Theragenomic Medicine and the Apple Watch: A wealth of health data on your wrist
Last Updated on June 20, 2015 by Joseph Gut – thasso
June 18. 2015 – The following article is from Medscape Multispeciality News & Perspective Section. I have nothing contributed to it, all credentials rest with the author, and all rights rest with Medscape. It is just that I, being a technology and knowledge aggregator junkie of some sort, am impressed with the possibilities devices like the Apple Watch, just to name one out many, and software frameworks such as HelthKit offer in healthcare, particularly in the monitoring of individual patients with each of them with his unique theragenomic outfit (granted, possibly later than sooner). Nevertheless, I thought it worthwile to make this excellently written article available to you on the thasso post platform, particularly since we have discussed already several times the prospects of mobile device technologies in the individualized monitoring of vital factors (e.g., glucose) and/or in theragenomic and personalised medicine in general.
Here we go:
Wearable technology—or “wearables”—are electronic technologies incorporated into items of clothing or worn as accessories. Today, wearables are increasingly used to collect and transmit health or fitness data directly from the user’s body. As most of us can attest, our smartphone has become so much a part of us that it might be considered by some to be a wearable. One study even showed that 90% of adults 18-29 years of age sleep with their smartphones.
The smartwatch takes wearables to a familiar place: our wrists. A smartphone most often resides in your pocket and must be extracted to seek information or to determine the source of the vibration or tone notification. The smartwatch is not only a readily accessible extension of the smartphone, but it also can be a source of physiologic data derived directly from the wearer’s body. That is its true value proposition in healthcare.
Apple wasn’t the first to the smartwatch table, but it wasn’t the first to the smartphone table either. The Apple Watch™, however, might represent the first wearable that truly penetrates the healthcare market. Why? Because the device is an industrial tour de force and part of a strategy in which healthcare penetration was a very deliberate goal.
Apple’s record of both addressing consumer needs and creating demand for its products has been extraordinarily successful. CEO Tim Cook’s strategy for the company has followed that of founder Steve Jobs’: Offer a limited number of products, focus on the high end of the market, prioritize profits over market share, and use savvy marketing to develop a craving among consumers for new Apple products.
The success of this strategy was borne out by the sale of 1 million Apple Watches in the first 24 hours the device was available for purchase. To best penetrate the healthcare market, Apple executives met repeatedly with US Food and Drug Administration officials, presumably to proactively resolve any safety and security concerns before the release of the Apple Watch.
It is noteworthy that in June 2014, Apple was not even mentioned by the market research firm Visiongain as a top-20 company in the wearable sector. However, 6% of adults (9% of men vs 4% of women) now say that they will purchase an Apple Watch.
Game Changer in Health Care?
One could imagine many practical functions of the Apple Watch. For example, does sending voice messages from your smartwatch rather than text messages from your smartphone sound inviting to you? On a trip to China last year, CEO Tim Cook saw Chinese smartphone wearers doing just that. UBS Securities analyst Steven Milunovich thinks smartphone voice messaging capabilities could be extremely popular. For patients, the potential for communicating notifications about healthcare and receiving appointment and medication reminders—such as those delivered by WebMD’s Medication Reminders app for the Apple Watch—are attractive.
Although the value of health apps to healthy individuals has been raised, a study of pooled data on digital health interventions by the Mayo Clinic found the use of telemedicine, web-based strategies, email, mobile phones, mobile applications, text messaging, and monitoring sensors with patients improved cardiovascular disease outcomes.
In one recent survey, US consumers responded that the most desired functions that they seek from wearables are the ability to exercise smarter and to collect and track medical information. The road leading to body-sensor information being directly transmitted into an electronic health record (EHR) via the Apple Watch is being paved by another Apple innovation: HealthKit. This platform allows different sensors to integrate with Apple devices via specially designed apps.
As a further indication of Apple’s focus on healthcare, the firm developed ResearchKit, a platform that pools data from consenting patients into clinical research studies on the basis of the ResearchKit health apps. Given that biological sensors reside right on the watch, it might be expected that the Apple Watch—by virtue of its direct integration with HealthKit and ResearchKit—will increase the use of health and fitness apps by patients and physicians.
However, the rate of acceptance of this new technology by physicians is age-dependent. According to a survey by MedData Group, a healthcare technology firm, two thirds of doctors younger than 40 years believe that a fully connected healthcare environment will take place within the next 5 years, whereas 61% of those older than 40 years think it will happen more than 5 years from now.
