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Apple Watch 4: Why the future of digital health depends on Apple finding a cloud partner

Apple's September event is over and leaves us with the Apple Watch Series 4, which has improved capabilities over its predecessors, including Atrial Fibrillation (Afib) detection and built-in ECG (electrocardiogram) support. These opportunities should not be ridiculed – the FDA has given its approval to the fact that the Apple Watch is classified as a genuine medical device. The benefits for patients have already been proven.

I would know, because the basic cardiac arrhythmia technology now built into Apple Watch Series 4 has saved my life.

Watch Series 4's software-based arrhythmia detection was tested with Apple Heart Study, a collaboration between the Cupertino giant consumer electronics and Stanford Medicine.

The study, which began in November 2017 and was completed for new participants in early August 2018, combines the heart rate sensor originally introduced on Series 1, along with data collection and telemedicine software used on the iPhone.

The data were forwarded to Heart Study researchers, where samples from participants in the study were analyzed.

If a participant had signs of Afib, the iPhone Accompanying application reported to the user to initiate a telemedicine video call, where they would consult the Heart Study physicians who would review that data and possibly ask the patient to send an ePatch , a portable device that collects a broader set of electrophysiological data to further assist in diagnosing the condition.

In the Watch Series 4, the ePatch functionality is replaced by the native ECG sensor of the device, so all diagnoses can be done locally using a combination of software algorithms and the newer hardware.

Although it was not a pilot for the ECG technology in the Series 4, the Apple Heart Study is interesting in how it tested the value of the telecare intervention in the closed loop mobile research study with Apple Watch.

Does that mean that Heart Study is over? Yes and no.

The Watch Series 4 offers many benefits with the ability to diagnose heart problems locally and allow patients to review and analyze the results on their own iPhones. An iPhone that is connected to a Watch Series 4 via Bluetooth can run a PDF file that anyone can share with their doctor so they can view the data one by one.

But the true power of advanced sensors and health diagnostics on wearables will only be fully realized when the power of telemedicine is combined with cloud data analysis.

One thing is to conduct a survey with a sample of tens of thousands or even hundreds of thousands of patients where portable sensor data can be collected and analyzed by a team of research physicians for academic purposes, such as with Heart Study.

But it is a very different matter to produce a health cloud in which the data of tens of millions of patients can be analyzed and historically monitored on a large scale to proactively follow the current circumstances and gain more insight into that data.

And it is also that much more difficult in terms of level of effort and required infrastructure to provide a hosting platform where external suppliers can become tenants to provide services that patients and a much larger pool of physicians can access from apps and web.

The actual interaction between patient and physician in Heart Study, along with the video telephony platform it used, was performed and designed by American Well, a leader in remote medicine.

Stanford Medicine was the overall administrator of the Heart Study, but it was the physicians from American Well who did all the legwork and consultation with patients like me.

American Well's telemedicine platform is very similar to Apple's FaceTime software, and end users (like myself) can confuse it in the first place because it is embedded in the Health Study app and the experience is very similar.

However, it is different because it has other features that make it HIPAA-compliant, which is essential in the medical industry for protecting patient data.

Such a platform would be needed if Heart Study were not just an academic exercise to provide an effective service that patients and their physicians could use.

What Apple has created with Heart Study and Watch Series 4 is nothing short of incredible. But Apple is not a hyperscale cloud provider or a healthcare provider. It is also not an integrator of health systems. And it should not be one.

Apple makes mobile devices and platforms. It is up to its partners to grow the ecosystem for Watch Series 4 and do the heavy work now.

Telemedicine platforms such as American Well will be extremely important if health clouds are created because it adds the necessary human interaction element. But the only way to scale to tens of millions (or hundreds of millions) of users is that Apple is working with a hypersal cloud provider that already has partnerships and experience in medicine.

Although the current business partner of Apple, IBM, offers a lot of expertise in the field of overall software and integration efforts with expert system and analysis platforms such as Watson (who could add a whole new dimension to looking at health data) and experience working with many healthcare customers who are in charge as a professional service organization, it is not equipped to lead a health cloud of that size because it has not done the necessary infrastructure investments.

So who are we talking about who can offer that? You can count them on one hand. Amazon, Google and Microsoft.

Amazon certainly has the infrastructure to do this because it is the cloud heavyweight. It may very well be that there are hosting services that third parties will create on AWS and that can connect to iPhones and eventually the Watch Series 4 and its successors.

But I do not see a strategic partnership between the two companies because there are too many areas in which they compete – IoT is the primary – and it is only a matter of time before Amazon itself makes its own health portable.

Also: Apple Watch Series 4: Cheat sheet TechRepublic

Similarly, Google has its own Wear OS and its own IoT platform and is unlikely to work with Apple, although Cloud Platform offers many benefits.

Where is that going? Microsoft. And Azure.

As I said before, I think it is finally time for Apple and Microsoft to bury the battle ax.

Apple and its customers can benefit a lot from an extensive partnership, and it's not just all the software and tools that the Redmond giant has created for Apple's platforms. It is also the enormous power of Microsoft's cloud, which includes a highly advanced and highly scalable platform for data analysis.

And Microsoft's partner ecosystem to join that platform for creating finished software and services in the vertical healthcare industry is huge.

I believe we are about to enter a grand future of advanced preventive medicine with wearables and the Apple Watch, like the iPhone, is becoming the dominant leader in its field.

But only when hyperscale cloud computing, Big Data and telemedicine are combined with these devices will we see the real benefit of these technologies at scale. We are now at the forefront of that event, but the old rivalries must be resolved and the malice of old conflicts must be buried from platform wars that have long since ended to make real progress.

Will the preventive diagnostic power of Apple Watch Series 4 only really be released with a hyperspacial health cloud? Talk back and let me know.


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