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The Apple Watch – Tipping Point Time for Healthcare
- brandonb 8y agoIf you're an engineer who wants to make the vision Steve paints into a reality--but for everybody, not just for Apple Watch owners--I'd love to talk with you. I'm a co-founder at Cardiogram. In multiple N=14,011 studies with UCSF Cardiology, we've shown that heart rate sensors on consumer wearables can detect multiple major health conditions like sleep apnea, hypertension, diabetes, and atrial fibrillation (https://cardiogr.am/research https://cardiogr.am/research). These conditions affect more than one billion people worldwide, and are frequently undiagnosed -- for example, more than 80% of people with sleep apnea don't know they have it. We're live on iOS and Android, and we could use help in several areas: mobile and frontend engineering, senior machine learning engineers, and payer relations (the reimbursement from health insurers that Steve talks about). If that sounds like you, please email me at brandon@cardiogr.am!
- monkmartinez 8y agoWhat kind of stack are you currently developing in?
- brandonb 8y agoFor the Cardiogram app, most of the UI is developed in React, Redux, and D3 (for interactive charts). For functionality that needs to be native--for example, integrating with the Health app or Google Fit--we use Swift (for both iOS and watchOS) or Java (for both Android and WearOS by Google, which is itself based on Android). The backend is written in Node with PostgreSQL as the database. Since it's a large dataset (terabytes), we rely quite a bit on PostgreSQL 10's partitioning feature for our larger tables: https://www.postgresql.org/docs/10/static/ddl-partitioning.html https://www.postgresql.org/docs/10/static/ddl-partitioning.h... The machine learning code is written in Python, using Keras, TensorFlow, Pandas, scikit-learn, statsmodels. Our AAAI-2018 paper has a bit more info on how DeepHeart (our deep neural network) works. We also do feature engineering and traditional machine learning models when appropriate: https://www.aaai.org/ocs/index.php/AAAI/AAAI18/paper/view/16967/15916 https://www.aaai.org/ocs/index.php/AAAI/AAAI18/paper/view/16...
- dmead 8y agoI'm an engineer and i have valve disease. whats up.
- rootusrootus 8y agoEver thought about opening an office in Portland? :-) I don't have any real desire to move to SF but I do miss the fact that a lot of the cool jobs only happen down there. Ah well.
- brandonb 8y agoI'd love to open a second office one day. I'm from Seattle and my co-founder is from Vancouver, so the Pacific Northwest is a natural choice. Right now we're 10 people, so a second office isn't imminent, but we're definitely aware that not everybody can live or wants to live in the bay area.
- jasode 8y ago> heart rate sensors on consumer wearables can detect multiple major health conditions It sounds so logical and inevitable where this technology is heading for health care. Over 10 years ago, I paid $1200 to wear a Holter monitor[1] for 24 hours. In contrast, a consumer wearable like Apple Watch is $399. Arguably, the Holter monitor fee also included the doctor's time to read the ECG recording. But it also seems like a lot of the rudimentary analysis of heart data from wearables will be done in the cloud with machine learning. Hence, the price of basic diagnosis goes way down. With the increasing aging population in USA, Europe, and Japan that will want to stay on top of medical issues, it seems like a big business opportunity. A bunch of players are going to compete in this space. Good luck to you! [1] link for those not familiar with the device: https://www.google.com/search?q=holter+monitor https://www.google.com/search?q=holter+monitor
- JshWright 8y agoYou're never going to diagnose something based on a watch (or other consumer focused wearable). The watch is just telling you that you should go talk to your doctor (so they can get you on a real cardiac monitor and get the level of information needed to make a diagnosis). Consumer wearables aren't going to be replacing Holter monitors. EDIT: A lot of folks seem to be interpreting my comment as implying there is no value in this technology. That is absolutely not the case. There is huge value in widely deployed screening like this (especially since it looks like the specificity is quite high). My point is that these devices will not be replacing diagnostic equipment (in fact, it may very well increase its use as more conditions that would otherwise have gone undetected will now be flagged for further diagnostic testing).
