Rough draft of thoughts on overall marketplace impact of Apple HealthKit. This version uploaded 9/15/14.

1. Approaching Healthcare Technology
In 2015:
The Impact of Hardware on Telemedicine
Advancement
September 15, 2014
Rough Draft: Version 1.0

2. Situational Overview: Using HealthKit For
TeleMedicine Development
September 10, 2014
• Payment- Insurance auto-payment via TeleHealth appointments. (Cigna/Apple Appointments) —
> could possibly be integrated into iCal
• Video- Advanced video from iPhone6 will allow for more advanced remote patient appointments.
• Image Stabilization & Medical Purposes- The image stabilization features of the advanced
camera can be used
• Doctors w/o Borders & Specialists in US- Integrating doctors without borders with Epic
Health Systems specialists to provide high-quality medical care to patients being treated
abroad.
• iWatch & Wearables- Impact of iWatch on patient/predictive analytics and remote patient
monitoring.
• AT&T & Verizon- AT&T has suggested that they will be responsible for covering the wireless
services of major health providers. (I.E. hooking up all the iPads with WiFi & the server rooms
with remote monitoring/chronic disease management constant sharing capabilities)

3. The Providers: Verizon /
AT&T
• Provider Key Roles-
• Remote Patient
Monitoring/Chronic Disease
Management- Providing wireless
service to care providers for
purposes of remote patient
monitoring data transfer.
• AT&T- Will work with large hospital
systems and existing care providers.
Likely that Verizon will have their
own group of large-scale contracts
with care providers, but AT&T has
stated that this is a strong
monetization strategy in their future
(when it comes to healthcare data
technology.)

4. New Devices & Why They
Matter
• iPhone6 (Music, Camera) = TeleHealth
• iWatch (Health, Payment) = Nike Fuel For Every1

5. Breaking Down Individual
Hardware Significance
• iPhone6- The iPhone6 will allow for advancement in the technical medical
technologies available for mobile consumption.
• New Camera- Will allow for the advancement of telemedicine facilitation through
mobile devices. The powerful camera (which will be used by medical providers
across the world), will be equipped with the software/hardware to conduct
“significant” medical review through remote appointment.
• Fitness Calibrator- The fitness calibrator makes the iPhone into a wearable-like
device, which hasn’t been massively available previously. The phone could
possibly serve as an activity tracker, meaning that people would only need to
have their phone on them (or near them with the iWatch), and have this activity
data automatically uploaded to their activity data charts.
• iWatch- The significance of the iWatch is the mass-market for wearables and
advanced medical activity monitoring.

6. EHR Add-Ons & Certification
Requirements
• Certification Requirements- EMR Add-on
companies currently have to get approved by a
third-party for “medical clearance” to be adapted to
an existing EMR system.
• Drummonds & EMR Certification Companies-
Will these companies that exist entirely for this
purpose be forced out of the market? Do these
certifications, which cost tens of thousands of
dollars, still have any credibility or requirement?

7. Retail Health & Centralized
Patient Data
• “You’re Sick, We’re Quick”- Partnerships with CVS Health will
allow for patients to go to minute clinic and allow them to easily
access patient records and accrued medical data from
wearables.
• WalMart- WalMart has encouraged health data innovation, and
could play a strong role in releasing the healthcare technology
movement to non-urban regions throughout the US.
• CVS / Walgreens- Could be fighting a battle to be the primary
instant care provider of patients across the US. Would assume
that the would partner with insurance companies to make sure
that their services are covered under common patient insurance
plans— meaning that patients would no longer be required to
have a primary care physican, and could instead easily just pull-up
to a CVS whenever they’re sick. This concept could have a
major impact on healthcare revenues from major provider
groups. (Need to do a thorough analysis of healthcare provider
revenues).

