Synchronicity: The Missing Link for Smart Watches to Become Smarter
By Richard Schwartz, Innovation & Partnerships Officer, Publicis Health
“A connecting principle
Linked to the invisible
Science insusceptible …”
— Synchronicity, The Police, 1983
Because of my role at Publicis Health, I spend a lot of time thinking about the alignment of “ability” when it comes to connected health solutions and systems, and why the orchestration of various abilities really matters: the technical ability, regulatory ability, personal ability, and interoperability (a.k.a., synchronicity).
For synchronicity fans like me, it was exciting to see the recent news about the Apple Watch Series 4’s ability to take an ECG, detect atrial fibrillation (AFib), sense falls, and provide slow heart rate alerts. Many people with AFib are asymptomatic and the condition is almost imperceptible without getting strapped to a 12-lead ECG, often saddling patients with significant costs and inconvenience. With specs like these, Series 4 may have made a leap further away from mere wearable. For perspective, according the National Stroke Association, AFib raises a person’s risk for stroke by 500%, and most AFib-related strokes (75%) can be prevented.
While Apple touted Series 4 as the first over-the-counter ECG, Alivecor’s Kardia pad and band (which currently works with the iWatch) actually received FDA clearance earlier this year. Granted, the Series 4 is self-contained and the Kardia band and pad require integration with the iWatch. The iWatch is newsworthy, but we should not dismiss that our smart watches and devices such as Fitbit have long been able to detect heart rates and even abnormalities in them. While there are currently limits and noise in these data, another FDA approved solution surely beats testing that occurs once a year or longer.
In November of last year, Cardiogram, with its deep neural network, DeepHeart, announced early clinical results showing abilities to recognize hypertension and sleep apnea from wearable heart rate sensors — with 82% and 90% accuracy, respectively — on Samsung, Apple, Fitbit, and Garmin devices. At the top of 2018, Samsung and UCSF announced the launch of My BP Lab and along with it, the ability to monitor blood pressure, stress levels and obtain personalized insights via the optical sensor in the Galaxy S9 and S9+. The convenience of being able to simply monitor and track hypertension, which is estimated to lead to 1,000 deaths each day in the U.S., is significant and truly linked to the invisible.
I was a subject in the Cardiogram Study conducted with UCSF and it detected an abnormality in my heart rate that had me on the table for several hours a month later for some repair work. My issue was invisible and the Cardiogram solution detected the imperceptible. But, I had to know enough to take action and this is where the connecting principle — true synchronicity — becomes the weak link and the biggest opportunity.
Three Connecting Principles to Achieve Synchronicity
1. Expedite the Human Touch — There is no prevention without a human approach to intervention.
Let’s be realistic: no smart watch, phone, algorithm, or sensor has ever detected, prevented, or solved an issue for one human in the absence of another.
While it is wonderful for our devices to detect, they also need to connect us to a human and intervention. Apple referred to the Series 4 an Intelligent Health Guardian. Without a human, all of the potential tech solutions are simply Intelligent Symptom Alerts.
The fall detection Apple announced on September 12 is undoubtedly a technological upgrade to the iconic “I’ve fallen and I can’t get up” LifeCall wearable from the late 1980s. Still, in 30 years, I think the sensors in any device have progressed enough to tell and assist us when we have fallen as well as let us know if there are changes and preventive actions we can take if we are “about to fall.”
When our devices indicate a potential or actual issue, prevention and intervention are the next best actions. Apple did not share much on what happens when the Series 4 detects issues, but if prior work is an indication, you may get a phone call from another person.
I recently concluded my participation in the Apple Heart Study, the data from which supported the FDA approval of the Series 4 capabilities. Had one of my 544 contributions shown an issue, it would have prompted a notification to commence a telemedicine consultation with a study doctor provided by American Well.
Samsung devices are already preloaded with American Well in the Samsung Health App and in July they announced a strategic partnership with Anthem for non-emergency care, on-demand, directly from your device, and connected to a professional. This is the emergence of anywhere care, embedded in our tech, turning simple alerts into interventions.
2. Mandate Connected Care — We do not lack technology, we lack connectivity.
Now, how do we enable real humans to help others? A starting point is ingesting the active, passive and patient-reported data we generate to work for us and our care teams — assisted by machine-learning algorithms. Not all of our data will be neat and structured, but we have the technology to train algorithms to assess, interpret, and guide proactive and reactive interventions off relevant points we generate.
