The Apple Watch – Tipping Point Time for Healthcare

If you&#x27;re an engineer who wants to make the vision Steve paints into a reality--but for everybody, not just for Apple Watch owners--I&#x27;d love to talk with you.<p>I&#x27;m a co-founder at Cardiogram. In multiple N=14,011 studies with UCSF Cardiology, we&#x27;ve shown that heart rate sensors on consumer wearables can detect multiple major health conditions like sleep apnea, hypertension, diabetes, and atrial fibrillation (<a href="https:&#x2F;&#x2F;cardiogr.am&#x2F;research" rel="nofollow">https:&#x2F;&#x2F;cardiogr.am&#x2F;research</a>). These conditions affect more than one billion people worldwide, and are frequently undiagnosed -- for example, more than 80% of people with sleep apnea don&#x27;t know they have it.<p>We&#x27;re live on iOS and Android, and we could use help in several areas: mobile and frontend engineering, senior machine learning engineers, and payer relations (the reimbursement from health insurers that Steve talks about). If that sounds like you, please email me at brandon@cardiogr.am!

Medical device engineer &#x2F; founder here. I&#x27;d love for the Apple Watch to fulfill Steve Blank&#x27;s aims here, but there are very real clinical problems that don&#x27;t automatically go away because Apple is great at industrial and UI design. The false positive risk with their a-fib detection will cause thousands of patients to ask their healthcare providers for further tests, only to find out they were fine. This isn&#x27;t unlike the issue where iPhones have been inundating 911 call centers with unintentional &quot;butt dials&quot;.<p>This doesn&#x27;t mean that Apple won&#x27;t be successful in healthcare. It&#x27;s just that the main challenge isn&#x27;t in creating a nicer product. The challenge is in showing a net positive impact on patient outcomes.

I have signed up for, but not yet started a study at University of Michigan that is giving out apple watches and blood pressure monitors as part of a health study. Apple Inc is listed as a sponsor that will have access to all of the data. Among other things they are collecting blood samples and survey data. It has a concentrated period of 45 days of data collection, but goes on for 3 years. I am slightly concerned about the privacy issues, but I decided its worth it to see what they can come up with.<p>The study that I am joining &quot;MIPACT&quot; is not well publicized, and I only heard about it through a friend at work. I wonder how many similar projects they are supporting around the country.

Pardon my cynicism, but it strikes me either as naivety or fanboy-ism to label the Apple Watch as the &quot;tipping point&quot; for healthcare tech. Wearables for consumer health that touch on actual healthcare in a few areas are a pretty low hanging, low yield fruit if you want to talk about &#x27;disrupting&#x27; the industry. Maybe I&#x27;ll eat my words in a few years when wearables somehow force EHR systems to be interoperable or tackle some of the other massive issues in healthcare tech. I doubt it, though.<p>This is nothing against the Watch tech itself. There&#x27;s probably a lot of cool applications for that tech. I just don&#x27;t think Apple&#x27;s advancement of wearables is monumental to the healthcare industry, or potentially disruptive.<p>&gt; The FDA – Running Hard to Keep Up With Disruption<p>Honestly, I don&#x27;t really know what he&#x27;s talking about with this &#x27;disruption.&#x27; Just because the FDA is trying to keep pace with all the tech being built by health tech startups, it doesn&#x27;t mean anything is getting disrupted. I have yet to see what I would consider a disruptive technology sweeping over the healthcare industry.

I have to wonder if the subsidizing of the Apple watch is a huge push for healthcare on it. For instance I was able to get the Series 3 for $120 through my provider. Which is a hefty drop from $400. I can&#x27;t get the same discount on the Samsung watch, or any other smart watch, which is ironic since my Samsung watch works on both Android and iOS and does health tracking as well.

It&#x27;s surprising that the Apple Watch still doesn&#x27;t include an ANT+ radio receiver to gather data from dedicated heart rate monitors and other devices. Of course it&#x27;s possible to use Bluetooth (BLE), but it&#x27;s less efficient, less reliable, and not as well supported by third-party devices. I wonder why Apple left that feature out considering that most of their competitors have it and it doesn&#x27;t cost much or really impact battery life?