8. Using Medicare & Medicaid Correctly:
Advancement of Free Healthcare
• Retail Healthcare- The increased patient data, and
likely centralized patient record system, will allow for
the onset of “retail healthcare,” in which medical
care will be offered at retailers like Wal-Mart and
CVS.
• CVS Health-

9. Developing “EHR Modulars” w/
HealthKit:
Building IAAS/PAAS Add-Ons
• EPIC Systems Connection- This initial partnership could
be a signal to major health information technology
providers to make partnerships with HealthKit and
ApplePay for purposes of appointment processing and
medical data storage/transfer.
• Hospital Systems & Patients- One hospital system
integration is the equivalent to thousands of providers for
start-ups with a per provider revenue structure. (The Fee
Model) —> $79.99/review for disease diagnosis
facilitation could easily run up revenues in the billions
under the right product.

10. Eli Lilly Pharmaceuticals
• Eli Lilly’s Medication Adherence Department- The
Big Pharma giant has recently taken an interest in
medication adherence innovation

11. Celgene

12. NYC Start-Ups To
Watch
• AdhereTech- Medication adherence technology
“hardware” provider with an interactive pill bottle.
• HelloHealth- Application system that facilitates
telemedicine appointments/ “transactions”. (looks like they
switched to a revenue cycle management platform—
which would exclude them from the race, as ApplePay will
likely integrate with a major RCM provider.) ——could be
also integrated with a major supplier of employer
healthcare finance management providers. (recently
public one could be a major partner)

13. Individual Product
Healthcare Impact Analysis:
iPhone6+

14. Impact of New Health
Indicators
• Activity- Pulling Nike+ metrics
• Blood Pressure/Blood Sugar- New data indicators integrated from third-party medical
hardware add-on devices.
• Heartrate-
• Hydration-
• Nutrition-
• Oxygen Saturation-
• Respiratory Rate-
• Sleep-
• Weight-

15. iPhone 6 Individual
Features & Healthcare
Impact
Maximizing Hardware Offerings When Developing For
HealthKit

16. Using The Fitness Calibrator
For Fitness Applications
• Start-Up Casualty: Amiigo- The whole concept of this start-up was to have a wearable
that adapted like the calibrator does. (Lifting Weights, Running Upstairs, etc.)
• Advancement of Shoe Clip- The shoe clip could be a powerful wearable for fitness,
etc. Applying advanced footwear wearables to specified sporting activities could be a
smart market pivot. (Assuming that the advanced technology specific to this individual
wearable will be outpaced by the advancements in the iWatch & Apple’s wearable
strategy. (iPod —> iPod Mini, etc.)
• Price For Amiigo- Depending on the intellectual property, Amiigo is likely to be
valued low (depending on their current orders)—the product is currently in a pre-launch
stage, and has been active on KickStarter. Acquisition of the company could
be an important part of the cycling sneaker wearable integration strategy. The real
value in this acquisition would be the technology for integrating the calibrator
specifically into a sneaker (or footwear). This intellectual property value would
significantly decline if the iPhone6 basic technology can map foot steps and foot
calibration as accurately, or more accurately, than the existing technology that powers
the Amiigo footwear device.

17. Medical ID: Stored Patient
Registration via ApplePay/Passbook
Medical ID Concept-
Patients will be able to store
their medical history on
ApplePay, and transfer this
data to providers through
NFC/ApplePay secure
payment.

19. Apple HealthKit

21. Shared Care Plan Management:
HealthKit Functionalities
• Shared Care Plan
Management- Apple’s family
sharing invitation technology
indicates that patients will
easily be able to share their
medical data stored on iOS8
with family members through
a pre-formatted data sharing
platform. This ability to share
medical data with family
members can easily be
applied to care providers of an
individual patient.

22. Learning From The Amiigo Casualty:
Developing Fitness Applications For The
Calibrator
• Accelerometer- Not much without the
accelerometer?. The major concept of the wearable
was the ability to track workouts and the intensity of
individual sets.
• Customized Fitness Applications- Athletes will be
able to review their workouts with precision—
knowing the intensity of the workout, weak spots,
and immediately receive a comparison analysis to
previous workouts.

