The Apple Watch, in 2014, started as a ‘style’ accessory for tech-savvy Apple fans. Over the years, the Apple Watch has emerged as the ultimate wearable for tracking health. The advanced sensors, health features along with reliable data has forced some doctors to include the Apple Watch in their patient-care toolkit. While there are plenty of health trackers in the market, for the Apple Watch, it was always more than just providing sensors and throwing raw health data to users.
From getting instant ECG reports at any time and now with Health trends, Apple is trying to help users understand the ‘hints’ their bodies keep providing at times. But how did health become the core focus for Apple or what is Apple trying to do differently?
Dr. Sumbul Desai, Vice President, Apple Health in an exclusive interview with Debashis Sarkar, Editor, News18 Tech shares some insights as to how things are decoded at Apple.
Question: When the first Apple Watch was launched, it was mostly perceived as a device for ultimate style-statement or something to flaunt. But over the years, the Apple Watch has become a serious user-friendly device for tracking health. Can you please take us through that journey?
It’s very organic. We never sat back and said, okay, one day we’re going to do health. The transition is very organic. When we introduced the Apple Watch, we put the heart rate sensor on the Watch because of our focus on accuracy and to make sure that we were accurate in measuring calories. As a result of that, what happened just by virtue of people wearing the Watch all the time, they are basically wearing a heart rate monitor. Soon, we started getting letters from users.
The letters said things like: ‘Hey, I was wearing my Apple watch, and I noticed my heart rate was elevated. I went to the doctor and I found out I had an infection or I had an allergy or had AFib.’
At Apple, we never sat back and said, okay, one day we’re going to do health.
Then we (at Apple) said, ‘Okay, what can we do next?’ So, it is then we introduced the high heart rate notification and we started getting even more letters from users. People started writing to us saying things like: ‘I ended up getting a high heart rate elevation.’
One of my favourite Apple Watch stories was how a pregnant woman, who got a high heart rate notification, went to the hospital in a thyroid storm. Her condition could have been fatal for the foetus. But thanks to the Apple Watch notification, she ended up basically saving her foetus’ life. It is just because she got notified and was able to get to the hospital sooner.
Later, we introduced low heart rate notification. A lot of letters we got from people, when we launched high heart rate notification, were around AFib. So we said: ‘Okay, well, we can tell you the speed of your heart. Now, let’s look at the rhythm of the heart’.
And then we started pulling on that thread, and we dug into the AFib notification. Soon, we introduced irregular heart rate notifications in the ECG feature.
We got even more letters about how people noticed AFib which basically notified people of things like blockages in their arteries. We then introduced ‘AFib Burden’, it’s not in India yet, but it’s a feature that will tell you how much time you’re in AFib. So, the essence of that story really is that we were pulling the thread as we received more letters and heard from customers, and it was a very organic journey.
Question: How is the decision made at Apple as to which new health feature will be introduced in the next Apple Watch?
It’s a multifactorial process. Often, just as I said, we get letters and those letters allow us to then think and maybe hint us that we should dig into something a little bit more. So, we definitely use that as a mechanism. We have a very cross functional team. Everybody on the team will come up with ideas.
What’s really great about working in a company like Apple is that ideas come from all levels.
What’s really great about working in a company like Apple is that ideas come from all levels. And then we will evaluate whether we think we can scientifically deliver on that idea. If we think we can, then we start doing early engineering feasibility studies, then if we learn from that data that we think there’s a possibility to do this, we then do a validation study, so you start developing the algorithms, then we do even more validation studies. And then once we have the validation studies, we feel good about the metrics, then we start designing the features.
It’s a very long process. But what it’s grounded in, is the belief that we need to provide actionable insights that are grounded in science, in a privacy preserving way and that empower the user to live a healthier life. So, that really helps drive our selection of what to work on next.
Question: Can you please give some background as to what kind of research is done, people who are involved and the effort that goes into making the Watch reliable.
We are very cross-functional at Apple. We work with clinicians on my team, we have designers, engineers, algorithm engineers and we collaborate with external partners. Sometimes we collaborate with key opinion leaders who are experts in certain types of medicine or science. We collaborate with institutions. Basically, what we say is, almost everybody at Apple touches every product we deliver, and it’s very, very cross functional.
…almost everybody at Apple touches every product we deliver, and it’s very, very cross functional.
Question: It’s good to have high-tech health features on the Apple Watch but how is Apple helping users to actually get more insights motivating them to do something about their health?
