by Darrell Etherington
Apple's health business could now stand alone as one of the largest in the
sector in terms of sheer reach - if it could ever be disentangled from the
company's other products, which, by design, it really can't. At the
company's annual WWDC global developer conference last week, a variety of
new health-related features were introduced that cover not only the
wellness-oriented Apple Watch lineup, but also the company's iPhone, iPad
and beyond.
From product design, to participation in academic research, to hiring, Apple
has demonstrated a concerted effort to do more in health. I spoke to Chief
Operating Officer Jeff Williams, Vice President of Health Dr. Sumbul Desai
and Vice President of Fitness Technologies Jay Blahnik following its WWDC
announcements to learn more about just how important health and wellness are
to the consumer technology giant's ambitions.
Williams started off by reiterating something I've heard from Apple in the
past on the subject: As a company, it never really set out with a strong
intent to get into the health business - at least not in the way it set out
to develop a product like the iPod or the iPhone.
"It started when we were working on the watch," he said. "And because the
watch was such a personal device, and you're wearing it, we thought that
there is a huge opportunity to maybe give people information about their
health, and the more we started pulling on threads, we decided that not only
is there an opportunity - there's a responsibility to do more in the health
space."
Williams said that the impact of that felt responsibility is what has
resulted in the many health features Apple has introduced in the years since
the Watch's introduction, both on the Watch and across its platforms.
Ultimately, Williams said, Apple has two "fundamental tenets" that undergird
its approach to introducing new health-related products and services: that
they be "deeply grounded in science," and that "privacy is at the core of
everything" Apple does.
Informed patients, augmented physicians
Those principles are at the heart of the new features Apple unveiled at the
conference, according to Desai, who pointed to the scientific rigor behind
their introduction of sleep-stage tracking for the Apple Watch, and the
fresh FDA clearance of their AFib history feature, which will roll out to
Apple Watch users in the U.S. with the watchOS 9 update sometime this fall.
"As Jeff alluded to, everything we do in health is based on the science, and
AFib history was validated in a clinical study, with participants wearing
both Apple Watch and an FDA-cleared reference device," Desai told me. "In
that study, the average difference in weekly measurements between the two
devices is actually less than 1%."
That's a remarkably thin margin for a piece of non-specialized consumer
tech, which comes with the added benefit of being worn by owners
consistently for the bulk of the day over a period that can span years - a
claim no dedicated medical heart-rate monitor can match.
The significance of offering AFib history as something Apple Watch owners
can share with their physicians, combined with all the other health data
that they can export via PDF should they choose to share a more complete
picture, might not be immediately apparent, but it represents a depth and
breadth of individual patient data that healthcare professionals have never
had access to before. I asked about how this kind of groundbreaking work
will impact healthcare as a whole, and whether Apple is working with medical
professionals on understanding those impacts.
Desai (a physician herself) pointed out that Apple spends "a lot of time
talking to physicians," both on studies like the one it's conducting with
Toronto's University Health Network (UHN), which we covered last year, and
in other capacities as well.
"We don't want to throw technology over the wall," Desai explained. "We want
to actually bring the physicians along so that they understand how this can
be used, because to your point, it's going to change their practice, and
it's also going to change their interactions with their patients."
"It's clear to us that the future of healthcare still has the
patient-physician relationship at the center of it," Williams said. "We just
want to enhance that. We don't view that technology somehow replaces [that],
we just view that it enhances that relationship and in the future, you'll
have a much more empowered patient, and a physician who is able to operate
at the top of their license because they just have a better set of
information with which to work."
Williams acknowledged that features as detailed as AFib history "will take
some time" to be "understood, used and adopted," but he cited one powerful
way it could have an immediate impact: Detecting a case in which a patient
receives an ablation treatment to resolve chronic AFib, but in which that
treatment doesn't take the first time and the AFib (which would be otherwise
asymptomatic) remains.
Apple is also introducing medication reminder features to Health, including
the ability to scan labels to add your own medicines, and get reminders to
hopefully improve adherence to their intended use. It'll also provide users
with info about potential negative interactions, and offer yet another way
in which patients can have more informed conversations with their doctors
with actual data to back them up.
Super sleep science
Apple's approach to sleep tracking is likewise backed by science, and
promises to contribute still more back to the research community through a
new Apple sleep study that the company is adding to its ongoing heart study
as an opt-in option for Apple Watch owners to join when the new update
launches. Williams prefaced the feature by acknowledging that Apple is
hardly the first to do sleep-stage tracking (dedicated health-tracking
companies including Oura and Whoop have been offering that for years, for
instance), but again references a need to feel confident in the science
behind the feature before bringing it to the public.
