The Apple Watch, Fitbit, and Healthcare

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Does anyone really know what time it is?

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“I’m not recommending it for most people as anything other than just a novelty,” said Ethan Weiss, a University of California, San Francisco cardiologist. Dr. Weiss was quoted in a recent review of the new Apple Watch Series 4 by the New York Times.

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That raises some fundamental questions.

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Are we as a society getting too concerned with the data of health rather than the act of staying healthy? Is something we strap to our wrist advanced enough to influence our life insurance coverage per the news from John Hancock regarding a change in their underwriting policies? And what about our right to privacy now that our employer can monitor our fitness and recommend a coach or customized care plan based on a Fitbit?

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Here at VertitechIT, we make our living on healthcare data, specifically the secure networking and management of the terabytes of information that health systems use to keep us healthy. Innovation and technological advancements are the lifeblood of our business. So why, like the Federal Food and Drug Administration aren’t we ready to give the wearables-market a standing ovation just yet? Our Chief Medical Officer Dr. Neil Kudler offers a few thoughts.

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Apple’s chief designer, Jony Ive, claims that the Apple watch has always been envisioned as a health device. Do you think it has succeeded this far?

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\"\"Kudler: As a wearable device for athletes and engaged enthusiasts, I think it does a decent, though imperfect, job.  The inability to accurately identify activities without user prompting is an issue solved by other wearables.  As a health device, I’d say it’s in its fetal stage.  Identifying atrial fibrillation (Afib) is “cute” more than meaningful.  If it’s a harbinger of more sophisticated functionality, sign me up. 

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We reviewed Apple’s health app back in June and found that the company had no plans to flesh out HIPAA compliance. Is this something Apple watch owners should be wary of? Are there any potential HIPAA issues?

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Kudler: As I alluded to then, it isn’t only HIPAA that I’m concerned about, but the responsibility to provide accurate, meaningful and timely information to the user.  Who is responsible for machine or report failure when a patient presents with first time stroke due to unrecognized Afib and a physician says, “Go buy an Apple Watch for your health?”  When I send a patient for a diagnostic test, I’m responsible for the results and the consequent treatment plan.  As the physician, am I responsible for the alerts sent to the Apple Watch if I fail to communicate or act?  The communication and liability loop need further clarification.

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A new feature on the generation 4 Apple watch is the ability to detect falls and report the incident to emergency services. Do you think EMS will become wary of a “watch that cries wolf” if there’s a large influx of false reports?

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Kudler: My fear is just the opposite, that false alarms will be a source of overutilization and added expense. It reminds me of those who alarm their homes and set them off accidentally, the police are legally obligated to investigate if the homeowner does not cancel the false alarm in time.  The homeowner is then billed a chunk of change regardless of true or false alarm.  Will CMS assume the financial responsibility for EMS calls?  Same goes for cardiology.  Depending on the precision of a “single lead” ECG, will it be possible to distinguish an arrhythmia from movement artifact well enough not to order the echo and stress test for fear of liability?

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The FDA mentioned specifically in its review of the device that it isn’t intended for people under the age of 22, nor is it for people who have been previously diagnosed with Afib, but Apple doesn’t mention this caveat anywhere in the description of the device. Does this strike you as odd?

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Kudler: Clinically speaking, it makes no sense for alerts to be sent to those with established Afib.   In its current state of design, the watch is at best aa screening, but not a diagnostic tool. This approach doesn’t align with current guidelines.  According to the US Preventative Services Task Force (USPSTF), there is no definitive evidence to support screening for Afib, particularly in those less than 65.  And the sweet spot for the Apple Watch market is not the Medicare bracket. 

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As for the age limit, this does make sense.  If a young adult or child presents with Afib, the likelihood of a structural abnormality is significant and would require intensive evaluation and follow-up.  In other words, it’s a different disease than the Afib we are discussing. 

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Are people who begin to rely too heavily on the results of wearable technology something you’re concerned about?

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Kudler: Nope, the more the lay public engages with their own health, the better off we will all be. 

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So should I go out and buy this watch with my heart health specifically in mind?

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Kudler: Go for it if you are healthy but use it to improve heart health through behavioral change and body awareness.  My sense is that the Apple Watch is still a solution searching for a problem.  Until wearable technology assists with management of chronic disease, with an emphasis on passive data collection, this is a gimmick for “quantified self geeks,” gadget freaks, and Apple fans, myself included.  It’s important that the general population know that Afib is not a health epidemic and its signs and symptoms are generally appreciated without a watch. 

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According to Statista, over 325 million wearable devices are on the market today (830 million will be in use by 2020). 52% are smart watches. Discerning the truly valuable from the truly marketable is sure to get more and more difficult as time goes by. Tick tock…..

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