- coder543 8y agoThe Apple Watch can perform an FDA-cleared diagnosis of certain forms of Atrial Fibrillation, and if what they showed on stage is to be believed, it can produce a really clear ECG that's also FDA-cleared. Just because you're redirected to a doctor doesn't mean the watch did nothing, it just means the watch can't provide a complete patient care cycle. The condition is identified, now what? False-positives can happen even with current medical-grade technology. It's just a question of how the false-positive rate compares. "Never" is just such a strong word, given how quickly technology has advanced, and given how you don't seem to be aware of what exactly the new Apple Watch is supposed to be able to do. Do you work for a Holter-producing company or something?
- avgDev 8y agoIs there any interest in developing software to help arrive at a diagnosis? As that would somewhat overlap with the ability to track users vitals. I suffer from chronic pain, and doctors are seriously unreliable when it comes to diagnosing something relatively complex, even though the research is there and has been available for many years. I would be interested in joining a project that would become a tool that helps diagnose complex conditions, or at least provide a path for diagnosis.
- agumonkey 8y agoI need a list of seriously precise devices that are below 200$. By ~seriously I mean something I could rely medically and not a tiny wrist watch that will have too much noise / jitter to be useful. It's for family members (including me). thanks
- DenisM 8y agoYour web site doesn't have a page about hiring, and I could not determine where your offices are located.
- brandonb 8y agoGood point. We're in San Francisco, and yeah, we should add a hiring page. :)
- toomuchtodo 8y agoThanks for your work! I bought an Apple Watch primarily to use with Cardiogram.
- brandonb 8y agoThanks for using it, and for the kind words!
- deleted 8y ago[deleted]
- clamprecht 8y agoI have a question about the Apple Watch's EKG/ECG feature, maybe someone can answer: I had a routine EKG last week for a pilot medical certificate. Before the EKG, the nurse rubbed a cold gel on my skin, at the places where she then placed the EKG contacts. I'm assuming this gel was to ensure good contact. If doctors have to rub this gel before an EKG, why doesn't the Apple Watch need this, to ensure good contact?
- MBCook 8y agoI’m guessing it just relies on pressure. The watch is held against your skin by the band, your finger is held against the crown by your muscles. I guess they’ve tested it and it seems to be good enough. As EKGs go it’s a relatively basic test, is the equivalent of having a single wire. I’m very curious to see what doctors/etc. make of it once the feature is released.
- monkmartinez 8y agoYou probably had a either a 12 lead or 3 lead EKG... the Watch is only a single lead. Therefore, much less is needed in terms of conductivity for the sensors to measure.
- harshreality 8y agoIf you're measuring (or applying) voltage on skin, you get cleaner data if you use conductive gel, since you have less chance of a poor electrical contact between sensor and skin. If you can't use it though, you can't use it. The data may have glitches, anomalous readings, but most of it will be pretty good most of the time, or they wouldn't bother with the feature. I'm also not sure what the apple watch's sensing mechanism is. Is it reading voltage or is it measuring something else that's correlated?
- ip26 8y agoAlso worth thinking about- the EKG is your "golden reference". You do it once, you want it to come out clean, you want it to come out right, and you may make treatment decisions based upon it. The watch is always running, can throw out large quantities of glitches & anomalous readings, and only produces an alert to seek followup.
- walterbell 8y agoCan Apple Watch be used without iCloud, with sensor data sent only to a local iOS device (iPad without LTE baseband radio, only WiFi) for local analysis? If so, there could be open-source iOS apps that enable privacy-oriented health data collection on the watch, e.g. with E2E encrypted messaging initiated by the device owner, when data review is wanted.
- Pamar 8y agoI think this could be doable, the only problem is that you are introducing an extra failure point (i.e. watch works, support device is down/battery dead/unable/ to connect to Internet/outside of wifi range) and if I have to choose between "data privacy" and "I had a stroke and need medical care" I'd go for the latter.
- graeme 8y agoApple watches can only be paired with iphones. I suppose you could use an iphone without LTE setup, but it would still have a radio. That said, I believe health data is end to end encrypted within icloud.
- maxerickson 8y agoOn device only is the model they are promoting: https://developer.apple.com/documentation/healthkit/protecting_user_privacy?changes=_6 https://developer.apple.com/documentation/healthkit/protecti...
- sirn 8y agoApple Watch can be used without iCloud for sure. iCloud Sync for Health data were added in iOS 11, and it can be disabled easily by a toggle. Apple Watch can only be connected to iPhone, though (not iPod touch) so have it sync to a device without LTE baseband radio is not possible.
