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Why the Apple Watch won’t disrupt health care. Yet.

Robert Pearl, MD
Health Technology
October 15, 2014
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I had little doubt the long-rumored Apple Watch would be cool. U2′s live concert and surprise album announcement at Apple’s unveiling a few weeks ago only reaffirmed the company’s ability to launch a product unlike anyone else.

Cool or not isn’t the question. Usefulness is. The iPhone and iPad radically changed how people lived their lives. The first generation of the Apple Watch won’t.

The health application

One way Apple hopes to increase the value of the new watch is by equipping it with software that can capture and track health data.

Apple is promoting its new Health app as an easy-to-read dashboard of personal health and fitness information tied to the iPhone.

The app collects information from the user by asking questions (height, weight, etc.) and monitoring data (number of steps, heart rate, etc.) from other wireless medical devices.

And, in addition, sensors on the Apple Watch continuously collect and supply apps with real-time data on physiological functions like pulse and blood pressure. Already, some hospitals are hoping to use the Health app to monitor blood glucose levels in children with diabetes.

But as I wrote in my recent column “5 Things Preventing Technology Adoption In Health Care,” the U.S. health care system is nothing if not resistant to new technologies — especially those that fail to achieve measurable improvements in clinical outcomes.

And consumers can be just as fickle when they don’t see results. A new report shows a third of all consumers abandon their “smart wearables” within six months.

From my point of view as a physician and health care leader, for the Apple Watch to have as great an impact on the world as the iPhone and iPad, it must do more than just generate data. It will need to make it easier for physicians to provide medical care and, ultimately, help patients achieve their health goals.

Even physicians who are early adopters of new technologies will be cautious.

Thousands of heart rate measurements, hundreds of blood pressure readings and daily fitness data are more likely to overwhelm doctors than inform them. Few physicians see value in receiving gigabytes of unsolicited information and data.

And having all of this data in an electronic health record (EHR) would consume large amounts of memory, making it more difficult for physicians to access the information they need.

What’s more, any device that sends data directly to an EHR would be classified as a medical device. That’s tricky for two reasons: Medical devices require FDA approval and they could create liability for the product’s manufacturers and distributors.

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Solving the real problem

Instead, as business guru Clay Christensen recommends, innovators hoping to introduce disruptive technologies should begin with this question: What is the real problem we’re trying to solve?

The limiting factor in patient care isn’t a lack of biological data or measurements. Physicians usually know the status of the patient’s diabetes or abnormal heart rhythm. What they would like to influence is the patient’s behaviors once they leave the doctor’s office.

Getting people to exercise, take their medication and eat healthily are the types of lifestyle changes that can make a difference.

Doctors would like a smart watch that helps spot warning signs and that alerts the patient to call their physician when something unexpected happens.

And, of course, a device with an immediate feedback loop — one that would tell patients when to take more or less medication based on specific physiological changes — could also be valuable, assuming it were proven to be accurate, secure and safe.

But none of this is what the Apple Watch does. At least not yet.

Maybe the next generation will focus on specific medical conditions and be designed for patients whose medical problems would benefit from continual feedback. For example, research shows remote monitoring can improve survival rates for people with pacemakers.

But the need for continual monitoring varies greatly from person to person. For people with pacemakers, an alteration in heart rhythm can lead to death. For almost everyone else, continual monitoring will have minimal impact on the outcomes of their medical problems.

And even if the watch and health app could impact people’s health status, it remains to be seen whether consumers will trust them.

Companies like Google and Microsoft failed in their quest to market repositories for medical data because many Americans were reluctant to put their personal medical information in the cloud.

And it’s easy to understand why. With new data breach incidents seemingly every week, consumers are concerned about the security of their health information.

To Apple’s credit, apps that use its HealthKit framework are forbidden from storing this information in the cloud. And developers are forbidden from sharing any user’s health data except for use in medical research — and even then, only with the user’s permission.

The future of smart wearables

So, will the Apple watch change medicine or will it simply become a cooler iteration of today’s fitness trackers?

Most futurists see tremendous opportunity to improve health outcomes through wearable medical devices.

And if Apple and other manufacturers can inspire users to invest more time and energy in maintaining and improving their health, the world will become a healthier place.

But most physicians, some with optimism and some with caution, are taking a wait-and-see approach to wearable devices.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com. 

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