In part one of this series, we introduced the new Apple Watch Series 4 and explained its health-related features. Here, we look at…
What it Means for Individuals
In short, better access and more control.
V. Seenu Reddy, MD MBA FACS, is the Director of Cardiac Surgery Outreach at TriStar HCA and National Physician Cardiovascular Council Chair at HealthTrust LLC. (He is also an advisor to Health:Further’s sister company Jumpstart Foundry.) He sees parallels between the Series 4 and advances in diabetes management:
“Putting patient’s health data in the hands of the engaged and educated patients is a game changer. Imagine managing diabetes in era before accurate home testing for glucose levels. We have achieved great strides in the control of patients’ diabetes if they are engaged and educated to use the data. Similarly, more cardiovascular data will empower patients to engage better in their heart health.”
Consumer-focused devices like the Series 4 provide improved access to home monitoring that could very well reduce hospital readmissions and negative outcomes. A recent paper published in the Canadian Journal of Cardiology looked at the use of remote automated monitoring (RAM) for patients who had just undergone non-cardiac surgery:
“Perioperative complications are a major neglected public health issue with substantial economic implications.” However, they see the possibility that continuously and remotely monitoring “physiologic parameters, along with biomarker measurements, has the potential to reduce major perioperative complications and hospital readmissions by up to 50%.”
The paper focuses on complex ambulatory systems made by medical device companies designed to monitor a range of vital signs and biometric readouts. However, it also mentions the value of consumer devices like the Apple Watch, saying that “recent developments are promising” in terms of both algorithms and devices.
Beginning to add truly medical functions (e.g., not just steps and sleep, important as those may be) to consumer devices expands access to care for a broad swath of the population. For one thing, it consolidates functions into a single device. No one is claiming we’re even close to the Tricorder of sci-fi lore, but we’re making progress.
In addition, a wearable can make things more comfortable and accessible for patients. That CJC paper spent significant time discussing the “ethical implications” of RAM, in patients who had just undergone surgery. (Note that in this paper, RAM referred to any type of device, not just consumer wearables.) The authors stated that,
“RAM technologies will also have implications from a social justice and equity perspective in terms of access to services, effect on home life, patient autonomy, and interpersonal relationships. […] Additional considerations include ease of patient/family use, effect on activities of daily life, and perceived stigma of wearing monitoring devices.”
Here is an area where a smartwatch could provide dramatic improvements to a patient. One is (presumably) more comfortable wearing an Apple Watch than a Holter Monitor, although as of today it’s not exactly an apples-to-apples comparison when it comes to function.
Though currently a luxury item, it’s not unreasonable to envision programs to provide Apple Watches or similar devices to underserved, at-risk patients, to assist with both connectivity and health. Will Apple or Medicaid soon start offering subsidies for the Apple Watch, similar to programs for cell phones, wheelchairs, diabetic supplies and pharmaceuticals?
*We are interviewing cardiac patients and will be publishing their comments on the Series 4 and what it could mean for them soon.
This remains to be seen. What happens when every cardiac patient buys an Apple Watch and starts sending ECG traces their cardiologists on the fly? Even more, what about all the healthy patients who do the same? Will physicians have time to look at all the new data? What about reimbursement?
The authors of the CJC review first reference in Part One said, “Wearable technologies invert the conventional paradigm of health assessment, with otherwise healthy individuals presenting physicians with their health data for interpretation”
Bryan Menell, CEO of Verimos and a self-decribed technologist, has mixed feelings. On one hand, he’s concerned that billing and time pressure will keep general practitioners from being able to sort through it all.
“How are physicians going to deal with all this data? Let’s say you have your ECG and your heart rate and your sleeping. If I went to my general practitioner with all this stuff, number one, they don’t have the tools to go weed through it, see what it means […] Number two, that’s time-consuming for them and unless there’s a code to bill for them to go through this stuff they’re not going to spend the time looking at it. I’ve talked to a few MDs and they tell me, ‘All that stuff is great, but I don’t have the time to go wade through it.’”
On the other hand, specialists might have more room to check this information, which seems reasonable when you’re talking about system-specific data like an ECG that could be sent to a cardiologist:
“Now, when you get to the specialists, maybe. Because they’re probably making a little bit more money per visit, per patient, treating unique conditions. Your oncologist might be able to spend the time going through it.”
Still, Menell, who’s company Verimos exists to help consumers manage and secure their personal health information while making it actionable (“We’re like the Mint.com of health and wellness”), sees huge value in collecting data outside clinical settings. He referred back to the Apple Keynote, during which American Heart Association President Dr. Ivor Benjamin said, “Capturing meaningful data about a person’s heart in real time is changing the way we practice medicine […] People often report symptoms that are absent during their medical visits.”
According to Menell,
“I think the most telling thing about the keynote was the doctor. He implied that when clinicians see patients for just one spot in time, it’s hard to deliver valuable advice. Taking measures inside the four walls of healthcare is also expensive. Ambulatory data, especially over time, can be hugely valuable to healthcare providers. What happens in a person’s typical daily life? It’s like the missing link. In the future I think people will come to their clinicians with a load of ambulatory data to help diagnose issues.”
Reddy is optimistic that the pros of the Series 4 and the overall trend towards ongoing monitoring through consumer devices will outweigh the cons:
“Fitbit level data, if able to be downloaded and summarized by an accompanying app or software in physician offices, can provide a much better overall picture of a patient’s activity level and cardiovascular parameters than one blood pressure measurement or EKG made at the time of a single visit.”
And about the influx of data?
“More data is not necessarily better data but a more comprehensive picture of a patient’s activity level and heart rhythm enabled by smart devices will improve the design and implementation of treatment plans and interventions.”