- oflannabhra 8y agoYes, you can use an Apple Watch without using iCloud. You cannot pair an Apple Watch to an iPad. iCloud Syncing for your HealthKit data encrypts and stores your data in iCloud, similar to iCloud Keychain. If this is enabled, HealthKit information is stripped from iCloud backups, if you use them. You can also do local encrypted backups through iTunes. If you don’t use any of the above options, HealthKit data stays on the device. On device, HealthKit has lots of permissions for apps to access health data, including per app reading and writing permissions for each data category.
- mikekij 8y agoMedical device engineer / founder here. I'd love for the Apple Watch to fulfill Steve Blank's aims here, but there are very real clinical problems that don't automatically go away because Apple is great at industrial and UI design. The false positive risk with their a-fib detection will cause thousands of patients to ask their healthcare providers for further tests, only to find out they were fine. This isn't unlike the issue where iPhones have been inundating 911 call centers with unintentional "butt dials". This doesn't mean that Apple won't be successful in healthcare. It's just that the main challenge isn't in creating a nicer product. The challenge is in showing a net positive impact on patient outcomes.
- ghaff 8y ago>where iPhones have been inundating 911 call centers with unintentional "butt dials". This happened to me just a few months ago. I'm sitting in the passenger's seat of a car and, out of the blue, I get a call from a weird Caller ID which, of course, I hang up on. I get another call, this time from a regular looking number in the local area code. I reluctantly answer it (in spite of my friend driving telling me to hang up) and it's nearby emergency services. I'm of course totally confused and ended up hanging up on them when they start asking my name etc. It turns out there's a setting you can change to make this harder to do by accident but I had no idea until I looked it up.
- debt 8y agoNot to mention the health angle requires Apple lock down the device even further to stay HIPPA compliant; to keep from prying eyes. Apple has pit the FDA against the FBI.
- nradov 8y agoNothing in HIPAA would require Apple to lock down the device in ways that would inhibit the FBI. Those are entirely separate issues. For example, a key escrow scheme (which I don't support) could still be fully HIPAA compliant.
- ascagnel_ 8y agoAFib detection will only be reported if it's detected six times, to reduce the impact of false positives. https://twitter.com/benbajarin/status/1040018930637520896 https://twitter.com/benbajarin/status/1040018930637520896
- post_break 8y agoI have to wonder if the subsidizing of the Apple watch is a huge push for healthcare on it. For instance I was able to get the Series 3 for $120 through my provider. Which is a hefty drop from $400. I can't get the same discount on the Samsung watch, or any other smart watch, which is ironic since my Samsung watch works on both Android and iOS and does health tracking as well.
- graeme 8y agoInteresting. Is the Samsung watch less effective at heart health tracking, or does Apple just have better partnerships with insurers?
- brandonb 8y agoFor what it's worth, United Healthcare's Motion program supports Fitbit, Garmin, Samsung, Apple Watch, and more: https://www.mobihealthnews.com/content/unitedhealthcare-adds-apple-watch-motion-employee-wellness-program https://www.mobihealthnews.com/content/unitedhealthcare-adds... UHC is the U.S.'s largest insurer, and they claim to have validation data that shows this program saves money.
- awakeasleep 8y agoUHC's Motion program is an incentive program for higher value employees. It's more of a perk for the c-suite or law partners than a serious attempt to improve health.
- post_break 8y agoThey both use the same crappy way of reading heart rate through a camera so it can't be that drastic of a difference. My samsung watch tracks flights of stairs, heart bpm through out the day, nags about water just like the Apple watch, etc. Even has a samsung health app that lets you do a video call to an actual doctor who can send scripts for sickness.
- Eric_WVGG 8y ago
- appleiigs 8y agoI cringe thinking about people using an Apple Watch for healthcare. I had to give my Apple Watch 3 away because: 1) its heart rate monitoring while running was terrible. I run in a HR range and AW3 wasn't accurate enough for that. It would show a rate too low and then impossibly high within a couple minutes... couldn't use it to pace myself. 2) battery life. If you run for 2 hours, you likely can't get through the day. I had to charge it every night. In the case of a medical monitoring device, I guess you'll have to settle for being monitored for only part of the day??? I ended up buying a Garmin Forerunner 935 and its HR is more accurate and battery life is much better. (But not saying Garmin is OK for health care either)
- stcredzero 8y agoI run in a HR range I'm not familiar with this term. I just had an image of our Human Resources officer shooting at people running on an indoor track with a nerf gun.
