possible), why should this be the driving reason for single payer?

          Single payer is an impossibility and can’t work anymore than if the government were to outlaw private tech companies with the promise that a single government agency could produce a better cell phone than the free market could ever accomplish. Who would believe this possible and yet we have people in this country who think a government department can provide better medical care than the free market.

          Do people not know what is going on at the VA TODAY?

          1. Hmmm, It works for the rest of the civilized world, and even some parts that are a bit sketchier. Have a look at infant mortality rates around the world! The USA is 29th, while Cuba is better, for example. A major illness, which none can foresee, should not cost you your house. At least the USA could join the 20th century, if not the 21st.

            1. Infant mortality rates is a very interesting statistic. What very few people know is that the way the statistic is calculated is by the number of deaths of infants divided by the number of live births. What is interesting is that there are no standards as to what constitutes a live birth. So in the US, any child born who takes a breath is considered a live birth. So a severely premature infant with a serious birth defect (who will die) counts as a live birth. In other countries, that very same birth would not be counted as a live birth. In fact, in a few countries, only infants that survive the first day are considered live births.

              When you make adjustments for those factors, the difference between the US Infant mortality rates and other countries changes dramatically. Then there are other confounders. Infant mortality is a terrible statistic to use to compare the health care in one country with another.

          2. Free market … what a joke. At a high level, large corporations find ways of eliminating competition by colluding with one another to divide markets. Look at what’s happened with the ISP industry. I have one choice for cable internet, and that’s Comcast. Look at Microsoft in the 90’s. The term “free market” may sound like a real thing to you, and it may sound pretty. But it isn’t always a reality, and it isn’t always good.

            If you produce food in vast quantities in this country, we as a populace have (through government) required that certain health standards be met that are rightly higher than what a company would meet in a “free market”, and for good reason.

            Private companies are not inherently ethical or conscientious beings, they are driven by profit. The life and death of human beings shouldn’t be in the hands of the free market.

            And someone necessarily is going to know my medical history. I honestly would rather the government know than a private company. The government has never harmed me with knowledge it has about me, nor is it in the government’s interest to do so. It doesn’t stand to gain. Whereas a private insurance company could and most certainly would use such knowledge against me in its quest for profit.

            “Oh, sorry, we don’t cover the way in which you broke your arm, didn’t you read the fine print? Thanks for your monthly payments by the way, sucker. Free market you say? Guess what? Our competitors are doing the same thing, and even if they didn’t this isn’t their turf, so where you gonna go? lol”

            And as to your mention of the VA: there’s a reason why the “free market” isn’t out there providing health care to wounded veterans as the VA does. There’s no money in it.

            1. So the government has not harmed you? That’s great.

              Obvious you are not in the VA system or applied for tax exempt status as a Tea party group.

              Yet you trust the government for healthcare?

              This does NOT compute.

          3. Do you feel better that Google already has all that info on everyone?

            And single payer DOES work in other countries, contrary to what the people who wanted to defend the status quo prior to ACA would have us believe.

            Your assertion that ACA requires healthcare practitioners to collect information about guns is bullshit. In fact, the ACA has provisions prohibiting this information from being collected. You are ill-informed.

  2. I am a retired doctor and the author is correct .In my opinion the real reason for this mess is hospital IT departments who routinely receive seven time the hardware costs per networked machine in service contracts and therefor have a vested interest in systems that do not work well .
    I do think that Apple is up to the challenge and there are EHR’s out there that run well on Macs and IOS devices .
    Ironically the hospital I worked at was at one time considering the Newton as an input device(15 years ago)
    If Apple does cut the Gordian knot the rewards to Apple and Healthcare will be enormous . billions are spent each year on redundant testing of patients simply because systems don’t tok to each other .Privacy and data protection is the pivotal issue -so why did we end up with Windows based systems ?

      1. Yes, at my last employer the IT department routinely charged our department $60K for a machine that I could have assembled with off the shelf parts from Frye’s (a local PC parts retailer) for well under $3000. Their labor rate was calculated by dividing total IT annual salaries by the number of potential person-hours available in a year. Thus, sloth and bloated bureaucracy were rewarded with ever higher labor rates.

        1. Hence the pejorative Microsloth, a bloated techno-monarchy boasting many gibbering minions and sycophantic sympathisers, all antithetical to human progress in favour of personal gain.

            1. Stop the partisan crap, anonymous cretin. Few of our “representatives” in Congress are doing their jobs, regardless of political party. In fact, it is the mindless, extreme partisanship of people like you that have driven the country into gridlock.


            2. Anonymous cretin?

              And your avatar is not?

              Fight fire with fire, eh? Well, I can appreciate that approach.

              No, I don’t think I’m the problem, rather the solution.

              In 2014 Fall elections vote OUT ALL Dumb Democrats following the incompetent President off the cliff.

              Retain courageous Democrats that speak out for the good of the American people, bucking party masters remaining SILENT for one reason — POWER.

              Unfortunately, it is power to the Democrats OVER power to the people.

              Decoder: ‘People’ means EVERYONE not just those who register Democrat.

              Hey mocking avatar, have a great day …

            3. Please do stfu, you hypocritical toady of the propaganda talking point sheet of the week. You have no mind of your own, just the usual hate attitude you’ve been trained to exude. Predictable, boring con-job as per the protocol.

