Apple’s ECG App and the Advantages of Scale

Community Blog: As you know, Apple, Google, and other consumer-focused big tech companies are investing heavily to get into the healthcare space. One of the most interesting developments occurred in mid-September when Apple announced its new ECG-enabled Series 4 Watch, which is able to detect signs of atrial fibrillation. (See “Digital Technologies Shake Up Arrhythmia Monitoring Space Part 1: Apple’s New ECG-Enabled Watch: Gizmo or Game Changer?” MedTech Strategist, September 28, 2018.) Given Apple’s largely young and healthy user base, this clearly takes ambulatory AF screening into uncharted territory. What does it say, though, about where we are headed in healthcare? And how important is the anonymized healthcare data I assume Apple will now be able to collect and analyze with the Watch?  

Sloan Gaon: We live in really interesting times. Things that we didn’t even conceive of five years ago are now reality. And that’s what makes where we are today—the intersection of health outcomes and data—a really interesting place to be. At PulsePoint we started talking about what we call ‘radical health personalization,’ and we think what Apple’s doing directly correlates with that phrase. When you think about radical health personalization, it’s taking micro-data, aggregating it at scale, and using that data to drive better health outcomes. So at PulsePoint, and I think what you’re seeing across the industry, is what we in the marketing technology space call the ‘power of scale datasets.’ When you have massive amounts of health data that is being aggregated and analyzed, you can drive a lot better health outcomes. Let’s talk about the Apple Watch. If you’re having some episode and you’re seeing it over the last three days, for example, that’s going to drive you to go see your doctor or go to the hospital, whatever the case may be. Prior to this Watch, you would have little valid data from which to take action. So we’re really excited about what’s happening, not just with Apple, but with a lot of the biometric-collecting devices and how they can really drive better health outcomes. 

Is the bottom line to motivate people to take more responsibility for their own health? Is that where we’re headed in the future? Taking healthcare directly to the individual, even before they become patients in the traditional sense of the word?

 Yes. I think the market is evolving toward that and it’s moving much faster than even patients or healthcare practitioners are thinking about. So, I look at myself. I go to a company here in New York City called OneMedical. They have an app, and all of my health files, test results, and anything else related to me gets funneled into this app. When I see a doctor out of network and he asks me ‘what’s your cholesterol level’, two years ago, I would have said ‘I don’t know, go call my doctor.’ Today, I open the app and show him the data. So I think there’s this drive, and I think it’s market driven, where the patient is becoming more and more the center of the universe as it relates to healthcare. That wasn’t the case in the past—the payor and the healthcare practitioner were at the center of that universe. That is shifting, and the more data that’s collected, and the more data that the patient has control of and understanding of, the better outcomes I think we’ll have.

“Everyone including my grandmother has big data now. The real goal here is big insights.”

You mentioned something very interesting, and we talk about it here at PulsePoint. Everyone including my grandmother has big data now. The real goal here is big insights. Because big data doesn’t give you anything; it’s the insights you glean from that dataset that really matters. So when I look at this app that I have and the data that I have at my fingertips, that’s going to allow me to manage my health better than I ever have been able to before. And that’s going to enable me to ask better questions of the healthcare practitioner or of my provider.

The other thing that I think is interesting, and we’re seeing more of it as we move to the patient-centric world, is that more and more employers are being hit with really massive changes within their health plans. We see this here at PulsePoint.  We’re trying to change the health program and insurance that we have with our team. And that’s changing things like deductibles and copays because we can’t shoulder the burden of healthcare any longer like we could 5, 10, or 15 years ago. With that, patients now have to re-think whether or not they’re going to go to the doctor if the co-pay is $50. So I think patients are going to be much more sensitive to utilizing our healthcare system. And the fact that they have more data available—their own data, as well as data that’s available on online searches—I think that will drive different behaviors that didn’t exist before. Things like the Apple Watch just give us more data and we can make more decisions for ourselves. And I think that’s the change that were going to see.

There are some potential drawbacks here though. If you’re wearing a watch and it says you have an abnormal heart rhythm, are people going to freak out and run to the ER? There is a possibility that costs could go up if that happens. Is that not a risk with something like this—the more complex information we give people on their own—without a doctor’s guidance—the more likely they are to overreact and panic about it?

I think we’re way past that point. Google changed the way people view healthcare. It used to be that if you had an issue, you went to the doctor and the doctor sent you whatever information he or she had. But today with Google and other online health information, people are making their own diagnoses anyway. If I feel a heart rhythm disturbance, I’m going to go to Google and get some information that’s either going to drive me to go to the hospital or not. I think there’s some risk in that bad devices lead to bad behavior or bad results but I think more information is better than less information. The more we empower people to be active participants in their own healthcare, the better they are as patients and the better the healthcare system is.

Is data security an issue as we move towards this type of consumer-based healthcare?

Data security is always going to be a risk in the type of connected environment that we live in. What I’m seeing in our industry, as someone who has lived and breathed technology my entire career, is security keeps getting better. That doesn’t mean you’re not going to have breaches and information compromises, but it’s getting harder and harder to do that, and the newest platforms have been built with the latest and greatest security authentications. Systems that were built 10-15 years ago are the ones that are being compromised, the newer ones, generally speaking, are not. There’s a lot of investor money going into this. So while security will always be a concern, it’s becoming less of a concern.

