Article
What Does the Release of iOS 18 Mean for the Digital Front Door?
November 6, 2024
Introduction — iOS 18 Implications to the Patient Experience
In healthcare, a Digital Front Door strategy refers to providing patients a frictionless, omni-channel experience with a single point of access across all touchpoints, regardless of disparate back-end systems being used, such as Electronic Health Records (EHR), Customer Relationship Management system (CRM), and scheduling. Like a house’s front door, the Digital Front Door welcomes patients and helps guide them through their journey. Patients receive one unified experience as they navigate their healthcare needs. A robust Digital Front Door Strategy also provides seamless transitions between digital, in-person, and other channels.
A Digital Front Door strategy also must be a mobile-first strategy. For consumers, many healthcare interactions are timely and deeply personal, thus perfectly suited for a device that rarely leaves a consumer’s side. From Livefront’s work with healthcare clients, we know that a well-crafted mobile strategy leads to higher conversion rates. In working with one of our national healthcare clients we have seen the conversion rate among mobile consumers be on average 2.5 times higher than web users. Prioritizing the consumer mobile experience is critical for healthcare systems.
Given consumers’ use of mobile in healthcare, and that over 50% of mobile phones in the US are iPhones, it is important for health systems to pay attention to new iOS innovations. Apple’s recent launch of iOS 18 presents opportunities for healthcare systems to bring new capabilities to patient interactions. Historically, each new iteration of iOS heightens consumers’ expectations for what is possible through their mobile device, and the Digital Front Door of the healthcare patient experience is not immune. iOS 18 brings new APIs that enable health systems to add new mental health and translation services into their native app. Most notably, Apple is also launching Apple Intelligence, Apple’s new personalized artificial intelligence (AI) system, integrated within iOS 18 and run mostly on-device. For many consumers, Apple Intelligence will represent the first time AI is incorporated into their day to day lives. While Apple Intelligence is not directly targeted at healthcare, health systems should be aware of its implications.
We’ll first explore the Digital Front Door strategy then discuss implications of the launch of iOS 18 and Apple Intelligence on the digital patient experience.
Welcoming Patients at the Digital Front Door
Digital Front Door strategies have evolved out of necessity. Prior to the COVID-19 pandemic, many patients’ healthcare interactions already included some digital touchpoints, such as accessing an EHR or paying bills online. However, the COVID-19 pandemic forced a rapid expansion of healthcare digital capabilities. Virtual care was not yet widely adopted prior to the pandemic and was often limited to a narrow set of use cases. According to the Centers for Disease Control and Prevention , telehealth visits increased 154% during the last week of March 2020 compared to March 2019. In addition, patients’ digital experiences were often spread across disparate systems with separate logins and entry points.
With COVID-19, healthcare systems had to consider their broader digital strategy and prioritize initiatives to improve the patient experience, as behaviors and expectations changed. Patient expectations are shaped by other online consumer experiences, such as booking a hotel online, then skipping the reception desk by completing check-in via an app. The intuitive, seamless digital experiences consumers have outside of healthcare continue to set a higher bar for consumers’ expectations within healthcare for the same speed, simplicity, and personalization, and iOS 18 only continues this trend. However, healthcare is far more complex than most consumer experiences and carries far more risk if the wrong choices are made or steps are not carefully coordinated.
Key touchpoints in a robust Digital Front Door strategy start prior to a patient choosing a health system, with research and consideration, and continue through finding care, preparing for care, receiving care, and post-care follow-up. It also takes into account caregiver needs.
Examples of a streamlined Digital Front Door strategy include:
- Helping patients understand their symptoms, and giving them tools to find and select the right care option online based on their needs and provider capacity
- Enabling patients to find providers that match their preferences regarding specialty, gender, location, languages spoken, acceptance of new patients, and more
- Allowing patients to schedule many types of care online and find appointments based on preferences such as location and urgency
- Providing caregivers with proxy access to various capabilities, such as scheduling appointments and viewing test results for those in their care
- Allowing patients to fill out forms digitally ahead of an appointment as well as avoid any paperwork duplication
- Enabling caregivers and other support, such as translators, to remotely attend an appointment
- Tracking patients’ conditions outside a clinical setting via remote monitoring devices
Health systems are recognizing the need for a more robust Digital Front Door strategy and accelerating investment in it, but many feel they are lagging behind. In a recent survey of 200 global health system executives, McKinsey found that virtual health and Digital Front Door are among the top investment priorities, along with revenue cycle management. However legacy systems and budget constraints are major limitations to improvements, providing a competitive advantage to those health systems that do prioritize investment in a differentiated Digital Front Door experience.
A robust Digital Front Door Strategy does not just enhance the patient experience; it has an impact on a health system’s bottom line. For example, it can drive the scheduling of routine care appointments to online channels, reducing call center wait times and allowing the call center to focus on complex cases. It can help avoid patient leakage to other systems by ensuring referrals are in-system. And by providing the convenience consumers expect, it can improve patient satisfaction.
