In a media interview last week, Tim Cook seems to strongly suggest that Apple will launch new medical services or device features in the near future.
But for this, we can't help but wonder what it is and when it will be launched. Naturally, Cook will not reveal a little wind. However, Apple has revealed some actions that may play a more meaningful role in the healthcare system. The company may focus on three areas: blood pressure management, diabetes management, and sleep science.
blood pressure
In the first edition of Apple Watch 2015, Apple embeds an impressive precision heart rate sensor and continues to add heart monitoring capabilities. The latest major improvement is the addition of an electrical sensor needed to form an electrocardiogram that measures the electrical signal characteristics that control myocardial pumping. Although Apple Watch's ECG has had a positive impact on the lives of some users, it is not a mainstream feature for most users. However, blood pressure monitors may be closer to this requirement. According to the US Centers for Disease Control and Prevention, approximately 75 million American adults have high blood pressure.
Some clues left by Apple indicate that it is considering this technology. The US Patent Office published an Apple patent in June 2018 describing a "simple blood pressure measurement system." Apple cited an application in this patent: an inflatable blood pressure cuff can be embedded in the watch's strap. The wearer feels that the wrist is squeezed and the new sensor on the watch measures systolic and diastolic pressure.
Medical device manufacturer Omron recently showed a new product at CES that seems to prove that it can be approved and marketed by the Food and Drug Administration. Like the technology described in the Apple patent, Omron's product, called HeartGuide, uses a pneumatic cuff built into the strap of a wrist-worn device to measure blood pressure. Omron said that although there are other wearable blood pressure monitors, they rely only on sensors and can only provide an estimated blood pressure reading. The device also contains the electrical sensors needed to create an ECG. Apple may be looking for ways to add blood pressure readings to existing cardiac monitoring functions.
Diabetes management
"Apple has shown great interest in the concept of diabetes and continuous glucose monitoring," said Tim Bajarin, president of creative strategy and long-time Apple analyst. Bajarin with diabetes uses a system developed by Dexcom that monitors blood glucose through several small pointed needles that penetrate under the skin of the user's abdomen and obtains measurements by sampling glucose present in the interstitial fluid. Blood glucose levels can be continuously measured and wirelessly transmitted to the Apple Watch display.
Apple also works with a company called One Drop, which produces a blood glucose monitoring kit that sends user blood tests directly to Apple Watch.
While Dexcom and One Drop currently rely on collecting fluids or blood directly from the user's body, it is said that Apple is developing a non-contact blood glucose level collection method. The company hopes to use a luminescence sensor to measure blood sugar levels, which can illuminate the blood down the bloodstream of the user's wrist and identify blood sugar molecules.
"Although this is hard to do, I know they are very interested in it," Bajarin said. If Apple can find and use this method to collect reliable results, it may change the lives of many people. According to the American Diabetes Association, approximately 23 million people in the United States have diabetes, and another 7 million have diabetes but have not yet been diagnosed. The number of people with diabetes worldwide is far more than 400 million.
Sleep science
People familiar with the matter said members of the Apple Health and Smart Watch team were very interested in sleep science. But so far, Apple has not built a native sleep monitoring application in iOS or watchOS, nor has it embedded a special sleep detection sensor in Apple Watch or AirPods.
Last year, Apple acquired Beddit, a Finnish sleep science company that produces a thin sensor pad that can be placed under a user's mattress and can measure sleep time, heart rate, breathing, snoring, and bedroom temperature and humidity. It also comes with an app that displays and manages the data collected from the device. In December last year, Apple began selling the first Beddit products since the acquisition. Therefore, we can foresee that the company will eventually embed some Beddit features in iOS or watchOS.
Apple has tried many ways to help people measure and understand their sleep. According to people familiar with the matter, the company even produced a prototype of a "sleep mask" with sensors.
His competitor, wearable device maker Fitbit's work in sleep science may also provide some clues to Apple's dynamics. The company added a relative SpO2 sensor on its wearables to measure oxygen levels in the bloodstream. Using this data, Fitbit can determine interruptions in breathing during sleep, such as breathing interruptions caused by sleep apnea. Other Fitbit sensors detect indicators such as sleep duration and sleep quality. Fitbit is testing a way to aggregate a set of sleep measurements into a simple “sleep score†that users can see after sleep every night.