23. Personal Health Data
Management
• More Data, New Data- The increase in wearables, in addition to the iPhone6, is bringing both larger amounts of
patient data along with new forms of patient data into the healthcare data “ecosystem.” In addition to the new
advanced forms of wearable data that will be integrated into Epic Systems, it should be noted that there has not be
any data transmitted automatically from wearables into a major health information system to date. This is a
significant note, as the concept could span hundreds of millions (if not billions) of people as the iPhone/iWatch
technology becomes more prominent globally.
• Apps For The New Data- Much of the health data that will be collected through the iPhone6 & iWatch has yet to be
introduced into the healthcare data ecosystem. This new data can be used for advanced predictive algorithms for
medical analysis by care providers, as well as for chronic disease and personal care management.
• Device Add-Ons- Market for new hardware that can connect to the iPhone6 & integrate with HealthKit likely to be
a major growth sector in the healthcare technology market. Apple has discussed the requirements for medical
device certification with the FDA— meaning that it is likely that these hardware add-ons will not require FDA
approval, making the development process much more open and easy.
• Individualized Athletic Profile- Developing a software that will allow for athletes to capture an accurate measure of
their current athletic state.
• Actual Medical Metrics- Using add-ons to the iPhone6, patients will be able to measure and record vitals that
were previously not commonly taken, yet alone recorded through technology for long-term analysis. These metrics
include glucose levels, blood pressure, hydration, sleep cycles, and advanced activity data. These metrics can be
used to develop an individualized overall health concept for patients to measure their health/fitness performance
against a metric customized to their body and “ideal fitness state.”

24. Determining Overall Athletic Health Using
Fitness Metrics: Capturing An Accurate
Depiction of an Athlete’s Current Fitness State
• Collecting An Accurate Image of An Athlete’s Current
State- Combining all of the metrics that are produced
through wearables into individual metrics that focus on
athletic strength and core fitness as the metric for
“healthiness.” Meaning that the concept would be to
determine the ideal fitness level of an individual person,
and develop their fitness metrics to measure their current
fitness state in relation to this idealized “fit” state.
• The Combo- Activity, Dehydration, Blood Sugar, Blood
Pressure, Long-Term Sleep Patterns w/ Analysis

25. FaceTime HD: Making The
Appointment More Authentic
• Increased Call Clarity (Camera/WiFi combo)- The
ability for TeleMedicine appointments to appear more
authentic when performed through a mobile device
through enhanced camera technology that makes up
FaceTime HD.
• “Doctor Relationship”- Could psychologically make
people feel more comfortable with performing a medical
appointment over the phone, as they will be able to
very clearly see their medical provider. This could be a
significant deal when addressing the on boarding of
elderly patients, etc.

26. Wi-Fi Carriers: Using Wi-Fi
calls for TeleMedicine
• Advantage: Using WiFi for TeleMedicine- Using WiFi-only strategy
means that patients only require access to a wireless network, instead of
LTE, etc.
• Middle America- This is important when addressing the telemedicine
needs of “Middle America.” Many of these Americans have dial-up
internet connection, which would have previously prevented them from
participating in telemedicine/only verification because of the speed
requirements for this type of internet function.
• Network Speeds & TeleHealth- Using a WiFi only strategy, telemedicine
companies will have the opportunity to reach all patients despite their
home internet connection speeds.
• Public WiFi- Easily could partner with AT&T, Verizon, etc. and offer
WiFi technologies for the public in mass ranges.

27. Individual Product
Healthcare Impact Analysis:
ApplePay

28. Processing Health Insurance
Payments via Apple Pay
• Concept: ApplePay will allow for insurance
verification transactions through partnerships with
insurance providers.
• Major Partners- Insurance Providers: Cigna,
Aetna, Humana (fill these out— and add significant
insurance providers and their patient numbers)
• Health Data- ApplePay could allow for patients to
securely send their patient data through NFC. (See
Patient Registration NFC concept graph)

30. Developing Technologies For Apple Pay
Insurance & Patient Information
Verification
• Concept: Patients would have
the ability to send their data
through ApplePay, along with
their insurance verification
information. The patient
information could be stored in
the “ApplePay” information
docket, and be administered to
a care provider through NFC.