Efforts like Centers for Medicare & Medicaid Service’s Blue Button 2.0 are a big leap and have commitment from technology and health leaders to work toward interoperability in EMRs and ensure patient data are connected and accessible. If data are not infused into the doctor’s workflow, simply and seamlessly — we’ve wasted an opportunity.
Epic’s MyChart, can flow data into Apple Health, opening the doors for the data individuals generate through devices, labs and engagements to work for them. In the absence of machine learning to sort out issues in our data, harvesting it from our devices is like having your health records in a dusty drawer.
Another critical area such devices can address are Patient Reported Outcomes (PROs). PROs are increasingly integral to device trials. In an October 2017 article in Cardiology News, Dr. Bram Zuckerman, MD, director of the FDA’s division of cardiovascular devices said, “We need PRO information because it reflects important aspects of patients’ health-related quality of life.” The opportunity and necessity here in trials and in care is for patients to be able to easily report outcomes and issues that are further validated by their devices.
The FDA is clearly eager to help connect PROs from our device data to enable better actions and outcomes as Commissioner Scott Gottlieb, MD, spelled out in his blog post “FDA’s Comprehensive Effort to Advance New Innovations: Initiatives to Modernize for Innovation” from August 29, 2018. Dr. Gottlieb said, “Electronic capture of PRO data (ePRO) is also becoming standard, providing a rich pipeline of structured clinical data. In addition to ePRO, mobile wearable technologies can complement traditional PRO surveys by generating objective, continuous activity and physiologic data.”
Pharma, payers, and providers should be quite interested in opportunties to connect their brands, plans, and protocols to a patient’s behaviors and progress to treatment and outcomes benefits.
3. Make the Invisible Actionable — Prevention is an investment, treatment is a cost.
When a proactive care team supports patients and remains connected to each other and relevant data, carefully designed supportive services are the next essential pieces to deliver synchronicity.
The warnings my smart watch and phone provided through the Cardiogram App were critically important, but the onus was on me to act. On the road to recovery, the management of all aspects of my issue, have fallen primarily on me. In the moment I was diagnosed with a condition I will have for the rest of my life, I was clearly unprepared, totally unqualified, yet completely in charge.
This is where predictive, personal, connected, supportive services kick in. Like Waze, these services should get smarter about me and smarter for people like me. Like the interface between my car, app, and the manufacturer — warning signs should be managed before they are issues and appointments scheduled. If we are brazen enough to say “the consumer is in charge,” we owe them better information, and enablement, and support — not just the data.
I started out with a quote from the 1983 hit Synchronicity by the Police because in all of health technology the missing link has indeed been synchronous actions between data, people, and actionable solutions.
During the Apple announcements, Dr. Ivor Benjamin, President of American Heart Association, said, “The ability to access health data from an on-demand electrocardiogram or ECG is game-changing.” I am not going to be overly bold and disagree with Dr. Benjamin, but I will add that the game-changer is the ability to provide and enable those next best action needed for the patient and provider to connect.
Apple has raised the bar, and now more partnerships with big tech, health entities, and even some unexpected collaborators will ramp up.
We will soon see more opportunities in health solutions and growth of IoMT (Internet of Medical Things) further fueled by 5G and Edge Computing starting in 2019. 5G and Edge will soon assist with more robust remote patient monitoring and care, the latency of data gathering and interpretation will greatly decrease, enabling machine learning solutions connected to our devices better abilities to process and communicate life-saving data without the delay of streaming to the cloud. But let’s not be led to believe science is insusceptible to the hype and red tape. Unless we connect data to actions and empathy, the best innovations in the world remain vulnerable to the status quo, or as Eli Lilly CEO David Ricks said in his August 27 Fortune article, “The greatest barrier to the system we want is the system we have.”
We are standing at the corner of Gradually and Suddenly in health. We’ve spent decades, creating infrastructures to support possibilities, and announcements like Apple’s show we suddenly have the abilities to see the invisible right from our wrists. The progress and openness we see at the FDA, CMS, at events like HLTH, and in investments in disruption are demonstrating and enabling these critical abilities. So, perhaps, to quote The Police, the next tech giant to announce a game changer will show us how, “With one breath, with one flow, you will know, Synchronicity.”
If you have never listened to the 1983 release from the Police, Synchronicity, you have missed what Rolling Stone named in 2012 as one of the top 500 albums (448 to be exact) in history.
Richard Schwartz leads the partnerships and innovations focus at Publicis Health with a careful eye on the trends and trendsetters shaping the future of health and wellness. He has worked across numerous aspects of health for more than 20 years and has a passion for connected health technologies and solutions that drive optimal outcomes. Rich operates under the very simple North Star that “health is simply the best problem to solve.”