Currently, Apple Watch does not support this method because its battery can't last a day and night. But Beddit has been able to create a "sleep score" from the collected data. As a result, Apple already has the software and expertise to monitor sleep, and now only needs to find a way to support this feature in hardware.
Apple's healthcare history
Bajarin pointed out that we often associate Apple's healthcare business with Apple Watch, but it has actually started before. The company began with the iPhone's health and wellness features, including features like step counters and workouts. It then builds a unified platform for collecting personal health data in iOS health apps. ResearchKit and CareKit were subsequently launched for researchers and caregivers. Recently, Apple has added a feature that allows people to save a limited version of their electronic medical records on their devices.
When the 2015 Apple Watch came out, things began to become more serious. Bajarin said: "Apple Watch brings health features to wearable devices and improves measurement accuracy." Apple Watch was initially positioned as a fitness device, but its goal has always been to build more direct monitoring of health. In addition to the ECG reader, the Apple Watch now has a fall detection feature that alerts the caregiver or loved one if the sensor in the device detects a sudden fall of the wearer.
For a long time, Silicon Valley companies such as Apple and Google have tried to avoid dealing with the Food and Drug Administration and seek to provide health functions that do not require government approval. This has changed as technology companies realize that contact with the FDA is inevitable. For example, when Apple submitted an ECG function for approval, it gained the first experience with the FDA. The ECG system received a new license from the FDA one day before the public release.
Collaboration with the FDA includes incorporating the agency and its guidelines into the development process as early as possible. Vic Gundotra from AliveCor explains that this requires a different way of thinking about product creation. The Kardia Band from AliveCor is the first FDA-approved ECG wristband. Seeking approval for digital health products is an expensive and time consuming process that seems to be an unpleasant process for Silicon Valley companies. Former Google executive Gundotra, who is responsible for Google Photos and Google+ development, said he and the team spent some time adjusting to the organization's methodical, evidence-based approach.
Apple has now entered this process. Bajarin noted that its strength is the ability to allocate a large number of engineers and clinicians to work closely with the FDA to advance the approval process. Apple has the money to hire any health care professional it needs, and has also done a lot of recruitment. Many of them work in the health lab in Santa Clara, and Apple employees are often brought into the lab to help test the new health features of the iPhone and Apple Watch. We may just begin to see the fruits of their labor.
Privacy targeting
In addition to health features and functions, Apple has done a lot of work to change its position in the healthcare industry. Data privacy is a huge consideration for all technology companies involved in the medical field. Apple has been conducting a long-term high-profile campaign to protect personal data, even without law enforcement. This is also critical for companies like Facebook that are profiting from collecting and utilizing user data. On the technical side, Apple stores sensitive personal data (such as Apple Pay transaction data) in a secure area inside the device, even if Apple doesn't see it. All of these measures have helped build trust and prepare consumers to embrace the era of Apple devices storing health data.
Doctor on wrist
Ari Roisman, CEO of CMRA, who created the camera wristband for Apple Watch, said that the more Apple Watch emphasizes health care, the more meaningful it is. "For many people, the Apple Watch is a trusted companion. It's like a doctor on the wrist, and you know it very well," Roisman said. “Ultimately, it will feel what nutrients are flowing in your blood.†Blood pressure and blood sugar data can also add more detail.
Apple Watch has touched a lot of people. It doesn't change the world like the iPod or iPhone, or change Apple, but it still has this potential. Analysts said that Apple has sold as many as 60 million Apple Watches so far, and its sales may grow to more than 100 million by the end of next year. Roisman said: "When you have powerful computing power, plus sensors on your skin, you can do a lot of things, and you can intuitively perceive a lot of things."
The types and quantities of biometric and diagnostic data collected by Apple Watch will likely grow rapidly in the coming years. The challenge we face may be to limit the data traffic provided to caregivers to the most meaningful and immediate actionable reality.
Before Steve Jobs's death, Tim Cook and other Apple people promised to the upcoming CEO that they would begin to study how Apple is involved in health care. Bajarin said: "Steve is very disappointed with what he saw during his illness, which led to a discussion about how Apple plays an important role in improving the health care system and medical monitoring." From Cook’s remarks last week. Look, he still remembers this promise.
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