Apple recently announced the latest version of its watch, the Series 4. The new marketing materials on Apple’s website highlight that this is not just a watch, but also a “proactive health monitor.” Apple doesn’t define this term, but they do provide three health tracking examples of what the Series 4 can do:
Are these features groundbreaking? Can the Series 4 change unhealthy habits or behaviors of patients? Will it improve health outcomes for at-risk patient populations or the chronically ill? Perhaps even prevent unnecessary hospital admissions?
No one can answer these questions yet, and the current data should create some skepticism. The scientific research (e.g., peer-reviewed empirical studies and reviews of literature) on user engagement and the impact of digital devices on care delivery and health outcomes is sparse. In general, the evidence concludes that out-of-the-box devices (like a watch) are not likely to cause long-term changes to patient behavior, the behavior of care providers, or dramatically improve quality of life for chronically ill patients. For more information about this research, check out VirtualHealth's previous post.
The long-term impact is critical because there is a need for sustainable solutions for high cost, chronic conditions that utilize a disproportionately large number of clinical resources like diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disorder. Any medical device that attempts to significantly impact the behaviors of chronically ill individuals must be cost-effective and remain functional for years, not weeks or months.
So all of this brings forth an interesting question: Can Apple succeed where others have failed? Maybe.
Apple will have to overcome the barriers described here, plus many more. Apple has two primary advantages that other technology companies, healthcare systems, and care providers do not have at their disposal: consumers actively engaged with their existing products and large sums of money.
The first advantage Apple has is the hundreds of millions of existing customers (and potential patients) that already utilize their products. It claims that its watches can passively collect, analyze, and share the relevant information with the appropriate care provider for Apple's existing, at-risk customers. The Apple Watch could potentially save lives, decrease healthcare costs, and positively change the lives of those that need it.
Second, Apple has a lot of money. As of August 2018, Apple reached a valuation of 1 trillion dollars, with approximately 260 billion dollars in cash reserves available. For comparison, the U.S. government has around 451 billion in cash reserves as of 2017.
This fact is important because healthcare is not cheap. It is very common for new medical device companies and healthcare innovations to die a young death, not because they lack clinical effectiveness, but because they lack financial resources. Specifically, basic research, clinical development, and implementation of new medical devices come with a significant financial burden. These expenses are one of the reasons why large government entities like the National Institutes of Health (NIH) within Health and Human Services (HSS) exist: to help subsidize the costs of healthcare research and implementation of new ideas and devices.
There is one final question that supersedes the success or failure of Apple’s watch: should Apple be ethically or legally responsible for informing their customers if they determine (from one of their proactive health monitors) that someone is at higher risk for an adverse health event?
If physicians, nurses, physical therapists, or licensed social workers fail to act upon actionable data that could impact the health status of a patient, either within an acute care environment (e.g., hospital) or a care management (e.g., long-term, outpatient care) setting, they are liable and can be fined, have their license(s) suspended, or even revoked.
Should Apple be obligated to act, with the same level of good faith and legal obligation as a licensed healthcare provider? Would anyone want them to serve in this capacity? What does it mean if Apple is not legally or ethically pressured to inform a customer if they are, say 80% more likely to suffer a fall or some other type of adverse event?
Patient data and privacy concerns have become more important than ever. With companies like Amazon joining Apple as new players in the HealthIT industry and considering recent data privacy breaches by large corporations such as Facebook, it stands to reason that the government may one day consider stricter regulations for personal information within technology platforms, either through legislation or a Supreme Court ruling. Such a change would reverberate throughout the healthcare and technology sectors, determining what companies can or cannot do with personal information.