Then you have the other concern around whether you have an open data lake or a closed data lake. Apple has a closed data lake—that information is going to be walled off and there will be limited access to it. There are other health data lakes that are open and are more vulnerable to those security issues. So there’s always going to be some concern, but that concern is being mitigated by the new security measures being put in place such as double authentications that are making it much more difficult to break into these systems.

“I don’t think Apple has a first-mover advantage, I think they have the advantage of having a scaled platform and scaled installation base. They own something like 17-18% of the [smartphone]market and that market tends to be a well-heeled demographic.”

Apple’s new watch also has fall detection and notification capabilities, and Apple has a number of other healthcare-focused projects in the works. For example, Apple recently purchased Beddit, a sleep monitoring company; it is opening up Health its app to outside developers; and it’s making it easier for people to get their health data on their smartphones. But the new ECG-enabled watch seems to me like a particularly important milestone. Does that give Apple a first-mover advantage in healthcare, compared to other tech companies? And how long will it be before the tech-medtech convergence is simply the norm?

Great question. I don’t think Apple has a first-mover advantage, I think they have the advantage of having a scaled platform and scaled installation base. They own something like 17-18% of the [smartphone] market and that market tends to be a well-heeled demographic. So they have the ability to overlay lots of applications and data onto their existing platform to add more value into the ecosystem that they’ve created. They started with a hardware/software platform and with music and they’ve just layered one thing after another onto that—from the app store to email to the cloud, etc. And I think healthcare is one way Apple is looking to differentiate itself from other phone manufacturers. If you look at what Android is doing or Samsung, they certainly have those applications, but I think Apple is light-years ahead of those platforms. So, again, I don’t think it’s a first-mover advantage, I think they just have an installed base that they can leverage off of and create differentiation in the marketplace. And [Apple CEO] Tim Cook has said this.

The other thing is that you eventually reach a point of saturation for your hardware and the question is what tertiary sectors can you get into that can create additional revenue streams?  You can connect Apple’s Health app with up to something like 16 healthcare systems. Here in New York, we have Mount Sinai, and anytime I go to Mount Sinai hospital or a Mount Sinai affiliated doctor who’s on the same EMR system, I get all of my health records consolidated into one app. This goes back to our earlier discussion around, in my view, more data is better than less data, which leads to better health outcomes. So I think Apple’s going to continue to roll that program out, and next thing you know, they’re going to have huge amounts of datasets that they can overlay on top of their hardware solutions to offer a better solution to the marketplace. And, once again, I think revenue streams will follow from that and it will allow them to build around their platform using software in the health sector.

With all of that data they’re collecting, I assume that would be of great importance if they’re developing AI-driven apps for healthcare.

Yes, definitely. I think we live in an AI and machine-learning world where we can take large datasets and make sense of them, so any company, whether as large as Apple, or even PulsePoint—we’re a fairly decent sized company and we’re focusing on a lot of different problems in the health sector—we’re applying AI and machine-learning to everything we do. Even the most basic of things, from recruiting to personalized healthcare advertising. That’s what we do, and Apple’s no different in that regard. And I think we’re going to continue to see more and more of that. The other thing that’s interesting is Apple has indicated that augmented reality is going to be a significant part of our experience going forward. So if you think about AR and healthcare, there are enormous applications in that space. I think we’ll see Apple accelerate its development of AR in healthcare applications in the future. And AI and machine-learning drives that AR and health data intersection.

That begs the question: is the data they’re able to collect the really big value to Apple here in terms of what they’re doing in healthcare and with the new monitoring capabilities in the Watch?

I think in this day and age, data is the new oil. And data is what’s going to drive, and is driving, industries forward, whether you look at healthcare, automotive, advertising, finance—data is that new oil. And in healthcare, data isn’t just the new oil, it’s the new automobile, it’s the new roadway, it’s everything all in one. That data is invaluable to making sure that Apple can provide applications that add value to the user, and in this case, the healthcare patient. And that’s only going to accelerate.

So what do you think will happen competitively going forward? Will other big tech companies follow suit pretty quickly with similar healthcare capabilities? What about Fitbit—they’re already active in health—do you think they’ll have an ECG-capable watch in the near future?

Well, let’s start with Fitbit. I’m a big Fitbit owner; I love their products and I’ve been using them for years. I think wearables is a really interesting sector, but I think wearables become a very concentrated application. So I don’t think there will be a lot of wearable companies that will be independent from these larger players. My estimation is that Fitbit will fit in somewhere in someone else’s platform and user base. I don’t know who will acquire it, whether it’s Apple or Google or a healthcare company like an Aetna/CVS combination, but Fitbit likely is not a stand-alone company, in my view. In terms of Google and Android, clearly Google has a strong health focus and presence. Alphabet continues to invest millions and millions of dollars in healthcare companies, and in a lot of healthcare data companies. I think we’re going to continue to see that. If you look at Google’s hardware, they continue to introduce new products, including their wearable devices and their watch, so I think they’re continuing to build off of their installed base. I think the challenge for Google is data. Apple has always taken the approach that users own their own data and Apple says they won’t utilize that data for third-party applications, but Google doesn’t have that safety net. Google uses the data they collect to drive advertising, among other things. So I think that’s going to be an interesting race between Apple and Google to gain the users’ trust. And right now, Apple has the upper hand.

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