Apple Health is not TikTok and other conversations with Dr. Oliver Aalami ( post WWDC Insight Series)

Apple showcased its upcoming health and fitness features at this week’s WWDC. The event once more highlighted the commitment Apple has towards health and healthcare. 

Apple’s focus on health data collected by wearable technology and new capabilities for sharing that data with doctors is impressive in the new iOS 15 and watchOS 8. 

We sat down with Dr. Oliver Aalami from Stanford University to get his perspectives and learn more about these new features following this week’s WWDC event.

Dr. Oliver Aalami is the Director for Biodesign for Digital Health at Stanford Byers Center for Biodesign and is also a Clinical Associate Professor for Vascular Surgery at Stanford University. 

Dr. Oliver and his team have experience working with Apple’s ResearchKit and recently launched a national precision medicine PAD trial called VascTrac. This new trial is a mobile phone-based trial that leverages Apple’s ResearchKit Platform to monitor a patient’s pre-and post-intervention activity.

Here are some of the key insights from our conversations with him.

Health is not TikTok

An essential component of maintaining personal wellness is tracking changes in one’s health over time and understanding some of the key drivers behind these changes in a meaningful fashion. 

Apple’s new Trends feature in the iOS 15 Health app accomplishes this intelligently and proactively by highlighting important changes that require a user’s attention.

Apple excels at doing this in a ‘passive’ manner and this is very important and subtle.

To me ,that was just another nod from my perspective to the team for their understanding that health is not Tiktok . It doesn’t need to consume every minute and every second of your day. We are not obsessed with reviewing our health metrics every five minutes like Tiktok or Instagram. It needs to be passive and provide really meaningful insights.

Apple’s new Trends, health highlights, and lab results features in iOS 15 all share this simple design sentiment around the “Passive” experience. Dr. Oliver added that Apple is getting better and better at refining all the potential data automatically collected via the Apple Watch and iPhone and packaging them into more useful insights for patients. 

Generating these insights from hundreds of hertz of activity data is something Adeeti Ullal and her core motion and sensor team at Apple achieve magically.

It may appear “Magical” to most of us. Still, it takes an incredible amount of effort and numerous validation studies for this team to make these features available and useful to us.

Walking Steadiness Score

Apple also showcased an exciting feature called the Walking Steadiness score at the WWDC.

The new Walking Steadiness feature uses custom algorithms to assess balance, stability, and coordination through built-in motion sensors on the iPhone to determine a person’s “fall” risk. 

Your Apple watch already had the ability to detect a fall and contact emergency services. The new Walking steadiness feature provides an early warning system that can help prevent many mishaps and save lives.

This is another great example of Apple’s unique “Passive” design, as per Dr. Oliver.

“Remember, one of the first things in the mobility section of the presentation, they talked about walking steadiness metric, and that was a passive thing. You don’t have to do anything! You turn it on, you permit it to sense, and it will passively then give you a notification as to how you are doing with your steadiness or if there is an issue or if there should be a concern.” said Dr. Oliver, when remarking about the new Walking Steadiness Score.

A design philosophy, also embedded within other exciting features that Apple showcased during the previous WWDC. in the areas of Cardio Fitness Levels ( VO2 Max) and the Six Minute Walking Test (6MWT) score features.

You know, one thing I liked is that they are moving more and more into the passive kind of space, where the devices, whether its the watch or the phone is monitoring your activity passively and making inferences passively.

Turn it on and let it do its thing!

But,

That can only happen in a platform ecosystem where there is trust between the company, the customer, and the health care provider.

Apple has been advancing its privacy leadership with its latest platform updates.

“For health researchers, Apple is very safe. Institutions are more likely to give the Apple ecosystem a pass, in terms of privacy and security than other frameworks”, remarked Dr. Oliver.

This is also exemplified in Apple’s approach to EHR and EMR (Electronic Health / Medical Records), an area that was an important topic of our conversations with him.