- appleiigs 8y agoWhen I run, I target a heart rate of 140 beats per minute, plus or minus 10 beats per minute.
- nradov 8y agoEndurance athletes commonly do workouts around heart rate ranges, sometimes holding a steady rate or sometimes cycling up and down between zones. Heart rates are typically divided into 5 zones based on the athlete's maximum rate. Targeting specific zones for specific amounts of time can be an effective way to boost aerobic or anaerobic capacity.
- joegahona 8y agoAlso a runner -- I had slightly different problems to you: - The GPS on the watch was terrible, often dropping out for me, and leaving out a mile here and there. Is this an Apple thing? My Garmin is way more accurate. - I need an always-on mode. I realize it drains the battery, but I own the battery and that is my choice. I need to be able to glance down and see my pace immediately, not fiddle with my wrist flicking until it comes on. - I'm also bummed that there's no Spotify support yet, and that it's not a true standalone LTE device. I want to ditch my phone and have a watch only.
- chrisBob 8y agoI have signed up for, but not yet started a study at University of Michigan that is giving out apple watches and blood pressure monitors as part of a health study. Apple Inc is listed as a sponsor that will have access to all of the data. Among other things they are collecting blood samples and survey data. It has a concentrated period of 45 days of data collection, but goes on for 3 years. I am slightly concerned about the privacy issues, but I decided its worth it to see what they can come up with. The study that I am joining "MIPACT" is not well publicized, and I only heard about it through a friend at work. I wonder how many similar projects they are supporting around the country.
- gaius 8y agoI have a watch with wrist HRM and I can say without a doubt that it is a complete gimmick. Sometimes I will be sitting calmly at my desk and I glance down and see it thinks my heart rate is 190. Or I will get back from a hard run and it thinks my heart rate hasn’t been above 70. A chest strap however gives plausible results. Anyone basing serious health stuff on this is crazy.
- IBM 8y agoGuess he's just going to ignore this post: Why Tim Cook is Steve Ballmer and Why He Still Has His Job at Apple (2016) https://steveblank.com/2016/10/24/why-tim-cook-is-steve-ballmer-and-why-he-still-has-his-job-at-apple/ https://steveblank.com/2016/10/24/why-tim-cook-is-steve-ball...
- unionjack22 8y agoAn EKG is done via a 12-point lead at specific areas of the body. At the moment, there is only one ECG sensor on the watch. When I told my SO who is currently in medical residency, the look on her face was of pure horror. I think to physicians and medical professionals, all this feature will do is to create more false positives and needlessly clog up already stressed clinics with wasteful checkups and add to the number of hypochondriacs. Maybe through ML Apple could enhance the accuracy and precision of the measurements but given Apple's history with iterating on intelligent features(Siri), it won't happen for a while. If Apple wants to have a meaningful impact on the health of their users, then maybe they ought to use the ECG sharing feature as a means of getting their foot in the door of the medical records industry where their product approach and design rigour is much needed. Moreover, Apple could leverage the ECG feature as part of the product experience to motivate people to engage in activities that get them moving which, at the end of the day, is where most users derive the most value from.
- briandear 8y agoSo the president of the American Heart Association as well as doctors at Stanford are all masking the “horror” of your resident wife? You know what’s worse than a false positive? A real positive and no way to know about it.
- bennyelv 8y agoOn an individual basis, yes. Across a population, not necessarily. If the false positives result in investigations that carry medical risk then it's possible that on the whole, more harm than good is done. There's also an interesting consideration around real positives that we've never detected in the past and that never presented any symptoms or negative outcomes. It's possible that we now start detecting cases which previously the patient went their whole life without knowing about and would be totally unaffected by, and introducing medical interventions that have downsides. How it all stacks up in the end we can't possibly know, but this development isn't automatically "good".