It’s something that I think we’re still early in our process. In the ‘Health’ app, if you notice, there’s a feature called ‘Trends’. The real purpose of ‘Trends’ is to start getting users to see insights that might motivate them to life a healthy lifestyle. So for example, if I look at my trend, I haven’t been sleeping much because of travel. So, the Health app showed that I have a decreased number of hours of sleep. The idea is to take action as soon as I start seeing the changes in data. We are trying to do more to be able to translate the data, so, that the user can actually get more health insights.
The real purpose of ‘Trends’ is to start getting users to see insights that might motivate them.
At the same time, we need to take care that we balance the health notifications and not end up over-notifying. And, as you know, people tend to ignore health notifications, so, providing insights that are actionable make more sense. So that’s something that we’re thinking a lot about, but I would say we’re still really early, much more can be done.
Question: There are counter-opinions from doctors who are saying that devices like Apple Watch are simply scaring users and that fear mongering is helping the booming health-tech market. Your comments?
I think most physicians will agree that if you educate people, the fear goes away. Fear comes from not understanding the ‘why’ behind things. At Apple, we spend a lot of time in helping users understand the notifications. If you look at our health features, the articles that we always release are in conjunction with the features. So, for example, if you go into the Apple Health app, there’ll be an article on why sleep is important, or like what does cardio fitness mean? Actually, that’s what I think is so powerful about what we do at Apple. It is the element of educating customers on areas of health that they may not have understood before.
Fear comes from not understanding the ‘why’ behind things.
The hope is: the more you spend time in educating people, the less afraid they are of it and become more approachable. And the more they understand the ‘why’ behind it, they get motivated to improve for the right reasons.
Question: Given that the Apple Watch mostly focuses on Heart Rate, it may be quite common for someone to get ‘High Heart Rate’ notifications despite feeling fine. Now, this may make the user take these notifications less seriously or they may ignore these health notifications entirely. So, the whole purpose of using Apple Watch gets defeated. Your thoughts?
There’s always a risk with any data. So, the way we get to that threshold (high heart rate above 100 bpm) is based on medical science. The threshold isn’t a threshold that Apple develops. We rely on clinical science to guide us. And the reality is, if you are heart rate is above 110, you’re tachycardic, clinically. Now, you may or may not have a condition. You may be having anxiety, which you could breathe and get it lowered. Or, you may be having shortness of breath that causes a high heart rate. We’re just there to provide information. What’s really important is that the information should be used in conjunction with other factors.
We’re not trying to replace the doctor. What we at Apple are telling you to do is say: Am I feeling abnormal?
So, we’re not trying to replace the doctor. What we at Apple are telling you to do is say: ‘Am I feeling abnormal?’ Because if you notice, when the Apple Watch alerts about high heart rate, the notification says: ‘If this is an unusual thing for you, you should contact a doctor.’ So we think a lot about that language. We don’t just say go to the doctor. And so I think we mitigate that the best we can. We try to educate the user on what this means so that they can take the rights to next steps.
Question: Health data is very personal. How is Apple able to allow third-party app developers to bring apps while maintaining privacy of users?
Privacy is never a sacrifice in anything we do at Apple. We think that you should expect the same privacy from technology as you would from your doctor, period. We enable the use of our metrics through the health kit. And privacy is built into how those metrics are used. So ultimately, we are very focused on making sure that even within our developer ecosystem, that privacy is number one, and that’s how we think about it. We have some rules that we put into place in order to make sure that happens.
Privacy is never a sacrifice in anything we do at Apple.
Is Apple by any way aiming to position the Watch as a device just not for consumers but also for healthcare professionals, insurance companies and other B2B related industries so that the Apple Watch can be found in enterprise use cases as well? For example, healthcare or insurance companies bundling an Apple Watch to monitor vitals of patients or customers?
We are really laser focused on empowering customers to take health in their own hands because ultimately, health is such a personal thing that it’s really important to make sure that you as an individual is really understanding the ‘why’ behind your health. We have research studies through our investigated initiated research programme where the Apple Watches are used in clinical health settings. And we’re really excited to see what we learn there.
There are some examples of life insurance companies using the watch, and we’re really excited to see what we learn there.
We have some initiatives that we’ve done. There are some examples of life insurance companies using the watch, and we’re really excited to see what we learn from there. But when we design our features and products, we’re really thinking about you– the user.
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