"The machine learning models that were trained, were validated against the
clinical gold standard of polysomnography [a type of multi-parameter sleep
study]," Desai added. "And this was actually one of the largest and most
diverse populations ever studied for a wearable."
"Prior to sleep stages, we were really focused on helping people meet their
sleep duration goals, since that's really important - that consistency - but
we wanted to go a little further and dig into the science, and provide users
with more information around their sleep cycles," Desai explained. "So using
the signals from Apple Watch's accelerometer and heart rate sensor, users
will now be able to see their sleep stages while they're in REM, core and
deep sleep."
Apple's use of "core" to define the type of sleep users spend the bulk of
their nights engaged in, which is more commonly referred to by other
sleep-stage trackers as "light," is an interesting break from the field: The
company found that "light" wasn't really the best descriptor, since it
tended to strike the average user as something meriting concern, when in
fact it's a perfectly normal part of the overall sleep cycle.
It's a good example of how Apple continually strives to balance a desire to
add increasing power and sophistication to its health features, while
maintaining their approachability and accessibility to a very broad
audience. That's also a key ingredient in their approach to the changes
coming in their new Fitness features unveiled at WWDC.
Keeping fitness fun while serving fanatics Blahnik has been with Apple since
before the Apple Watch was introduced, and he's overseen the company build
its fitness features from fairly fundamental activity tracking to a
sophisticated suite of metric management and a variety of professional,
guided workouts. At WWDC, Apple made a number of big announcements around
Fitness, including bringing simple activity tracking directly to the iPhone
for users who don't have a Watch, as well as a bunch of new metrics,
features and sport types for enthusiast and advanced athletes, and
improvements to the Fitness+ subscription workout service.
"Over the years, we've continued to push further and further, because we
know different things motivate different people," Blahnik said. "And we want
to make sure that we're constantly providing variety for different
personalities, and for the things that motivate people."
The updates include three new metrics for runners that can help avoid
injuries, including stride length, ground contact time and vertical
oscillation.
Blahnik pointed out that these are typically captured using a range of
specialized equipment or direct observation by a professional, and that
they're "really difficult to do from the wrist." Still, he says Apple was
able to build algorithms that track them reliably, and then display them
either directly during a workout session, or afterwards in the workout
summary.
Considering Apple spent a lot of time talking about these, and other
advanced features like custom workouts and automatic tri-sport workout
detection for triathletes, I asked Blahnik how Apple determines when and
where to address more advanced needs, versus more general population
features.
"Prior to Apple Watch, most people wouldn't know, unless they brought their
phone, even how far they had run, and [.] the more that this kind of
information becomes available, you do find users want more," he said. "Or
they maybe get on a journey where they're going to do their first 5K, and
they start reading more about their health. And so while [the new metrics]
do seem advanced, I'm always amazed at the fact that some of what we
measured in the beginning seemed advanced as well."
Blahnik says that in the early Apple Watch days, even having access to the
basic three rings that Apple still uses to categorize and present its health
data in summary - Stand, Move and Exercise - was itself "advanced" compared
to what was generally available. Still, even if users are seeking more
granular feedback, he notes that the challenge is in introducing
sophistication while still welcoming in those who might find the full scope
of what Apple Health has become overwhelming.
"I think for us, it's just a journey where we're constantly wanting to offer
more, trying to build the features in a way that are usable and inspiring to
both beginners and advanced athletes, and then never burdening the person
that just wants to come in and start the experiment," he said, pointing out
that the Workout app still looks and feels the same when first opened, and
reveals its complexity as you choose to dive in.
Health is quotidian
Apple's health efforts have evolved from a subset of one among many of a
single ancillary device's features, into something that spans the company's
entire product ecosystem, and that both informs and welcomes collaboration
from healthcare practitioners and researchers globally. I asked Williams for
a sense of how that shift has led Apple to think differently about its
overall approach to product development.
"I think everyone has an appreciation for the fact that these devices are
with you all the time," he said. "We have this huge opportunity to help
people with their health and so, broadly - with everything from Screen Time,
which is ultimately a health thing, since there's a huge mental health
crisis, and we think something like Screen Time helps contribute to people's
well-being - all the way across the company, people think about ways in
which our products and services can help people from a health standpoint."
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