32. Chip & Pin: NFC Insurance
Verification For Non-Device Users
• Chip & Pin Card Provider Opportunity- Could
possibly be a good play when it comes to the
insurance cards— as they can easily be the provider
of the NFC insurance cards that will hold patient
registration and insurance verification data.
• How It Works- To solve this, banks and retailers
are replacing traditional magnetic stripe equipment
with smartcard technology, where credit and debit
cards contain an embedded microchip and are
authenticated automatically using a personal
identification number (PIN). When a customer
wishes to pay for goods using this system, the card
is placed into a "Point of Sale" (POS) terminal,
which connects to the chip on the card. To complete
the transaction, the customer enters a 4-digit PIN.
When the POS terminal is connected to the
network, the authenticity of the card and chip can be
confirmed, along with the PIN, with the bank
servers. If the POS terminal is not connected to the
network, the chip can confirm to the terminal if PIN
was entered correctly.

33. Eliminating Emdeon w/ Apple Pay:
$1T in Payment Processing Now Available
• Eliminating Emdeon- Possibility that Apple has conceived away to work around Emdeon for
insurance payment processing. The company claims to process as much as $1 Trillion worth of
insurance claims per year, which could easily be processed through a system devised by Apple.
• Blackstone Group- This could have a potential impact on Blackstone, as they have control of the
company—it could possibly not have a reason to go public again, if Apple figures out a way to
process insurance payments using ApplePay. (See Apple, Visa, Cigna strategy) —Either way,
Emdeon is worth more than what they paid for it, despite the fact that it is in technological
shambles, and will likely be unable to keep up with/maintain the complexity that is ApplePay and
insurance verification.
• Taking Emdeon’s Core Market- If insurance payment processing is removed from the Emdeon
revenue flow, that would leave it only with revenue cycle management. This would be under the
assumption that their current revenue is focused on taking a percentage from the insurance
payment process—leaving them without a main revenue source, only the ability to possibly license
out their revenue cycle management software to healthcare finance management firms. Currently,
the major claim to fame for the company is their insurance gateway with “unlimited” access to
providers. Apple could possibly remove the requirement for this network, which would in hand
remove the requirement of working with/accepting insurance on a telemedicine platform.

34. Mobile Payment: Automated
Insurance Verification 2.0
• Cigna- Current leader of health insurance
technology in terms of engaging with the
patient/plan holder. Using Cigna with ApplePay will
allow for providers
• Aetna- Aetna had the Carepass, but stopped
development as of recent.

35. Apple Pay: Insurance Verification Network
• Emdeon Intelligent Network- This could be a strong play for Apple to cut out
Emdeon from the revenue processing algorithm. Currently, Emdeon is processing
$1T worth of insurance payments per year through an outdated insurance
exchange system. The development of ApplePay across payment providers has
the potential to eventually eliminate Emdeon from the patient payment process.
• Really need to consider the scale of this operation, and also the scale of the
operation that Apple has setup with ApplePay.
• Wi-Fi Processing Payments- Would be apple to process insurance payments
using only a Wi-Fi connection using an ApplePay insurance verification platform.
Emdeon is currently processing insurance numbers over the phone—meaning
that a receptionist is taking a copy of the patient’s insurance card and literally
calling the number in for verification and revenue cycle “management.” They still
are using paper/phone as a means to process insurance payments
(medicare/medicaid), and the mass-adoption of NFC across iPhone & Android
users.

36. Processing Patient Deductibles:
Streamlining The Joint Payment
Situation
• ApplePay & Patient Deductibles- Patients will have the ability to
pay for their “co-pay”/deductibles automatically through ApplePay.
• Insurance Processing/Credit Card Payments- Patients will be
able to automatically charge their co-pay deductibles through
ApplePay—all while processing the insurance automatically.
• Patient Payment & Healthcare “Debt” Management
Applications- Advanced data about patient medical expenses
has become available directly to the iPhone through the onset of
healthcare technology integration into the patient/provider
relationship. HealthKit developers have the opportunity to create
applications that can help patients (or employers possibly)
manage their healthcare costs automatically.

