Comparing Characteristics of Patients Who Connect Their iPhones to an Electronic Health Records System Versus Patients Who Connect Without Personal Devices: Cohort Study

Background While individual access to health records has traditionally been through paper and other physical media, there has been a recent push toward digitizing this process. Direct patient access to health data through application programming interfaces (APIs) is an important part of current United States policy initiatives, and Apple has created the product “Health Records on iPhone” to leverage APIs for this purpose. Objective The objective of this study was to examine the characteristics of patients at our institution who connected their personal iPhone devices to our electronic health records (EHRs) system through “Health Records on iPhone”, as compared to patients at our institution who used our patient portal but did not connect a personal device to our system. Methods We examined adult patients at our institution who had authorized an iPhone device to download their health data from the Partners HealthCare EHR via APIs through “Health Records on iPhone” from February 18, 2018 (the date this feature was enabled at our health system) until February 17, 2019. We compared these patients to adult patients who used our portal at least once during this period but did not authorize an iPhone device to download their data via APIs. Results Variables associated with an increased likelihood of using “Health Records on iPhone” included male gender (adjusted OR 3.36; 95% CI 3.11-3.62; P <.001) and younger age, particularly below 50 years of age. With each decade of age over 50, people were less likely to be “Health Records on iPhone” product users. Asian patients were more likely to use the product than Caucasian patients (adjusted OR 1.32; 95% CI 1.16-1.51; P <.001), though there was no significant difference between African Americans and Caucasians (adjusted OR 1.15; 95% CI 0.94-1.41; P =.17). Patients who resided in higher ZIP code income quartiles were more likely to be users than those in the lowest quartile. Conclusions Early results from the implementation of patient-facing APIs at a single institution suggest that there are opportunities for expanding these technologies to ensure all patients are aware of, and have access to, their health data on their personal devices. More work is needed on expanding these technologies to different patient populations.