Apple Watch Leaves Patients Connected with No Where To Go

Apple Watch Leaves Patients Connected with No Where To Go

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By GRACE CORDOVANO, Ph.D., BCPA

The highly anticipated unveiling of the Apple Watch Series 4 caused a news and social media sensation. Apple coined the iconic timepiece as the “guardian of your health”, with health tracking functionalities such as the ability to detect atrial fibrillation (AFib) by a self-performed electrocardiogram (ECG). But from patients’ and carepartners’ perspectives, there is a long road to a universally accessible, seamlessly implemented, mass-adoption, and meaningful use for this wearable technology.

Many experts, such as Dr. Eric Topol a cardiologist at the Scripps Research Institute, and other reports, were quick to highlight concerns about the consequences of false positives. The Apple Watch was criticized as a source for unnecessary anxiety. A letter from the Center for Devices and Radiological Health (CDRH) of the FDA, which cleared the ECG app as a class II over-the-counter (OTC) device, highlighted the risks to health and potential mitigation measures that the Apple Watch posed. Unfortunately, the vast majority of concerns in the public domain haven’t emphasized the risks to health due to poor implementation, integration, and adoption strategies of digital tools and wearables.

The current health care system needs to be significantly refreshed as it is not positioned to simply drop in advancements, such as those offered by the Apple Watch Series 4, into everyday patient care. Having Dr. Ivor Benjamin, president of the American Heart Association (AHA), endorse the Apple Watch at the Apple Keynote Event did wonders for the mass marketing appeal. It would’ve have been more credible and demonstrated more value if he stated that the AHA devised a strategic clinical practice implementation guide for cardiologists, created patient education materials for using the Apple Watch, partnered with payers to incentivize doctors to adopt the technology, and reimburse for virtual consults to support remote patient monitoring (RPM).


Let’s talk about the real-world use of the Apple Watch Series 4. Imagine I receive an alert from my Apple Watch that AFib has been detected. Here’s the cascade of questions that follow:

  • Who do I call: my primary care physician (PCP), cardiologist, or 911?
  • When do I confidently ignore, act upon, or wait to make actionable decisions about alerts I’ve received?
  • What do I do if I don’t have a PCP or cardiologist and I need to wait 3 – 4 weeks for a new patient appointment?
  • What if my care team doesn’t use this wearable technology in their practice or recognize the value of the data that is generated?
  • Does Apple have a national registry of physicians by zip code that I may call for a virtual consult?

These are only a few questions that come to mind. From a patient’s perspective, the vastness of the uncertainties can be overwhelming. As a patient, if I can’t get answers for my urgent questions, I’ll just stop wearing the watch so I don’t have to deal with the alerts. Cue the discussion on what the industry calls “poor patient engagement”, “patient non-compliance”, and “difficult to change behaviors”.

There isn’t a switch that can be flipped for mass adoption of this technology by all physicians. Currently, digital tools can’t be dropped into traditional patient care workflows and operations. Seamless implementation requires proactive methodical planning to identify barriers that will be encountered both internally from a workflow and operations standpoint, as well as externally by patients using the technology. As more digital technologies become available for RPM and digitization of the patient experience, strategic support tools must be provided to physicians and health care organizations to properly plan and prepare for the implementation of these technologies into their workflows and daily operations. If data is collected by RPM technologies, such as the Apple Watch, but there is no standardized process in place for reviewing that data and making it actionable, we have failed patients and simply created another data silo.

The readings obtained by the Apple Watch are not a substitute for professional medical advice or traditional clinical ECGs but serve as a screening tool. Alerts and symptoms will need follow-ups and medical attention. There are grave concerns in mass marketing this technology via direct-to-consumer (DTC) and over-the-counter (OTC) in a fee-for-service ecosystem. Poor health literacy, lack of patient education materials, fear, anxiety, lack of real-time medical support, and poor coordination of care may lead to significant overdiagnosis, overtreatment, potential increases in emergency room use, and increased costs incurred without evidence-based benefits to the end users.

With the digitization of the patient and point-of-care, we must address concerns about privacy and health data use. At the Apple keynote event, Apple CEO Tim Cook said “At Apple, we believe your personal information belongs to you. You should decide who you share it with and who gets to see it. Period. All your health and fitness data are encrypted on the device and in the cloud.

But what about de-identified data? While Apple states it safeguards patient data privacy and has gone to great measures to implement differential privacy, will this new watch functionality become an underground pipeline for access to mass quantities of health data that may be de-identified, aggregated, and sold for commercial purposes to third-party vendors? The genomic testing company, 23andMe, created a DTC genomic test, built up a customer databank of over four million participants that consented to research, and sold access to that databank in an exclusive partnership with pharma company GlaxoSmithKline (GSK).

