Apple Watch 4: Why digital health's future depends on Apple finding a cloud partner

The new capabilities of Apple's flagship wearable device will be further enhanced by allowing healthcare providers to directly interact with patients using telemedicine and to review and analyze their data in the cloud.
Written by Jason Perlow, Senior Contributing Writer

Apple's September event has come and gone, leaving us with the Apple Watch Series 4 , which has enhanced capabilities over its predecessors, that include Atrial Fibrillation (Afib) detection and built-in ECG (electrocardiogram) support. These capabilities are not to be scoffed at -- the FDA has given its approval of the Apple Watch being classified as a true medical device. The benefits to patients have already been proven.

I would know, as the foundational heart arrhythmia detection technology now built into Apple Watch Series 4 saved my life.

Watch Series 4's software-based arrhythmia detection was piloted using Apple Heart Study, a partnership between the Cupertino consumer electronics giant and Stanford Medicine.

The study, which began in November of 2017 and closed to new participants in early August of 2018, combines the heartbeat sensor initially introduced on Series 1, along with data collection and telemedicine software used on the iPhone.

The data was forwarded to Heart Study researchers where samples from study participants were analyzed.

If a participant had signs of Afib, the iPhone companion application alerted the user to initiate a telemedicine video call, where they would consult with the Heart Study doctors who would review that data and potentially ask to send the patient an ePatch, a wearable device which collects a broader set of electrophysiological data to further assist in diagnosing the condition.

On the Watch Series 4, the ePatch functionality is replaced by the device's native ECG sensor, so all diagnosis can be done locally using a combination of software algorithms and the newer hardware.

While it was not a pilot for the ECG technology in the Series 4, the Apple Heart Study is interesting in how it tested the value of the telehealth intervention within the closed loop mobile research study using Apple Watch.

So does that mean Heart Study is over? Yes and no.

There will be many benefits to the Watch Series 4 having the ability to locally diagnose heart conditions and for patients to review and analyze results on their own iPhones. An iPhone that is Bluetooth connected to a Watch Series 4 can output a PDF file that anyone can share with their physician so they can review the data on a one to one basis.

iPhone 2018 first look: Apple's launch event scene by scene (pictures)

But the true power of having sophisticated sensors and health diagnostics on wearables will only be fully realized when the power of telemedicine is combined with cloud data analytics.

One thing is to run a study with a sample size of tens of thousands, or even hundreds of thousands of patients where wearable sensor data can be aggregated and analyzed by a team of research doctors for academic purposes, such as with Heart Study.

But it is an entirely different matter to productize a health cloud where the data of tens of millions of patients can be analyzed and be tracked historically on a very large scale in order to proactively monitor ongoing conditions and to gain further insight into that data.

And it is also that much more difficult in terms of the level of effort and required infrastructure to provide a hosting platform where third-party providers can become tenants of in order to provide services that patients and a much larger pool of doctors can access from apps and the web.

The actual patient/doctor interaction in Heart Study, along with the video call platform it used was performed and designed by American Well, a leader in remote medicine.

Stanford Medicine was the overall administrator of the Heart Study, but it was American Well's doctors that did all the legwork and consultation with patients like myself.

American Well's telemedicine platform greatly resembles Apple's Facetime software and end-users (such as myself) may initially confuse it as such because it is embedded into the Health Study app and the experience is very similar.

However, it's different because it has other features in it that make it HIPAA-compliant which is essential in the medical industry for safeguarding patient data.

Such a platform would be necessary if Heart Study was scaled from being a mere academic exercise to an actual service that patients and their physicians could use.

What Apple has created with Heart Study and Watch Series 4 is nothing short of incredible. But Apple is not a hyperscale cloud provider or a health services provider. Nor is is it a health systems integrator. And it should not be one.

Apple makes mobile devices and platforms. It's up to its partners to grow the ecosystem for Watch Series 4 and do the heavy lifting now.

Telemedicine platforms such as American Well will be extremely important if health clouds are created because it adds the necessary human interaction element. But the only way to scale to tens of millions (or hundreds of millions) of users is for Apple to partner with a hyperscale cloud provider that already has partnerships and experience in medicine.

While Apple's current enterprise partner, IBM, brings a lot of expertise to the table in terms of overall software and integration efforts with expert system and analytics platforms like Watson (which could add an entirely new dimension to looking at health data) and experience with working with many healthcare customers under its belt as a professional services organization, it isn't equipped to run a health cloud of that magnitude because it hasn't made the necessary infrastructure investments.

So who are we talking about here that can provide that? You can count them on one hand. Amazon, Google, and Microsoft.

Amazon certainly has the infrastructure to do this as it is the cloud heavyweight. It may very well end up hosting services that third-parties will create on AWS that can connect to iPhones and ultimately the Watch Series 4 and its successors.

But I don't see a strategic partnership existing between the two companies because there are just too many areas they compete in -- IoT being the primary one -- and it is only a matter of time before Amazon itself creates its own health wearable.

Also: Apple Watch Series 4: Cheat sheet TechRepublic

Similarly, Google has its own Wear OS and its own IoT platform and is unlikely to partner with Apple either even though Cloud Platform has a lot of advantages.

So where does that leave us? Microsoft. And Azure.

As I have said before, I think it is finally time for Apple and Microsoft to bury the hatchet.

There's a lot of benefit Apple and its customers can derive from an expanded partnership, and it's not just all the software and tools that the Redmond giant has created for Apple's platforms. It's also the tremendous power of Microsoft's cloud, which includes a very sophisticated and highly scalable data analytics platform.

And Microsoft's partner ecosystem for tying into that platform for creating finished software and services in the vertical healthcare industry is utterly massive.

I believe we are about to enter a grand future of advanced preventative medicine using wearables and the Apple Watch, like the iPhone, is going to become the dominant leader in its field.

But only when hyperscale cloud computing, Big Data, and telemedicine is combined with these devices are we going to see the real benefit of these technologies at scale. We are on the forefront now of that happening, but the old rivalries need to be dissolved and malice from old conflicts need to be buried from platform wars that have long since ended in order for real progress to be made.

Will the preventative diagnostics power of Apple Watch Series 4 only be truly unleashed with a hyperscale health cloud? Talk Back and Let Me Know.


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