I have a question about the Apple Watch&#x27;s EKG&#x2F;ECG feature, maybe someone can answer:<p>I had a routine EKG last week for a pilot medical certificate. Before the EKG, the nurse rubbed a cold gel on my skin, at the places where she then placed the EKG contacts. I&#x27;m assuming this gel was to ensure good contact. If doctors have to rub this gel before an EKG, why doesn&#x27;t the Apple Watch need this, to ensure good contact?

Can Apple Watch be used without iCloud, with sensor data sent only to a local iOS device (iPad without LTE baseband radio, only WiFi) for local analysis?<p>If so, there could be open-source iOS apps that enable privacy-oriented health data collection on the watch, e.g. with E2E encrypted messaging initiated by the device owner, when data review is wanted.

I cringe thinking about people using an Apple Watch for healthcare. I had to give my Apple Watch 3 away because:<p>1) its heart rate monitoring while running was terrible. I run in a HR range and AW3 wasn&#x27;t accurate enough for that. It would show a rate too low and then impossibly high within a couple minutes... couldn&#x27;t use it to pace myself.<p>2) battery life. If you run for 2 hours, you likely can&#x27;t get through the day. I had to charge it every night. In the case of a medical monitoring device, I guess you&#x27;ll have to settle for being monitored for only part of the day???<p>I ended up buying a Garmin Forerunner 935 and its HR is more accurate and battery life is much better. (But not saying Garmin is OK for health care either)

&gt; Sooner than people think, virtually all home and outpatient diagnostics will be performed by consumer devices such as the Apple Watch, mobile phones, fitness trackers, etc.<p>Well I do think &#x27;not very soon&#x27; - because I only know a handful of people (all doing computery things) with an Apple Watch or FitBit&#x2F;Android thingy, and even of those fond of tech it&#x27;s only a minority.<p>I cannot even fathom how long it would take to have this data even be acknowledged or just being able to be interchanged with German doctors and hospitals.

What about the Apple toilet? No joke!<p>A toilet that analyzes specimen data and alerts you of potential issues.

Guess he&#x27;s just going to ignore this post:<p>Why Tim Cook is Steve Ballmer and Why He Still Has His Job at Apple (2016)<p><a href="https:&#x2F;&#x2F;steveblank.com&#x2F;2016&#x2F;10&#x2F;24&#x2F;why-tim-cook-is-steve-ballmer-and-why-he-still-has-his-job-at-apple&#x2F;" rel="nofollow">https:&#x2F;&#x2F;steveblank.com&#x2F;2016&#x2F;10&#x2F;24&#x2F;why-tim-cook-is-steve-ball...</a>

I have a watch with wrist HRM and I can say without a doubt that it is a complete gimmick. Sometimes I will be sitting calmly at my desk and I glance down and see it thinks my heart rate is 190. Or I will get back from a hard run and it thinks my heart rate hasn’t been above 70. A chest strap however gives plausible results.<p>Anyone basing serious health stuff on this is crazy.

Yes, the tipping point for human privacy.

Insurance companies are already salivating to the prospect of ever accessing their customers&#x27; health monitor data.<p>Cross that data with customer loyalty card data regarding groceries purchases for the next decades, and one can practically automate ineligibility.

An EKG is done via a 12-point lead at specific areas of the body. At the moment, there is only one ECG sensor on the watch. When I told my SO who is currently in medical residency, the look on her face was of pure horror. I think to physicians and medical professionals, all this feature will do is to create more false positives and needlessly clog up already stressed clinics with wasteful checkups and add to the number of hypochondriacs.<p>Maybe through ML Apple could enhance the accuracy and precision of the measurements but given Apple&#x27;s history with iterating on intelligent features(Siri), it won&#x27;t happen for a while. If Apple wants to have a meaningful impact on the health of their users, then maybe they ought to use the ECG sharing feature as a means of getting their foot in the door of the medical records industry where their product approach and design rigour is much needed. Moreover, Apple could leverage the ECG feature as part of the product experience to motivate people to engage in activities that get them moving which, at the end of the day, is where most users derive the most value from.