What it Says About Consumerization of Healthcare
Across all of the articles written about the Series 4, as well as the interviews we conducted, the underlying theme was “empowering people.” Not that this is a new idea, or even really a surprise. Almost by default, any consumer device today is going to be positioned as something to “empower” us to be better people. Still, it matters here because Apple has so much weight in both the economy and society. The market goes where Apple goes.
Eric Howie, CEO of Life Detection Technologies (a portfolio company of Jumpstart Foundry) said,
“I firmly believe that providing consumers with accurate and timely information will be the primary catalyst towards the broad consumerization of healthcare. Apple’s announcement regarding the ECG function on their watch could be a small, but important step towards empowering consumers, lowering the cost of care and improving population health.”
There’s also a question of what the Apple Watch Series 4 does to the patient-clinician relationship, simply because there are so many of these devices sold. What does it mean when millions of patients suddenly have the ability to take more of an active role? It’s separate from but related to the issues raised by Bryan Menell, CEO of Verimos, about time and reimbursement in Part 2. Now, we see patients walking into the office, armed with ideas and “suggestions” for their clinician.
As that CJC review quoted in Parts One and Two of this series puts it,
“Wearables have the potential to become truly disruptive in our health care sector, with large segments of the population soon to have readily available health data that the physician must interpret.
“wearable technologies invert the traditional paradigm of health care delivery, with data collection and health queries often initiated by consumers and not providers.”
Menell’s take is a variation on the same theme, suggesting that the paradigm shift isn’t so much a potential outcome as one already in progress. Even though the Apple Watch is the most common watch on the planet, it’s a significant contributor to an ongoing shift rather than an early driver of it:
“People talk about the Eric Tool Book, The Patient Will See You Now, right? Really flipping the script on the medical profession. People come in, they’ve already done the research online around symptoms, what they think is going on […] And so sometimes they’re already coming into the doctor’s office armed with knowledge from the Internet – for better or for worse.”
Cardiac surgeon V. Seenu Reddy V. Seenu Reddy, MD MBA FACS, (and advisor to Health:Further’s sister company Jumpstart Foundry) thinks about this as a partnership more than the inversion mentioned by Menell. He said, “[The Series 4] is still a major step in empowering patients with tools and data to help them collaborate with their physicians and other healthcare providers.”
Going back to the issue of overwhelming clinicians, Howie expressed reservations for the current state of things: “While the advancement of a popular wrist-worn ECG is great, it does invite concerns of analysis paralysis and cyberchondria by the wearer, regardless of their existing health status.”
In his opinion, “A better implementation would be to gather the data, analyze it and then send it to the proper health care professional, and user, if there was an anomaly detected.”
Furthermore, changing demographics may make dealing with these shifts easier. Menell points to young physicians:
“I’ve heard some people tell me that the new kids coming out of medical school are used to taking in and ingesting lots of information about things, just as part of growing up in the digital age. And so actually there’s hope that the new breed of doctors, will be able to take in massive amounts of data like this to help treat patients.”
Indeed, no one we spoke with was an outright detractor of the Series 4 or what it represents. Rather, concerns tended to be focused on the current state of things, with optimism of where they can be in the future. Howie said,
“We are just at the beginning of a revolutionary change in healthcare that can leverage advanced sensors and big data to improve individual outcomes, but getting this process right will take time. Once this process is resolved we will see healthcare costs decrease dramatically while people live longer, healthier lives.”
Brennen Hodge, Founder of Citizen Health, took a similar tone:
“The trend of having devices monitor and track our health isn’t going away. With technology getting better every year, we will be having more diagnostic capabilities on our wrist, in our ears, and other parts of our body. Soon, our bathrooms will become “smart” with sensors measuring our “outputs.” With the cost to sequence genomes dropping to an affordable point for everyone and the rise of microbiomic testing, we’re about to enter a new age of health. One that is proactive, not reactive. One that works to stop diseases before the manifest. One that saves lives.”
But what about the actual medical implications? We were struck by a comment from Apple COO Jeff Williams during the product launch keynote. Referring to the admittedly beautiful image on the ECG app launch screen he said, “People in general don’t like things that are medical, this kinda makes you want to take an ECG.” Which sounds great, but do we really want people that excited to initiate medical testing for fun? More testing means a higher risk of finding false positives, according to that same CJC review linked above:
“[A]lthough these technologies have created new opportunities for detection and evaluation of arrhythmia, there is a significant risk of arrhythmia overdetection—for example, benign nonclinically relevant dysrhythmias or extraneous noise—or the underdetection of clinically relevant arrhythmias.”
“these devices may overcome barriers in conventional health care delivery, empower patients, and provide opportunities for arrhythmia screening in the general public due to their widespread adoption.”
In the case of the new Apple Watch, Dr. Reddy agrees:
“The Class II clearance granted by the FDA is a major step in consumer level products being given official recognition that they may be able to bring value to health maintenance and improvement in the general population.” (emphasis added)
Time will tell, but maybe that idea Williams presented in the keynote of the Apple Watch being “a guardian of health,” for a broad swath of the population isn’t just marketing and hubris. Maybe we really have reached the point where we can own our own health. Maybe.