By this point, I think that most people have seen the big announcement coming out of the Apple event that the Apple Watch 4 now has ECG and other heart monitoring capabilities built in. The watch will notify you if your heart rate is too low and instances of atrial fibrillation that it detects. Plus, all of this is done as an FDA cleared device (some are reporting that Apple got their FDA clearance in 30 days which is crazy fast for a medical device).
The response to this announcement has been quite interesting. Most aren’t surprised that Apple has been moving more and more into healthcare. Plus, there have been a lot of reports that have mistakenly called this the first consumer ECG which it’s not. AliveCor deserves that credit and I recently wrote about another consumer ECG which is just one of many that are coming. However, many are suggesting that the Apple Watch will be the first time that many younger, healthier people will be regularly using an ECG like this. That’s an interesting idea.
As you might have assumed by the title of this post, I think the Apple Watch announcement isn’t much ado about nothing, but it’s also not the announcement of “sliced bread” being invented either. Let’s dive into what this announcement really means for healthcare.
As I mentioned when I wrote about the other consumer ECG, there’s currently somewhat limited value in what can be done with a single lead ECG. So, it’s important to keep this Apple Watch announcement in the right perspective even though I’m sure most consumers won’t understand these details. One person even commented on how Apple created messaging that calls it an “intelligent health guardian” to confuse people while still avoiding liability:
Apple's attorney and marketers developed "intelligent health guardian" messaging to confuse people without taking any liability.
— Chinmay A. Singh (@cagefreesingh) September 13, 2018
Perception sells and Apple is as good at creating perception as anyone. Will many more people buy an Apple Watch if they perceive it as something that will help them monitor their health better? Definitely. However, there are some other consequences that many doctors are warning about when it comes to this type of tracking hitting the masses.
First up is Dr. Nick van Terheyden who provides a comparative example of why all this “testing” could lead to a lot of incidentloma’s (Nice word I assume he made up to describe false positives in health tests):
There's a reason why the CEO of the newly commissioned hospital that we built stopped "testing" the MRI's on staff/healthy people – you will find 20% incidenteloma's – expect the same stat to be true for routine monitoring of "healthy" group
— Nick van Terheyden, MD (@drnic1) September 12, 2018
A nephrologist at Cricket Health, Carmen A. Peralta, chimed in with this perspective:
Hi @chrissyfarr. I’m a Nephrologist. Our patients are at extremely high risk for sudden death, arrhythmia and hyperkalemia. They’re already anxious about this. I am concerned about false positives and visits to ER in this population. Need data on sens/spec https://t.co/U0AeyW0Dwb
— Carmen A. Peralta (@Peralta_KHRC) September 12, 2018
The problem with these devices is that it’s not in Apple’s best interest to truly educate a patient on what the device can and can’t do. If a single lead ECG like this was a reliable arbitrator of when to go to the ED or when to not go, then it would be extremely valuable. However, many doctors I’ve talked to are suggesting that a single lead ECG isn’t sufficient for this type of information. So, a false negative or a false positive from the Apple Watch can provide incorrect reassurance or unfortunate anxiety that is dangerous. Who’s going to communicate this information to the unsuspecting Apple Watch buyer? My guess is relatively no one.
Another doctor made this ironic observation when it comes to the false positives the Apple Watch will produce:
Will be offline for a bit while working on my “Apple Watch said you were in a fib but your EKG is normal please fu with your PCP” template.
— Eric Funk (@efunkEM) September 12, 2018
You can just imagine the Apple Watch template in an EHR system. I wonder if it will include an Apple Watch education sheet. Maybe the EHR could send that education sheet to their watch instead of the portal. Wishful thinking…I know.
Another doctor made this poignant observation about the announcement:
I got an idea. Let's not prevent afib. Let's wait until they get afib, then make a $400 watch to poorly diagnose it n celebrate the win. ($$) Man are our priorities screwed up. N sell it to 30 yr olds that don't need it. ✌️? #medtwitter #HITsm
— The Roctor,MD (@TheRoctor_MD) September 13, 2018
We could go on for a while about prevention versus diagnosis. However, I don’t think it’s really an either or proposition. Prevention is great, but detection and diagnosis are as well since we can’t prevent everything.
This MD/PhD student summed up where we’re at with these consumer health devices really well:
Patients need reliable and accurate devices for home monitoring that can prevent then from having to interact with an antiquated, frustrating, inefficient care system. Watch is in right direction but still far away: https://t.co/V1BZL5LlBh
— Erik Reinertsen (@erikrtn) September 13, 2018
I agree completely. The Apple Watch is directionally good, but still far away from really making a significant impact on health and/or our healthcare sysetm.