It is well known that vast quantities of patient data are needed to power machine learning algorithms to advance AI-based platforms. Medical data trading is a multi-billion-dollar industry, unbeknownst to patients and the general public. Patients want to partner to advance human data science and should be offered transparent opportunities to do so as well as informed ways to opt-out. Access to one’s health data, even if it’s been anonymized, should be compensated. There are great opportunities to elevate industry standards on data privacy and transparency with the launch of wearable technologies. As the self-proclaimed guardian of people’s health and one of the world’s most powerful and influential companies, Apple is perfectly positioned to disrupt the way we imagine healthcare of the future and the way we advance human data science: inauthentic, transparent partnership with patients.

There is a significant difference in disrupting to be the first-in-class for a designated technology and disrupting to authentically improve patient care and the patient experience. The two are not synonymous. The creation of a digital technology alone is not disruption. The seamless implementation and universal adoption of a digital technology, deeply rooted in transparency and partnership with patients, is what leads to not only disruption but rather an enhancement of care as we know it. No single entity alone can disrupt healthcare. It must be a non-siloed, collaborative approach with every stakeholder working together.

Grace Cordovano, Ph.D., BCPA is a board-certified patient advocate and patient experience enhancer, who blogs at Enlightening Results and is passionate about elevating the patient’s and carepartner’s voice.

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12 Comments on "Apple Watch Leaves Patients Connected with No Where To Go"


Member
Millenson
Oct 1, 2018

Right on target, Grace. The health care system still doesn’t know how to deal with the reality of patients telling them, “Nothing about me without me…but sometimes without you.”

Member

It’s so silly. This isn’t a “nice-to-have” strategy but rather should be recognized as essential business strategy, let alone striving to deliver value-based, human-centered care that is truly actionable.

Member
Jeff Goldsmith
Sep 29, 2018

Thank you for this sane and practical commentary. The obvious answer to the question of how to manage the atrial fib alert: truck on over to the Emergency Room for your six hour $2500 visit, and a real, multi-lead EKG and the cardiology consult that follows. Which you will pay out of pocket because you have a $5000 deductible HDHP health insurance plan.

Not only no obvious path to connect rationally to the health system, but also no viable business model to support consumer response to the alert. This is, sadly, the current state of telehealth in miniature. I love the Apple MacBook Pro I am typing this on, but . . . Silicon Valley is simply baffled by the real world of our health system.

Member

Thank you Jeff. The technology is obviously there. Presenting it on a sleek stage vs implementing in real life are 2 completely different worlds. Hasn’t anyone mapped what this actually looks like in real-life? Clearly isn’t a priority. We can and must do better.

Member
Sep 28, 2018

Apple CEO Tim Cook said “At Apple, we believe your personal information belongs to you. You should decide who you share it with and who gets to see it. Period. All your health and fitness data are encrypted on the device and in the cloud.”

As long as the consumer and provider are using Apple products/cloud. If not, the burden remains with the consumer to “get their data to their desired destinations”. A problem in healthcare is the industry at large seeks to solve the problem of data portability for their own benefit and to hell with the consumer.

While it is exciting to see non-traditional companies enter the health market with the potential to disrupt the industry, it is frustrating to see the formation of new data silos. Do health consumers now have to shop for “Apple/Android compatible health providers?” Let’s not make healthcare any more complex.

Member

These innovations that will bring us to healthcare of the future are indeed creating new age silos and digital social determinants of health. It’s all avoidable by including ALL stakeholders of the healthcare ecosystem in the launch of new tech and mhealth innovations.

Member
Sep 29, 2018

Great comment. I could not agree with you more. I have posted at recurrent length on my KHIT.org blog about glossed-over issues with what i’ve irascibly called “interoperabble.” Moreover, personally, I’m now 5 weeks out of open heart aortic valve replacement surgery. Ongoing relevant monitoring is of interest to me, but some of this stuff I’ve looked at is simply not viable — “worried well” toys that docs are not gonna have time nor interest in. Beyond that my 2018 chart (in Epic) to date is hopelessly complex and voluminous. Getting all of it, and then sharing it appropriately and effectively, well…

And I’m an advanced analyst and Health IT person. Imagine some ordinary patient.

Member

First of all, best wishes to you on your recovery. It is a sobering reality…”imagine the ordinary person”.

Member
Oct 1, 2018

Exactly – “it is not the data, it is the application of data that provides value…or not”. Data in the hands of the physician requires one level of interpretation, data in the hands of a consumer, another. All of it can be actionable with proper interpretation. Until we have an open and consistent flow of data – there is a barrier for innovators to develop solutions that interpret data across a range of stakeholders.