Apple Health user experience, SMART FHIR, and POWERCHART

We couldn’t agree more with Dr. Oliver when he said that he loves the health records portion of the health app. It is so much better than the healthcare portal offered to most of us by our healthcare/health Insurance company.

They are amazing designers. First and foremost, Apple is all about user experience and design. I think they nailed it with providing useful insights.

They upgraded the Lab portion by providing even more detailed descriptions of the lab data. And, you know, just continuing to guide to let people know that they are in range or out of range.

For most people, these numbers could be just mumbo-jumbo or just a random number. So that was really exciting to see along with Trends”.

Dr. Oliver also leads an initiative called CardinalKit at Stanford Center for Biodesign. CardinalKit is an open-source framework that is designed to make it easier to build digital health research apps.

He noticed something very important that most of us missed during the WWDC presentation this week by Dr. Sumbul Desai.

Apple is now using the SMART on FHIR protocol for sharing and presenting health data. 

I think its pretty exciting to see that. They didn’t talk about it specifically during the session but if you noticed, they had this image, which said Powerchart where the physician from their EHR can view ( probably using the SMART on FHIR API for authentication and so on from within the EHR), Which is super cool!!

So, I think that for providers, it may not be perfect, it still takes some work to implement BUT it is a super SMART CONCEPT To let providers literally authenticate the users, authenticate the patient from within the EHR with one click and see a dashboard of the patient generated data. I think That was super cool!

Although this new technology and provider user experience is amazing and is sure to excite most physicians who have been looking for a good patient record experience, there are certain headwinds when it comes to adoption and use.

We discussed at length some of these issues around adoption, particularly around the factors that create inertia and slow down the easier adoption of new digital health initiatives.

Adoption of New Technologies will increase with increases in alternative payment systems

Dr. Olver highlighted some of these challenges based on his experience and work in the industry.

One of the biggest comments that I wanna make, honestly, is about where this stuff (EHR/EMR) gets implemented.

I work at a private institution that is very much a fee-for-service model, and guess what; there is very little interest to implement this stuff in a fee-for-service environment. 

The people that are most incentivized to kinda leverage the power of the connected patients and digital health are more value based care models where they are incentivized to keep patients healthy and keep them out of hospitals and connect with them frequently.

He added that although the Medicare Advantage segment has been growing year over year, there are still many fee-for-service providers, and that is where there is a lot of inertia around adoption.

He also highlighted areas where new health technologies have a better chance of being adopted and used successfully.

“I see it implemented by the self-insured employers. The big corporations have to pay for their own healthcare. They are at risk, and they will pay the Livongos and Omadas extra money to leverage these tools to keep their employees healthy and lower their health care spending.

So I think it’s really important to understand that this is all exciting, but it is only one part of the solution.

There’s so much within the delivery system and the network that needs to be aligned better for this to be leveraged.”

“Covid has moved this along so fast, BUT I still think that we are still stuck in the old delivery models.  The adoption of these new technologies will increase as the alternative payment models evolve and increase. We need better incentives for providers actually to use these tools. 

But I must say that Apple has done a great job of trying to make this easier. We obviously need to validate all these things in various populations etc., for providers to start using it.”

His thinking is that as products improve and alternative payment systems and delivery models evolve, the adoption of new technologies will start scaling.

Continuous Glucometer could be the holy grail as opposed to Blood Pressure

Lets say that they add a continuous glucose monitor. Right. I mean, my goodness, that would be amazing if the Apple Watch could do that. As the value of this stuff increases and they create tools that the user can literally react to, it will expand the adoption

“It’s hard to react to high blood pressure and make an immediate change, right, or a high heart rate, or I don’t know, it’s just hard actually to react to that. But if you see your blood sugar is going up or down or whatever. And, you know, we know that food intake is a huge component associated with that, among other things.” 

This could also help with expanding the options around alternative payment systems.

“I don’t know, and I feel like, with this, The consumers could pay for this themselves rather than providers leveraging this information. Yeah.”