37. Individual Product
Healthcare Impact Analysis:
iWatch

38. Main Theme of iWatch Health
Announcement:
Everyone Will Accrue Personal Health Data
• Multiple Sources of Patient Data- In addition to
standard wearables, there will be an additional
mass-source of patient data collected from the
iWatch. (In addition to the data that will naturally
be collected from the iPhone6)
• Mass Market Consumer- Wearables are no
longer focused on marketing to the athletic
consumer, and instead are just massively
available. (Concept: High-End —> Mainstream)

39. Current Wearables
Technology Leader: Nike+
• Nike+ & Apple Fitness Management
Integration- Athletes will be able to easily access
the information processed through their Nike
activity tracking software directly on the
dashboard of their iPhone6. Theoretically, this
data will cause for patients to take their activity
data more seriously, and in turn organically
develop a “fitness craze” (get a better term)—>
that will advance the “quantified self” and integrate
it into the patient/doctor relationship.

40. TeleMedicine Appointment
Processing: Situational Overview
• The Network- Processing appointments/payments through WiFi, with
the eventual opportunity for all providers to
• AT&T will be providing the infrastructure for remote patient
monitoring for care providers. Verizon will likely be doing the same, if
not more, coverage of care providers for remote patient monitoring—
the point here is that they are being addressed by major carriers.
• T-Mobile will be encouraging the use of WiFi calling, and the sale of
phones that support WiFi calling.
• Addressing Their Market- T-Mobile’s on-boarding of WiFi phones
allows for their market to be on boarded to the telemedicine patient
population.

41. Epic: Using Epic Systems To Develop
HealthKit Based Technologies
• Large Hospital Systems- Major benefit of using Epic as part of your HealthKit strategy is the access to large-scale
health systems (such as universities, and public hospitals).
• Chronic Disease Management & Patient Records- The EPIC software will include access to currently existing patient
records. This access to existing patient records can be a strong asset for chronic disease management softwares, and
can use existing patient data to analyze and develop “comprehensive” chronic disease management plans.
• Nurses’ Notes Software: Approaching Healthcare Technologies For Providers- Building out specific applications
that benefit individual providers, and participants in the healthcare treatment workflow.
• Nurses- Softwares haven’t focused on the providers of healthcare, instead have focused on the patient. As Apple
takes the consumer-side of the healthcare market, the major healthcare circuit is going to have a hard time
developing softwares that will maximize this data integration into the patient care workflow.
• Registered Nurses & LPNS, etc- Developing software that allows for the delegation and management of tasks by
assignment hospital workers. This concept hasn’t quite been considered in the healthcare technology development
scene, and could be a major trend in the feature functionality development though 2020.
• Specialists via TeleMedicine- The collaboration between Epic & Apple will allow for increased access to “high-quality/
preferred” providers that are currently working at university health programs, or prestigious hospitals that
already have Epic (mostly due to financial reasons). HealthKit developers will be able to create applications that are
focused on providing patients with the highest quality healthcare providers, taking into consideration the concept that
the best providers (in theory?) will have access to the software first.

42. Patient Engagement 2.0

43. The New Patient Engagement
Pyramid: Identifying Each Level
• “Patients As Consumers”- This strategy should
apply when developing technologies for healthcare.
Patients should be seen as consumers of healthcare
services, with applications intent on enhancing this
consumption experience through direct and two-way
communication engagement platforms.

44. Addressing Meaningful Use
Requirements with $APL
• Develop complex wireframe of MU application of
ApplePay & iPhone6/Wearable Data

45. Questions For The Health
IT Industry:
• ICD-10- Will everything be coded in ICD-10, or will
there be a new method for coding medical data to
prevent hacking.
• Finger Print- Accessing and transmitting medical
data through the finger print click?
• Meaningful Use-