            4. Here is your Fall assignment.

              Vote for ALL Neocons and teabaggers if you want to change the world.

              Because Dumbocrats have got NOTHING. Pot smoking brain dead and reality detached since the 1960s.

              We need RESPONSIBLE realists to CHANGE the country and offer real HOPE.

              Got it?

            5. Yeah, how so?

              Name calling is SOOOOO … juvenile.

              When you grow up and engage specific points I have put out and articulate disagreement … only then will we talk again.

              You sir, have a great day.

    1. We ended up suffering ( I work in healthcare ) Windows because Microsoft and it’s partners pushed their shit into every crevice they could find, because Apple specifically stated in the EULA the OS X was not to be used for medical devices or equipment, and because a generation of IT Specialists were created that thought knowing Windows was knowing computers.

      Because of thus, devices that used to be built on UNIX have transitioned to software largely built upon Windows and in some cases Red Hat LINUX.

      Add in the fact that Apple has played with enterprise computing but never seriously moved on it- even after Apple was flush with cash they were running many of their computing services on Solaris despite having their own servers and a server OS.

  3. I agree. When my doctor asked me for the previous history of medication and report, I showed him from my iPad and he got very angry. I had to go another day with hard copy.

  4. Maybe this is Apple’s chance to revolutionize. They could offer the compatibility layer between the different EHRs! Imagine it, being part of the apple ecosystem automatically enhances your health care service due to seamless compatibility and communication between providers, no matter what their EHR system is. You could “share” your health data through a share sheet, and when you do so there is a drop down list of EHRs that you can format the data into. You just ask the provider what EHR they use, then select that and push it out. I know I’m oversimplifying it, but this is doable.

    1. I think this might be where IBM joins the party. With Apple doing hardware and device OSs and IBM doing big data and systems integration. The key is probably in a set of data format standards with which any compliant system can interact. Should be interesting.

  5. CMS mandated the conversion to ICD-10 by October 1, 2014.

    Few healthcare providers know all the alphabet soup initiated by WDC in the form of all the bureaucratic acronyms and fewer yet by far know how to deal with it.

    Since they don’t know all these things, they need a truly professional consultancy firm to advise on how to deal with this stuff.

    Meanwhile the physician is often told what to do and just muddles along without enough time or training to deal with all the IT system requirements.

    1. The is a big consequence of this IT complexity mandated by the US government bureaucracy that is not well recognized.

      Smaller community type hospitals are being shutdown or bought out by larger institutions that can afford to meet the IT, & personnel challenges that come with mandates and complexity.

      What do you think is going to happen to the rural hospitals with a 50 or 100 bed hospital who can’t afford to staff up to meet requirements or get the IT infrastructure in place?

    2. Sorry to say, but ICD-10 WON’T happen by the stated deadline. Not even close. The AMA is resisting this. And medical practices are WAY behind adopting the Hi-Tech mandates tied to ACA. ICD-10 will take years before it’s adopted as a working standard.

  6. I have complete confidence in Apple developing outstanding medical/health apps for their hardware. These types of apps that will allow users to better understand and manage their own health.

    However, the chance of these apps talking to the software of the healthcare industry is almost nil. Moreover, with the new federal requirements for electronic health care records that are part of the Obamacare legislation, the chances of iOS devices successfully talking to the equipment used by your doctor is even less than nil in the future.

    Our US healthcare system is only getting more complex, complicated, and expensive. But it is definitely not getting better. So if you want to stay healthy, you will need to manage your own health.

  7. You think this kind of idiocy is unique to the US?
    In the UK, the last (Labour) government instigated an IT system for our NHS (National Health Service), that was intended to link all hospitals and doctors surgeries across the UK, allowing all records etc to be easily accessible by any health professional at any time.
    After years of development, and £11Billion spent, it was scrapped because nobody could make it work.
    Eleven BILLION Pounds!
    The sheer incompetence of government beaurocracy knows no bounds.

    1. Interesting point. Not to defend bureaucracy too much, it does seem that people have trouble designing things in groups. There are many examples such as the one you cite about some organization spending billions for a computerized database system and getting nothing. There is something about a single mind being able to organize concepts in harmony that doesn’t transfer to large groups. Hence the phrase “designed by committee.”

      1. Splendid observation, John. It may seem obvious but it bears repeating. Personal creativity and political consensus are diametrically opposed concepts, their practitioners sworn enemies. Alexander the Great and Steven Jobs did not form focus groups — they consulted the Oracle, the Muse, to access higher awareness. Why fool around with feeble human opinions when you have access to the thoughts of the gods?

          1. Right to the point. Collaboration is actually a dirty word, after the Dutch, Norwegian, and French capitulation to the Nazis in WWII. Democracies can never cleanse the word of its atrocious linkage to crass and abject betrayal..

            1. And yet the Dutch Royal Family spent the war in Canada.
              There will always be collaborators in any conflict. The difference is whether it is a government collaboration or a personal one. Vichy France would be one example of government style. Individual’s activities are harder to quantify.

    2. Look at the Los Angeles school district they pick Apple/iPads but the existing IT department, Microsoft, Dell, HP and others aren’t going to stand by and let that decision stand, and they have attacked it at every opportunity and have been successful at watering down the original decision, that fight goes on across the country.

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