We also discussed how newer metabolic health platforms such as Levels and others are positioning themselves in this area, becoming a huge catalyst for change.

The majority of these platforms leverage cutaneous glucose monitoring sensors made by Abbot labs ( Free Libre)  or Dexcom G6, but the challenge is that these sensors are still very pricey.

That’s why having a device like Apple Watch to be able to read your glucose levels or predict glucose levels using digital biomarkers could be a game-changer.

“But I think that’s that would be a Holy Grail. I mean, that would be one thing that, you know, would take it to the next level. Yeah. Right. It could really affect you. Whether you would want to look at it frequently, at least initially, to learn about your eating and exercise and how it affects your blood sugar.”

Still Pretty Far from accurate noninvasive glucose measurements

When we asked Dr. Oliver about any potential information that he could share about some of the initiatives that tech companies such as Apple, Google, or Samsung are leading in the area of noninvasive glucose monitoring and if we are close to the holy grail moment, he remarked,

Oh, yeah, no, that’s a really good question. I mean, I wish. I don’t have any inside information. Or at least that I could talk about. But no, but I think there are definitely a lot of people looking at cutaneous kind of markers or surrogate markers that that give you blood sugar readings.

And so I think I know, we’re still pretty far away from, you know, just an accurate you know, and having an accurate cutaneous blood sugar kind of monitor. Unfortunately, you know, it’s that the issue is pretty challenging.

We, at myhealthyApple.com, have been following this area of wearables development for several years, and we’re super excited when Japanese company Quantum Operation showcased their smartwatch with glucose monitoring capabilities at the CES last year.

• Japanese startup to launch first noninvasive wearable glucose monitor
• Apple’s food monitoring feature could be the right step towards detecting interstitial glucose

Unfortunately, as Dr. Oliver pointed out, this is a hard area. Numerous validation studies will be required before having anything close to a smartwatch that can provide glucose readings.

Small things that make the Apple ecosystem sticky

Another Apple experience feature that struck a chord with Dr. Oliver during the WWDC presentation was the ‘Legacy Function Feature”. 

This was also one of the features that resonated with many people we spoke to following the event.

In fact, during the COVID outbreak, many of us had to, unfortunately, deal with tragic events and had a hard time finding a way to hold on to some of our precious digital moments and memories.

Apple’s Legacy function feature allows users to designate a loved one who can access their icloud data when they pass.

So I think that’s super smart, because I was with my father of the weekend, and he was telling me about all these things he has on his phone and old pictures, and I was like, oh, man, I hope what’s going to happen? Will I have access to those ever, you know, so now he can kind of put me down as his kind of surrogate or legacy person, and then I can request access to it.

I think that’ supersmart and the live monitoring ( Health Sharing feature) of a loved one is so brilliant.”

Apple’s new Health Sharing feature will go a long way in helping primary caregivers who have a challenging job caring for elderly patients. This feature will also hopefully bring us,  regular folks, more peace of mind as we can keep a pulse on the health of our elderly and loved ones.

Features like these are why we love Apple and are proud of the people that make this magic happen, and it takes a lot of effort to make this happen.

Thanks to people like Kaitlyn Kwan and her team at Apple!

A lot is going on at Apple with Health, and we are just at the beginning of the journey. It’s not the big, bold announcements that will change how we manage our health but cleverly designed intuitive solutions that will make a world of difference…

As Dr. Oliver reminded us again.

“These are the things that are going to make their ecosystem even stickier for people.”

We agreed to speak with Dr. Oliver again to learn more about CardinalKit and other exciting digital health and wellness technologies championed by him and his team at Stanford’s Byer Center for Biodesign.

Please stay tuned as we bring you new stories and reactions from other leading doctors and healthcare professionals who have been actively following Digital Health.

Please let us know if you have any questions. You can also reach Dr. Oliver Aalami on Twitter and follow him to learn the latest developments in digital health and precision medicine and the latest news from Stanford Byers center of Biodesign.