Enhancing the Mobile-First Digital Front Door with iOS 18
While a Digital Front Door includes the web, mobile is increasingly consumers’ preferred way of accessing health information. In addition, consumers are tracking their own health data more than ever via mobile apps and wearables. Whether it’s workout details, nutrition logs, or around the clock biometric measurement, today’s health-conscious consumers are measuring their own biorhythms with devices such as the Apple Watch or Oura ring. Though consumers expect their interactions with healthcare systems to be as effortless as their everyday interactions with the world’s most popular apps, healthcare systems have the unique challenge of meeting these expectations while also staying compliant with HIPAA and other strict governance. With the widespread adoption of iOS among health systems’ customers, new iOS 18 developments create new opportunities, and challenges, for a health system to expand their Digital Front Door strategy.
New iOS 18 Mental Health APIs in HealthKit
Mental health and whole-person wellness has been a growing area of concern for patients and health systems. Apple’s HealthKit already enables iOS users to track, store, and share health and fitness data, while third-party developers can request access to HealthKit data with the user’s consent. In fall 2023, Apple expanded its reach in tracking mental wellbeing by introducing State of Mind and two standard mental health assessments in its Health app for iOS and Apple Watch. With iOS 18, Apple is providing developers with new HealthKit APIs to bring those mental wellbeing features into third-party apps:
- Mental Health Assessment APIs: iOS 18 is making Pfizer’s standard anxiety assessment, the GAD-7, and standard depression assessment, the PHQ-9, available to third-party apps via APIs. These standard assessments are widely used for mental health screenings. Third-party apps can read and write the results of these assessments in accordance with Pfizer’s use guidelines, making them more accessible digitally and to a potentially broader audience.
- State of Mind API: State of Mind allows users to track emotions and mood, in the moment and over time. The State of Mind API enables third-party apps to integrate emotion tracking across various parameters, including the type and duration of the emotion, the intensity, and the situation. State of Mind also allows users to compare their emotions to other aspects of their life, such as sleep, exercise, and nutrition. The use cases are not limited to health; a developer can integrate the API and bring mindfulness to any experience where it may be beneficial for someone to pause and reflect, such as education or work.
These new APIs enable health systems to offer additional mental health services within their native apps, giving patients broader access to tools that assess and track their mental health digitally outside of appointments. The GAD-7 and PHQ-9 are sometimes administered on paper forms in a clinic. Integration of these assessments into a native app reduces administrative burden and form data entry, while allowing patients to take them outside of a clinical setting if needed.
In addition, a health system could offer the State of Mind emotion tracking in their native app for patients in therapy as a convenient digital way to regularly record emotions in between appointments. It can integrate the data, so it can be accessed by providers, removing friction from tracking and reporting compared to methods such as journaling (or remembering) how one felt in between appointments. Integrating the State of Mind API with a native app could strengthen the engagement of therapy patients via digital technology in between appointments.
Additional Language Support in iOS 18 via Translation APIs
Language barriers in healthcare can potentially limit patient access and create health equity disparities. It is challenging for health systems to serve all their communities’ language needs, which can also vary greatly by region. Human translators provide a valuable service but are difficult to scale. While many health systems already have some multi-language capabilities, iOS 18 introduces new Translation APIs that can provide additional translation capabilities within a health system’s own app.
Apple’s existing Translate app allows users to type language or take a photo and have the language or image translated into 21 supported languages, with Hindi being new this year. The new Translation APIs bring similar capabilities to third-party iOS apps (as well as to Mac and iPad). There are two Translation API options developers can consider:
- Simple overlay: The Translation Presentation API is the simplest method, providing a system UI overlay to display a translation. The overlay works best for showing a single translation, such as a text string, at a time.
- Flexible translation: The Flexible Translation API can translate multiple strings at once, such as a post-visit summary, and return the results either at once or as they are being processed.
By allowing broader translation capabilities within the health system’s app, these apps can serve a more diverse constituency. They can also reduce the need for producing some localized content. These APIs are not a complete solution for solving healthcare’s challenging translation needs; they translate selections of text and support a limited set of languages. But they are an incremental step toward making a health provider’s native app more language accessible within the app itself, given the large investment to produce additional language-specific versions of apps. These new APIs can make a health system’s Digital Front Door more welcoming to non-English speakers.
Bringing Apple Intelligence to iOS 18
Apple Intelligence, Apple’s new personalized AI system integrated within iOS 18, launched in October 2024 on select devices.¹ Apple brings its own proprietary approach to AI with Apple Intelligence, a “Personal Intelligence System” that can understand and generate language and images, as well as take actions. It leverages the end users’ personal context from sources such as mail, messages, photos, calendars, and more to generate personalized responses and actions. Some of these capabilities will be available for integration into 3rd party iOS applications.
Apple Intelligence’s core features include Writing Tools, Image Tools, Siri enhancements, and ChatGPT integration (free and without a ChatGPT account), some of which offer opportunities for health systems. While AI has been gaining public attention the last few years, unlike many AI tools, Apple Intelligence will integrate AI directly into consumers’ mobile devices, bringing generative AI into the daily lives of many consumers for the first time. Initial device and language constraints will limit the early user base, giving health systems an opportunity to plan for how they might integrate certain Apple Intelligence capabilities into their own apps to enhance their Digital Front Door.
