An Apple a day Really Might Save You

These days, there is endless talk about medical applications, smart watches, sensors and of course the data that all of these systems collect. There is a key word that everyone should know and understand, because it lies at the foundation of many of the arguments over the benefits of medical technology.

The word I am referring to is “silo”. This term has the same connotation as it does in every other aspect of life. It refers to the collecting of items and then centralizing them into one location. There is also the connotation, when this term is used, that access to these stored items is controlled. A silo that allows the items to easily escape, or for anyone to access the items at any time, does not seem particularly useful. And the same applies in the world of technology.

Every time you hear about a new technology, a new smart phone app or a new system that collects medical data, you should ask where that data is stored. Because these days, most people walk around with a supercomputer in their pocket, with gigabytes of storage on a chip, it is very common to hear that the collected data is kept on your smart phone. From your smart phone, you can then choose to share the data with whomever you wish, such as your physician. The problem is, that this data may very well be siloed on your phone. Unless you choose to save this data to a separate location, you could lose it all if you lose your phone.

One of the protections against the loss of data silos, is to copy their information [automatically, in most cases] to a remote site. These days, this remote site is the ambiguous cloud that we always hear of. But if the cloud is in effect just a single computer sitting somewhere in, say,, Miami, then this isn’t much help. There is no guarantee that this remote computer won’t get damaged and thus once again, you will lose all of your information.

In most circumstances, when people say that they’ve saved their information to the cloud, this actually means that their data is being stored in a very remote location with copies spread around the world. These locations usually house hundreds of thousands of computers in collections called data centers. These data centers are physically protected, sometimes even from the most extreme natural and human caused disasters. These data centers are also protected by the best available cyber security, so that this really is the best and safest place to save the last EKG that your cell phone recorded.

But if the information you have collected stays locked in a silo (even one as big as a datacenter), it cannot be used for a whole range of other important options. For example, let’s say that, Gd forbid, a loved one complains of chest pain and is rushed to the hospital by ambulance. It may very well be that in this specific case, the patient forgot to take his or her cell phone with her. As the doctors in the emergency room perform EKGs, they may find it critical to compare the present EKG to older ones. The fact that this patient’s old EKGs are on his or her phone, and well protected in a remote data center, is of no practical immediate use.

That is why the Apple HealthKit [I have absolutely no connection to Apple] is creating such a stir. Although there have been previous attempts at linking mobile devices to high-end electronic medical records used by hospitals and private physicians, it seems that once again, Apple has found the magic sauce to make it all work properly. Apple iPhones are able to collect a large amount of health data, especially with physical add-ons to the phone that turn it into an otoscope or EKG and much more. Apple has already created a link between their health data and the most used EMR  in the States (called EPIC). I believe that no one would be surprised if Apple would soon equivalent links with every other major EMR, effectively linking together most the health data of Americans.

What Apple technology does is allow for silos of medical information to interact under very strict rules. As such, when the patient with chest pain presents to the hospital, the doctors would be able to access old EKGs via the hospital’s EMR (via Apple HealthKit). This is unquestionably the holy Grail of medical technology. And if Apple manages to make this a reality, it will have contributed to the welfare of almost every single person in the United States. Hopefully, Apple will extend the reach of its technology to other countries and become the tool for universally sharing medical information.

It’s actually very interesting that Microsoft failed to do the same thing as Apple is doing now. Microsoft has a very advanced online personal health record system called HealthVault. But Microsoft never managed to make the connections that Apple has done. Perhaps it is that there is now a perfect storm between the [forced] computerization of all of the American medical systems and advanced smart watch technologies as well as advanced personal vital sign sensors. Whatever the case may be, Apple may end up saving more lives than anyone would ever have imagined.

I personally imagine that other companies like Microsoft and Samsung will do everything in their power to jump on the bandwagon and share and exchange medical information with Apple’s technologies. Also, I imagine that at some point, some version of these technologies will trickle down to the developing world. Just as it is hard to imagine a world before the iPhone [which is less than a decade old], it may be hard to imagine a world without unified health information within 10 years from now.

One can now see that there is nothing wrong with initially storing medical information in silos. But unless that information is available and can be shared when needed, it may effectively be useless. As much as data centers are well protected, and thus the best place to keep initially siloed information, they are still not indestructible. There actually is a relatively recent case of a major company having stored its information in separate locations, yet still losing a great deal of its data This is because the storm that hit was so big that it knocked out both geographically separated data centers.

There is another location where one could save information that would be protected from pretty much any event happening on the earth. And I will describe this in my next post.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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