- kendallpark 8y agoPardon my cynicism, but it strikes me either as naivety or fanboy-ism to label the Apple Watch as the "tipping point" for healthcare tech. Wearables for consumer health that touch on actual healthcare in a few areas are a pretty low hanging, low yield fruit if you want to talk about 'disrupting' the industry. Maybe I'll eat my words in a few years when wearables somehow force EHR systems to be interoperable or tackle some of the other massive issues in healthcare tech. I doubt it, though. This is nothing against the Watch tech itself. There's probably a lot of cool applications for that tech. I just don't think Apple's advancement of wearables is monumental to the healthcare industry, or potentially disruptive. > The FDA – Running Hard to Keep Up With Disruption Honestly, I don't really know what he's talking about with this 'disruption.' Just because the FDA is trying to keep pace with all the tech being built by health tech startups, it doesn't mean anything is getting disrupted. I have yet to see what I would consider a disruptive technology sweeping over the healthcare industry.
- nradov 8y agoToday the primary driver for clinical systems interoperability is federal government regulations (Meaningful Use, HITECH Act, MACRA, etc) plus requirements from payers (insurers). Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs, but that's really for iPhone / iPad devices and not directly related to wearables. EHR vendors are actively working to enhance their applications to cope with new data streams coming in from consumer wearables as well as connected home healthcare devices such as smart scales and blood pressure monitors.
- kendallpark 8y ago> Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs Is this actually the case? I haven't heard any talk of this at my institution, or on r/medicine.
- nradov 8y agoApple has signed up a number of prominent provider organizations but it's certainly not universal. Federal regulation will probably be necessary to get that data opened up everywhere.
- nradov 8y agoIt's surprising that the Apple Watch still doesn't include an ANT+ radio receiver to gather data from dedicated heart rate monitors and other devices. Of course it's possible to use Bluetooth (BLE), but it's less efficient, less reliable, and not as well supported by third-party devices. I wonder why Apple left that feature out considering that most of their competitors have it and it doesn't cost much or really impact battery life?
- mikestew 8y agoIt's surprising that the Apple Watch still doesn't include an ANT+ radio receiver Most of their competitors? Garmin's latest watches won't even talk to an ANT scale anymore (well, there's $300 kinda wasted). Garmin still has their line of ANT+ accessories, though. Moreso, I view ANT+ as the protocol for the athlete that isn't going to be using an Apple Watch during their workouts. "Oh, your $600 Garmin power meter pedals don't work over BLE with your Apple Watch?", asks no one ever. There are BLE heart monitors, foot pods, and power meters if you absolutely must use your sensors with something Apple. No, it's probably the optimal solution, but it's the solution Apple's market will be happy with.
- nradov 8y agoYou'd be surprised how many athletes are wearing Apple watches now, either alone or along with other fitness trackers or bike computers. I see Apple watches more and more at races and on Strava activities.
- wink 8y ago> Sooner than people think, virtually all home and outpatient diagnostics will be performed by consumer devices such as the Apple Watch, mobile phones, fitness trackers, etc. Well I do think 'not very soon' - because I only know a handful of people (all doing computery things) with an Apple Watch or FitBit/Android thingy, and even of those fond of tech it's only a minority. I cannot even fathom how long it would take to have this data even be acknowledged or just being able to be interchanged with German doctors and hospitals.
- SeanFerree 8y agoGreat information! Thanks!
- chicob 8y agoInsurance companies are already salivating to the prospect of ever accessing their customers' health monitor data. Cross that data with customer loyalty card data regarding groceries purchases for the next decades, and one can practically automate ineligibility.
- paul7986 8y agoWhat about the Apple toilet? No joke! A toilet that analyzes specimen data and alerts you of potential issues.
- breckuh 8y agohttps://www.youtube.com/watch?v=DJklHwoYgBQ https://www.youtube.com/watch?v=DJklHwoYgBQ This is a parody but actually has some great product ideas :)
- paul7986 8y agoThat pipe sounds solid ... maybe you can’t get solid data by analyzing poo? Though you sure can from urine. Overall I guess I’m missing things... like why is this idea being parodied?
- breckuh 8y agoIt's more of a parody of the Valley than the idea itself. Most of the aspects of the idea surround things like Tweeting, followers, et cetera. I like the idea of a pipe! Perhaps makes more sense than a smart toilet.
- deleted 8y ago[deleted]
- trophycase 8y agoYes, the tipping point for human privacy.