Apple Health
This week saw yet another point update from Apple to fix a problem, this time for an issue first introduced in late October. We also saw the release of an app we’ve been waiting for from Adobe for a year – one that’s underwhelming many of us, it turns out. Apple surprised us with some welcome electronic health record integration; now if only the rest of the health care industry would catch up. Thoughts on all this stuff in this week’s editor’s desk roundup.

iOS 13.2.2 and the relentless release schedule

iOS 13.2’s release revealed unwelcome new behavior: very aggressive RAM management that killed background app processes on many user’s iPhones and iPads. The problem was particularly apparent on devices with more limited RAM, but even newer devices ran into the problem depending on what apps were used.

Apple rolled out iOS 13.2.2 (along with an identical iPadOS release) this past week to correct the problem.

Apple now maintains five distinct operating system code bases: macOS, iOS, iPadOS, tvOS and watchOS, having broken off iPadOS from iOS this time around. What’s more, Apple locks itself and its vendors into a relentless annual upgrade cycle that’s linked to its own biggest product announcement of the year – the introduction of the new iPhone.

Is this strategy sustainable for the long term? I asked this question last week and I’ve been thinking about it since then and I still don’t have a very good answer.

This year definitely exposed some problems. I don’t think they’re insurmountable, but I keep hearing complaints within Apple – sometimes anonymously, sometimes publicly from former employees – that suggests this isn’t a new phenomenon, but the relentless drive towards novelty and a very decentralized startup-style management culture has exacerbated the problem as Apple’s product lines and underlying technology have become more and more complicated over time.

I don’t want to harp on the same issue. In fact, I think Apple deserves credit where it’s due this time around. It’s good to see Apple responsive to problems articulated by users, and any fears we’d have to wait until 13.3 to see a fix for this evaporated with iOS 13.2.2’s hurried release this week. But the constant iteration of maintenance updates is exhausting, and reinforces the idea that this has been one of the messiest and worst-coordinated operating system rollouts from Apple in recent years.

Apple leads the consumer tech industry in being transparent about many aspects of its business – from supply chain labor issues to green power initiatives to its actual privacy-related transparency report. But the company’s internal management processes and how it prioritizes and focuses development is still its secret sauce. I don’t expect the company to reveal such a competitively important aspect of its business to the world, but I do think Apple needs to do a better job of being open – both in terms of how it’s talking to us and how it’s listening to us.

Adobe, Photoshop, and managing expectations

Adobe used its MAX conference this past week to make a number of announcements, and to deliver – a year after first announcing it – a version of Photoshop designed for the iPad. It’s available for free download from the App Store, though to use it you’ll need an active Creative Cloud subscription.

Photoshop for iPad delivers the ability to view and edit PSD files on the iPad and supports layers, works with the Apple Pencil and adapts many of the same

Even before it had been released testers complained that things like filters, custom paintbrush libraries and other features where nowhere to be found. And Adobe, for its part, has promised that it will continue to iterate and improve Photoshop for iPad over time.

So far, though, it’s off to a rough start: users and critics alike complained long and hard, knocking Photoshop’s App Store rating down to 2.3 of 5 stars. The complaints prompted a response from Scott Belsky, Adobe’s Creative Cloud chief product officer, who said that if you try to make everyone happy with a 1.0 release, you won’t make anyone happy.

You don’t have to go far on the App Store to find other imaging apps from companies that don’t have Adobe in their name which haven’t disappointed users, and a lot of it comes down to setting realistic expectations. In short, it’s pretty clear this time around that Adobe overpromised on Photoshop for iPad and has, at least to date, underdelivered.

Adobe has a huge advantage by having a pipeline of products that creative pros depend on and many are more or less locked into using. It’s flip to say, “Photoshop not working out? Just try Pixelmator [or another app] instead,” because it requires the user to relearn how they’re doing things and find a workflow that makes it possible for them to get their work done. But when you have to settle for a solution that’s coming from the company you’ve hitched your wagon to and the results feel rushed or incomplete, it breeds discontent and resentment, and that’s certainly not a good look for Adobe.

Hopefully Adobe won’t make that same mistake with Illustrator for iPad, which they’re promising to deliver in 2020.

Apple and the sorry state of health records

The other news item that crossed my desk this week which really got me thinking was Apple and the U.S. Veteran’s Administration (VA)’s announcement that the VA’s Health Records Electronic Health Record (EHR) system is now integrated into the iPhone’s own Health app. This makes it easier for vets receiving care through the VA’s network of hospitals and doctors to see their meds, get access to essential records and manage other aspects of their health care, all from one easy-to-use place on their phone.

This sure beats my system. I am not a vet. But I am middle-aged, so I end up at the doctor’s office more than I would like. I live in an area dominated by a single, regional health care provider. They own and operate the two hospitals closest to me, and they also employ almost every doctor and specialist I see. They even own the labs where I get blood drawn. Plus there are a couple of other specialists I see who are part of other regional provider networks.

I have to access no less than four apps to see my medical records – none of which, sadly, are the iPhone’s Health apps. I needed to download different apps from the App Store in order to get access to those files. This past week, after I complained about this process in an editorial on iDownloadblog, I discovered that I needed to download yet another app to see my the results of a recent blood test I had done, because those records either haven’t been integrated with the other apps, or whoever is managing the data reconciliation on the backend is working on a backlog.

This is ridiculous. The Health Insurance Portability and Accountability Act (HIPAA) is 23 years old, and it paved the way for the current EHR landscape. One of the very promises of that act – built into the name – was that patients would have simplified and transparent access to all of their records when they needed them.

What EHR has turned into, however, is a badly fractured, balkanized landscape of disparate systems which don’t talk to each other in any meaningful way. So patients struggle to make sense of where their records are and how to access them, behind endless security firewalls that may pay lip service to patient confidentiality and security.

There’s no question in my mind that EHR systems are heavily optimized for one task, and one task only – efficient billing. Because it’s never more than a few days that I get a bill when I’ve forgotten a co-pay or have a deductible to cover.

The system stinks. Apple continues to have victories in this area – the company noted that it’s worked to integrate Health app support to more than 400 health care providers, up from 80 last year. I hope it will continue to pick up steam.

I just want my records in one place where I can find them. If that’s the iPhone Health app, all the better.

Anyway, those are the big Apple items that I’ve been thinking about this week. How about you? What concerns you? Sound off in the comments.