Almost exactly two years ago I wrote a post about how wearable technology can and should play a role in complex care coordination. The upshot was that with the right baseline and all members being part of the team to interpret the wearable data; one could educate, intervene and track progress. The release of the new Apple Watch 4 has demanded that I update my thoughts a bit.
The new Apple Watch 4 includes a Electrocardiogram (ECG) that measures heart rate. Apple has introducing this product is causing both excitement and skepticism. Although I still maintain that care teams can use wearable data effectively however not everyone getting “diagnosed” has a care team. The mass introduction of this product this is generating ethical issues around the technology. As digital health products continue to launch, it is important to be informed and also think about how it can do better.
On first appearance it looks like a sleek piece of technology that measures and outputs data nicely. You can also place it in a PDF format that can be communicated to your doctor… (press the play button for a 30 second demo)
This falls in-line with my idea that interpreting this data should be a team sport. The patient and care team huddling around the data and dicusss it. Having access to this data can empower patients to make decisions about their healthcare in be informed of their progress. Despite the sleek design and potential usability healthcare technology should be striving for, the Apple Watch ECG has come under scrutiny.
Although the Apple Watch has democratized your heart rate data there are serious questions about it’s accuracy and the scale of the launch. A good source skepticism I found was a “Skeptical Cardiologist”. Glad that providers like this are blogging and providing their insights. In his post he notes a couple of design and accuracy flaws. He also talks about the overall need for evidence about the Apple Watch ECG readings an we should proceed with caution. Patients also need to be aware of how “settings” can effect the data output.
Most criticisms have been around the scale of the launch. The large influx of questions about data interpretation will cripple doctors offices. That Apple Watch alerts will create many false positive readings and flood doctors, urgent cares, and ER’s with patients concerned about the Apple Watch. Some doctors have taken notice about this aspect. They are indeed getting calls about this. On the positive side this creates room for engagement around the data but many remain concerned doctors just don’t have the time.
Others are concerned about another ethical dilemma. That having ECG data may be empowering but what exactly does it mean for patients to have this data.
This thread via Dr. Grace Cordovano goes over these critical “asks” for Apple after patients read their own ECG. This highlights the need for digital health solutions to consider the consequences on the patient relationship to the technology and their providers.
2) when do I confidently ignore, act upon, or wait to make actionable decisions about alerts I’ve received? #AppleWatch #digitaltech #digitalhealth #wearables #Innovation #PatientAdvocacy #healthcare #medtwitter— Enlightening Results (@GraceCordovano) December 12, 2018
3) what do I do if I don’t have a #PCP or #cardiologist & I need to wait 3 – 4 weeks, or months, for a new #patient appointment? 🤔 #AppleWatch #digitaltech #digitalhealth #wearables #Innovation #PatientAdvocacy #healthcare #medtwitter— Enlightening Results (@GraceCordovano) December 12, 2018
4) what if my care team doesn’t use this #wearable technology in their practice or recognize the value of the #data that is generated? 🤔 #AppleWatch #digitaltech #digitalhealth #Innovation #PatientAdvocacy #healthcare #medtwitter— Enlightening Results (@GraceCordovano) December 12, 2018
5) does Apple have a national registry of physicians by zip code that I may call for a virtual consult? 🤔 #AppleWatch #digitaltech #digitalhealth #wearables #Innovation #PatientAdvocacy #healthcare #medtwitter— Enlightening Results (@GraceCordovano) December 12, 2018
6) Dear Apple, I’m waiting, #patients are waiting, #carepartners are waiting for answers. Where’s our support? Where’s the portion of your website dedicated to us?#PtExp #PtEng #AppleWatch #digitaltech #digitalhealth #wearables #Innovation #PatientAdvocacy #healthcare #medtwitter— Enlightening Results (@GraceCordovano) December 12, 2018
As Apple and other big technology companies enter the healthcare space, this will continue to be a problem. Launching healthcare products at such a huge scale comes with significant care and ethical implications.
Accuracy should not but I harken back to my original post about wearables. That in order to make any sort of educational or care decisions, heart rate data needs a good baseline. More study is needed about the accuracy but at best, baseline reliability is key.
Who interprets the data and how is an even more important question. I attempted to parallel this with mental health. Would it be responsible for Apple to release a depression screening app at large scale? Dr. Cordovano’s questions above would certainly get messy. Who assesses the risks? What if you have some but not all risk factors? How is this assessment any different from a face to face assessment? After any test one needs a provider to interpret and educate the results for patients. Initial screening via digital health is challenging but these questions about how to triage emergencies or what seems to be an emergency can’t be ignored.
Now that the cat is out of the bag, where should we go? Educational opportunities exist. After the initial screening this can still be powerful tool. Cardiologists and primary care doctors have the opportunity to have a conversation about patterns and risk. They can provide treatment plans based on real time data. They can compare what they know versus the data. They can measure effectiveness after interventions. As healthcare data does become more democratized this need for education and coordination will be there.
This technology is exciting but in order to be effective, assessment, triage, interventions and ongoing treatment needs to be a team sport. Doctors, care coordinators, payers, and digital health technology companies need to partner and design for the patient. I look forward to maybe blogging about this issue in another two years.
Now that the ECG is out, what do you think? Please feel free to comment below or give me a shout on twitter at @stuckonsw