Enhancing Communications with Apple Intelligence
Many healthcare systems are already leveraging AI for a variety of writing tasks, such as after-care summaries or writing insurance appeals. Apple Intelligence brings additional Writing Tools and the integration of ChatGPT to help users write, rewrite, adjust tone, proofread, and summarize key points. Writing Tools will automatically appear in third party iOS apps that are using UITextView, NSTextView or WKWebView. UITextView and NSTextView require use of TextKit2 for the full Writing Tools experience. By default, Writing Tools are an in-line experience, but developers can customize the behavior via an API to create a panel experience or to opt-out.
Siri has become more powerful in iOS18, with extended capabilities that invoke Apple Intelligence. Siri has improved language understanding, the ability to understand personal context, and the ability to read and act on text on screen for Apple applications. Developers can set up App Intents for Siri to invoke commands on third-party apps. The combination of Writing Tools, ChatGPT, enhanced Siri capabilities, and App Intents create new ways for patients to create more contextual communications and interact with health system apps.
For example, a health system could empower its patients to report medication side effects to a care team by creating an App Intent to launch messaging within its app experience. A patient who is experiencing side effects could simply say to Siri, “Send a message to my provider” to launch messaging in the patient’s health system’s app if an App Intent existed. The patient could then draft a message (or use ChatGPT to draft it) to describe his or her symptoms and use Writing Tools to edit the message for clarity and conciseness, then send via Siri.
For voice communications, iOS 18 gives users the capability to directly transcribe calls into the Notes app (with notification to the other caller). For health providers that communicate via phone call with patients, they should be aware of and have a plan ready if a caller requests to record a call, which can automatically become a written transcription.
Creating Email Messages That Reflect How iOS 18 Users Receive Them
While Writing Tools helps users express themselves, Apple Intelligence also gives healthcare consumers new tools for organizing and generating information, enabling consumers to find and act on relevant information more quickly. For Apple Mail app users, iOS 18 will create a digest of emails from the same sender, allowing them to see a summary of all emails from that sender. iOS 18 will also provide on-device categorization of email, such as Priority Messages, which will bring timely email to the top. Currently, many email applications allow a user to select viewing the first line of an email in addition to the subject. For Apple Mail users, Apple Intelligence will generate a one line summary of the email instead of a preview of the first line to give the end user more relevant contextual information about the email without opening it; it will also prioritize Apple Mail and system notifications.
Health systems vary in their use of email and other communications tools for patients, often due to HIPAA considerations. For any health system using email for patient communications, whether for marketing messages, flu shot reminders, or prescription refill updates, they will want to evaluate their email messaging and notifications, understanding they may be presented in a summarized and consolidated digest format to iOS 18 Apple Mail end users.
Apple Intelligence Privacy Considerations
Apple has long said that protecting users’ privacy is a core value and has taken steps to ensure Apple Intelligence is consistent with this value, but concerns remain. The majority of Apple Intelligence requests will be run on-device, but more complex requests may be processed via Private Cloud Compute. However, an end user will not have visibility as to whether a request is processed on device or via Private Cloud Compute. This could expose Protected Health Information (PHI) and Personally Identifiable Information (PII) to the cloud. Apple has committed their same privacy standards to request processed in Private Cloud Compute, but a risk remains.
With the new integration of ChatGPT, Apple Intelligence is building in additional privacy controls for requests to ChatGPT, including asking users to opt-in before requests are sent to ChatGPT, hiding IP addresses, and not allowing ChatGPT to store requests. Even with end users opting-in to ChatGPT, they may not fully understand privacy implications. After some corporate partners expressed privacy concerns about the ChatGPT integration, Apple announced the ability to globally opt-out of ChatGPT integration on devices .
Apple devices are often used by health systems’ customers and by their own employees. While Apple Intelligence may be helpful in crafting a response to a patient, information accuracy and privacy are concerns with AI. Third-party apps can disable Apple Intelligence’s Writing Tools. Each health system will need to evaluate Apple’s privacy standards against their own policies, taking into account issues such as regulatory compliance, security, control, transparency, and risk mitigation, and also establish governance structures for employee users of AI on Apple devices.
Conclusion — Enhancing the Patient Experience with iOS 18
Building a Digital Front Door strategy is critical to health care systems that want to provide a patient experience that meets their expectations and removes friction from finding and receiving care. iOS 18 brings a wide range of innovations, some of which can provide incremental but meaningful improvements to healthcare’s Digital Front Door. With the widespread adoption of iOS among health systems’ consumers and employees, health care systems can undertake incremental improvements to their digital experience by considering adopting new APIs that bring new health tools to their native app, as well as understanding the implications of Apple Intelligence to the broader ecosystem.
¹Apple Intelligence was released in beta in October 2024 on these devices: all iPhone 16 models, iPhone 15 Pro, iPhone 15 Pro Max, Mac and iPads with an M1 chip or later as part of an iOS 18, iPadOS 18, and macOS Sequoia update. It will be limited to device language and Siri set to US English and will not initially be available in the European Union.
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