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Get aniPhone and Call Me in the Morning | In sickness and in wealth—health equity and access | Savvy Cooperative | #AskPatients

Last week Apple announced the beta launch of its new Health App, which allows users to pull their health records onto their phones. And as with any Apple announcement, people are weighing in.

Currently, there are only twelve hospital systems linked to the app, so some folks astutely noted that it is only useful for people who get treated in those systems. An important point, but Apple doesn’t seem to have any issue scaling products. I’m sure they can overcome that one.

Another opinion by our friends, “e-Patient Dave” deBronkart and those at OpenNotes is that you only see what you’d already be able to see in your patient portal, not the physician notes (nor to my knowledge is there any way to edit or add additional notes). So the utility is limited and no better than current solutions.

But for me — the stand out issue is:

If you ain’t got an iPhone, you’re s*** out of luck.

After the announcement, it felt like people in the Twittersphere were giving virtual high-fives across the interwebs, like “we did it, guys, we solved health record access, Apple will take it from here.”

But not everyone owns an iPhone. Around the world, Android dominates — with an astounding 88% market share. In the US, Apple does better, but still only serves 34% of the market, which isn’t shabby for a single company, but is by no means inclusive of all Americans.

Global mobile OS market share, copyright Statista.

In fact, iPhone users have higher levels of eduction and higher annual income (the average income of a iPhone user is $85,000). And herein lies the problem.

We are solving problems for those who can afford it.

This is also the issue with Apple’s ResearchKit, which helps researchers develop apps on iOS to collect research data from patients — well, iPhone-enabled patients. Hello, selection bias. Which means we are only learning from — and therefore innovating for — a subset of the population. And now with Apple’s Health App, we are only providing this elite population with easy access to health records.

This isn’t a critique of Apple, the other big tech companies tried, Google with Google Health and Microsoft with HealthVault (both closed up shop), and Amazon is up to something. But it’s just a reminder that our work is not done.

Access to health records cannot be a function of financial status.

Even today, in 2018, there are hospital systems that charge patients per page for hard copies of their medical records. So while Apple now gives iPhone users access to records, let’s not forget the individuals who cannot afford either of these means for access.

We must acknowledge health inequities and social determinants of health and work to address them.

At Savvy, we are trying to do our part to be inclusive by ensuring that everyone can become member of our patient co-op regardless of financial status. Our members who can afford to contribute more help us award memberships to those who can’t (and by the way, our share price is $34, far below the cost of an iPhone). We want to make sure when companies come to Savvy for patient insights, they get diverse perspectives — not just those perspectives of upper middle class.

How are working to make sure your health solutions are inclusive?

Savvy Cooperative helps companies get diverse patient insights they need by providing an online marketplace to connect professionals directly with patients of all conditions. Reach out if we can help. or follow us on Twitter @savvy_coop.

Jen Horonjeff
Post by Jen Horonjeff
January 28, 2018
Jen Horonjeff, PhD, is a life-long autoimmune disease patient and brain tumor survivor turned human factors engineer, academic, FDA advisor, and now the founder & CEO of Savvy Cooperative.