Recently the Apple Watch’s latest feature went live – an electrocardiogram (ECG) app that monitors irregular heart rhythms. The internet is overflowing with reports from people didn’t know they had irregular heartbeats until they took their data to their doctors and received diagnoses of atrial fibrillation (AFib), a common cause of stroke.
As neurologists who treat stroke patients, we welcome technology that enables patients to receive faster diagnoses and better treatment. The Apple Watch’s ECG feature will collect troves of physiologic data. Buried within that data will be information that we, as doctors, could theoretically use to identify high-risk patients, and intervene to prevent serious events.
But data is only as good as what you can do with it.
Currently, there are no technology platforms that present Apple Watch data in a clinically useful way for doctors. We worry that without the development of infrastructure to manage the influx of data from patients’ devices, the promise of these apps will never be fulfilled.
The potential and limitations of the Apple Watch’s ECG feature can be seen in the story of a typical stroke patient – we’ll call her Kate.
When we met Kate, she was 55 years old and had always been healthy and active. She was a former competitive cyclist who swam several days per week. Kate was brought to the emergency room after experiencing difficulty speaking and a sudden onset of weakness on the right side of her body – classic symptoms of a stroke.
We diagnosed Kate with AFib. A rapid, irregular heartbeat had led blood to pool in her heart, forming a clot. That clot had then traveled to her brain, causing her stroke.
Kate left the hospital with a medication to manage the irregular rhythm of her heart. We provided her with a device to record her heartbeat and brought her in for routine follow-up visits.
But devices like the one we provided to Kate are “black boxes,” meaning patients cannot see their data until their doctor does. In addition, they only record a patient’s heartbeat patterns for a few weeks at a time, and only when patients feel like they might be experiencing an AFib episode.
Enter the Apple Watch.
Had Kate been using the ECG app prior to her stroke, she might have learned of her condition sooner, been diagnosed with AFib, put on medication, and potentially avoided the stroke.
But the ECG app has an enormous limitation from a doctor’s perspective. We cannot use it to monitor patients like Kate. Apple has not created the tools we need to analyze the data the watch is collecting, and because we lack the time to weed through that data, we cannot use it.
Apple cautions in its fine print that its latest technology is not for people who already have AFib. This is surely a move to protect its liability. But it is also a shortcoming of not just the Apple Watch, but of many other innovations in digital health care. All around us engineers are developing new ways to monitor patient data, including remote blood pressure cuffs, wireless smart scales, and sensors that track medication adherence. But the development of software to help physicians manage this information and glean insights from it lags far behind.
There is an enormous opportunity here.
We see early signs of innovation when it comes to making this data useful for health care providers. At Heartbeat Health, a recently-launched cardiology clinic in New York City, patients can upload data from their wearable devices and schedule a session with their cardiologist to unlock insights from that data. Recently, we saw an epilepsy patient at our clinic who pulled up her medication intake data on her phone (which was collected by a Bluetooth-enabled smart pillbox), which helped us fine-tune her seizure medications.
Technological revolutions don’t happen in isolation. They require simultaneous revolutions in hardware and processes. Steam-powered trains enabled the Industrial Revolution, but before trains could deliver goods and information across America, someone had to build the tracks. Likewise, the development of vaccines against communicable diseases saved many lives – but only once manufacturing and distribution systems were developed to ensure they got safely to patients.
We sit at the cusp of a technological revolution in health care. We imagine a day when data from wearable devices streams seamlessly into electronic medical records and algorithms flag warning signs of serious health events for doctors. This vision is within reach.
But to get there, the world needs technology that can disrupt traditional clinical workstreams and enable doctors to monitor and manage patients in real-time – not just offer diagnosis at the beginning of their journey.
Nirav Shah is a neurologist and former stroke director, Swedish Medical Center, Seattle, WA. Tanzid Shams is director of neurology, Ballad Health, Johnson City, TN. They are co-founders, Sentinel Healthcare.