The potential uses of this technology in nonhealthcare areas of business and education are already well appreciated.[12,13] Similarly, wearables such as the Apple Watch have significant implications for healthcare beyond clinical research. For example, wearables can act as specific role locators—for code teams, patient transporters, and disaster emergency planners, among others. They can also become quick mobile tools to help with some administrative tasks, including identifying ways to improve office or hospital workflow efficiencies.
Part of the excitement of the Apple Watch is the potential development of useful health and medical apps by third-party companies for the device. This is a win/win situation: Apple gets (hopefully) the best medical apps, and app developers get quick, widespread adoption of their products. For example, Cerner, the giant health information technology firm, is looking forward to its HealthyNow app becoming part of the Apple Watch user’s library. This app collects such information as weight, blood pressure, and blood glucose levels from individual Apple Watch wearers, and integrates those data into Cerner’s EHR.
For many physicians, all this might seem like pie-in-the-sky Star Wars talk. After all, we are still struggling with EHRs, which often make little clinical sense and frequently waste our time. But are you old enough to remember when beepers didn’t even display a call-back number? Who would have imagined that we doctors would become so dependent on our smartphones for use in daily life in the office and hospital? The Apple Watch, I believe, takes mobile technology to the next level. It is more convenient than its predecessors and will be most useful for the frequent notifications that now rule our professional lives.
Two Challenges to Mass Acceptance
Two issues concerning the Apple Watch for health care use are the cost of the device (prices on Apple’s website start at over $500) and the security of protected health information that the watch contains. Ten percent of consumers are willing to pay a significant price for wearables, but most prefer receiving such devices free from employers or insurance companies. Why should these companies foot the bill? The thinking is that if outcomes are improved, it will ultimately cost these firms less to monitor patients by way of apps than not to.
In a survey of insurers by the management consulting firm Accenture, 63% believe that wearable technologies will have a high or very high impact on their organizations. The biggest barrier to adoption of wearables cited by polled physicians is cost.
Questions about the security of data collected by the Apple Watch have already been raised.[16,17] Apple, for its part, has stated that the company will be blinded to data collected via ResearchKit apps.
With the Apple Watch capable of monitoring multiple vital sign functions—in addition to functions a smartphone might have—the issue of battery longevity has been a topic of discussion among market watchers. Battery life was discussed at the company’s “Spring Forward” event last March. It was announced that the watch would provide 18 hours of battery life, assuming that it was used to check time, receive notifications, use apps, and monitor a 30-minute workout. Of course, ultimately battery life will depend on individual usage.
Is Connectivity Here at Last?
I am inclined to agree with older doctors as to when a truly connected healthcare ecosystem is likely to be established: It will probably be later rather than sooner. Things move slowly in healthcare. That is no secret to anyone.
The real questions are: Will true connectivity ever happen, and will the Apple Watch be a game changer? It remains to be seen whether apps developed for the Apple Watch are better than other apps. Accessibility to EHRs, the data sharing capabilities of ResearchKit, or the prospect of greater market share might attract higher-quality and more established app developers or other businesses to partner with Apple.
The answer to true connectivity in healthcare doesn’t lie solely with this watch. However, Apple’s app-developer business partners could potentially make the Apple Watch the most impactful wearable from a healthcare standpoint.
IBM will be partnering with Apple. IBM’s Watson is a tool that will take large amounts of data and use it to provide decision-making support for healthcare providers. Combining this capability with Apple’s HealthKit will add significant functionality to the healthcare data that will be available to physicians. Partnerships with EHR companies will hopefully lead to the interoperability that we physicians have longed for since the adoption of EHRs.
App developers—including medical schools and healthcare enterprises—are eager to have their apps added to the Apple Watch library in the hope that they might be part of the changing digital landscape of healthcare. However, I believe that the success of the Apple Watch in healthcare will be closely tied to its success among consumers first. Such wrinkles as battery longevity, security, and cost will be eventually addressed. It is rumored that Apple will be asking insurers to subsidize the cost of the Apple Watch because of its potential impact on healthcare.
Be that as it may, I would make a case—as I’m sure payers would—that at least short-term feasibility studies demonstrating the effectiveness of the Apple Watch in patient engagement, adherence, and retention are needed before reimbursement for the device is considered. The success of the Apple Watch might help digital health technology companies that make other wearables, such as clothing or eyeglasses, to succeed.
That digital technology will have an impact on healthcare is a foregone conclusion. This technology already has made its impact felt in all other sectors of society, and leaders in the technology field are already looking to these types of tools to improve care. Whether the Apple Watch is the game changer in this regard has yet to be determined.
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