Apple Health: The next big thing

Apple Watch heart rate
Apple Watch heart rate (Image credit: iMore)

It's happening again. Real reporters from real papers of record are taking often single sources stories from the supply chain and, without providing anything by way of context or clarity, weaving yet another quarter of Apple-is-doomed stories to drive the stock price down ahead of what is usually the most lucrative earnings of the year.

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It's the rinse-and-repeat formula of hedge-funds and market makers self-admittedly manipulating media into covering their shorts and making their quarters, damaging businesses and cheating investors, without anyone ever being held accountable. I've already been there and exposed that so, for this piece, I'm going to take things a step further.

What happens when the rumors are wrong so always they're eventually right? When the clock stuck on noon actually strikes twelve? Who knows, maybe this quarter, maybe two quarters from now, maybe a year, maybe ten years. At some point, the law of large numbers kicks in and everyone on planet earth who wants an iPhone has an iPhone they're pretty much happy with. Then what does Apple do?

After iPhone

Sell more iPhones. Get on Verizon. Sell more iPhones. Get on China Mobile. Sell more iPhones. Make them bigger. Sell more iPhone… oh, you sold all the iPhones.

That's how Wall Street works. It doesn't matter how successful you are or how much money you make, it only matters how much more successful and how much more money you'll make tomorrow. You could literally be earning a trillion dollars a minute and they'll wreck you for a company losing almost that much — because it could start making it tomorrow!

But that's the bizarro world we live in, the one Apple has to deal with, and unless and until it can open up stores on Mars and start opening up the alien markets, the one it has to prepare for post-iPhone.

Now, from a product perspective, Apple's done a lot of that already. Everything from Apple TV to Apple Watch to HomePod to AirPods are products for people who already have iPhones. And, Apple's pitch is, if you get these new products too, they'll all provide even greater value together. Based on how Apple's previously "other" business has been growing, that's working. At least in terms of any business that's not already as big as the iPhone.

In the future, if Apple goes ahead with special projects like augmented reality glasses or autonomous technologies, maybe even including a car, that could grow even wider.

Another angle of attack is services. And Apple's been doing a lot there as well. From the App Store and iTunes Store to Apple Music and the upcoming magazine and television content, it's again a way to maybe conquest a few more customers but also earn more from existing customers, again by adding greater value.

It's services that I want to focus on here. But not the traditional support or entertainment services. As fun and as lucrative as I think those are. No, I want to focus on something that I think could be even bigger for Apple and more important for us.

Health services.

Falling into Health

The Apple Watch needed a more accurate calorie counter. That's how the story goes. Apple wanted fitness to be a flagship feature for its new device and there was no other way to do the job even passingly right. So, Apple invested in a heart rate monitor.

It wasn't part of some secret multi-year plan to provide customers were health information or pitched to Apple executives and the board as way of grabbing a piece of the multi-billion dollar medical industry. When first envisioned, it wasn't even intended as a way to ensure Apple Pay security on the wrist, though it certainly turned out to be a great way to do just that.

It was simply a way to make sure the Workouts app recorded how many calories you were burning as accurately as possible.

But it lit a spark.

Watch, interestingly enough, is run by Apple's chief operating officer, Jeff Williams. And, as he and his teams, which include Kevin Lynch, the vice president in charge of watchOS software, saw how it was working and what kind of data it was getting, health began to join fitness as an area of interest.

It was still slow. It was still steady. Apple needed a place to store all the information it was getting from the Watch, so the Health app was created. Then, it was realized could store a whole bunch of similar information, and from more than just the Watch. So, HealthKit was born, which could talk not just to Watch but to other apps and accessories, became an inextricable part of it.

The interesting thing about data is that once you start to get it, you start to imagine all the things that you can do with it.

The heart rate data, for example, led Apple to wonder what could be done if it detected abnormal heart rates. It wasn't a hospital-grade sensor, to be sure, but it was almost always on, and that's not true for most hospital-grade sensors.

But Apple also realized having devices with your all the time, including Apple Watch and iPhone, could be a boon to all sorts of health and medical services.

An Apple a Day

Medical ID was an obvious example. Just putting your critical medical information in an easy-to-access place could make sure emergency services personnel could get to it when they — and you — needed it most.

ResearchKit was a less obvious example. As Apple started to think about how it could affect health at a larger scale, using the devices we have with us, rather than relying on tear-tag flyers, seemed like it could be transformative. Again, it flew under the radar at first, never part of some big pitch or potential new revenue stream. But the potential benefits were enormous.

ResearchKit is an open source framework introduced by Apple that enables your iOS app to become a powerful tool for medical research. Easily create visual consent flows, real-time dynamic active tasks, and surveys using a variety of customizable modules that you can build upon and share with the community. And since ResearchKit works seamlessly with HealthKit, researchers can access even more relevant data for their studies — like daily step counts, calorie use, and heart rate.

The flip side of tear tag flyers for research were endless lists for follow up care. The same ubiquity of the same devices, Apple realized, could also help with that. So, next came CareKit:

An open source framework for developing apps, CareKit helps users better understand and manage their health by creating dynamic care plans, tracking symptoms, connecting to care teams, and more.

The next and most recent step for Apple is using its devices and its security to link us with our medical institutions through Health Records:

With the Health app in iOS 11.3, a new beta feature makes it easier than ever for users to visualize and securely store their health records. Now your patients can aggregate their health records from multiple institutions alongside their patient-generated data, creating a more holistic view of their health.

Apple has been accused of not consulting with outside healthcare professionals while working on the Watch and on its fitness and healthcare features. While that's sometimes true, it's mainly because Apple actively recruits healthcare professionals into its projects. Many of the team leads on Apple's health initiatives have medical degrees or are doctors who still spend part of their time practicing.

By bringing the expertise in-house, it means the experts can have earlier and fuller access to the projects and, instead of brief consultations, can help shape the projects and become invested in bringing them to market.

It also means Apple isn't just building tools for researchers and caregivers. Apple is building tools as and with researchers and caregivers.

Health & Privacy

Apple, famously, has had… absolutist ideas about privacy. Some believe to a fault — denying themselves the acceleration in machine learning that could be gained from mining the data of its hundreds of millions of users.

But, to its core, Apple believes customer data belongs to customers and doesn't want anything to do with it, unless it absolutely has to and then only for as long as it absolutely has to.

Data collection doesn't have to lead to data exploitation, though. That the biggest internet services companies have linked those two activities is a reflection only of the business model they've chosen. Different choices can also be made.

That's why, after some reflection, Apple decided it didn't have to be quite so absolutist about data, especially not when the benefit it could provide wasn't in business model but in customer care.

So, with HealthKit, Apple set it up so users could explicitly opt-in to sharing their data. That way, if the effects or complexity of their conditions made it difficult to enter precise information, like what medications are being taken and when, Apple linking everything together for them can help.

The advantage Apple has, and the peace-of-mind Apple customers have, is that none of this information is sucked up to anyone else's servers, used to feed anyone else's database, and then used to build profiles and auction off ads.

Instead, the data is used to try and better understand healthcare concerns to, ultimately, better treat patients. And the amount of trust that engenders can't be underestimated.

Duke University's MS Mosaic is a one example.

Multiple sclerosis is an immune-mediated illness that strips neural circuitry of its insulation, thereby slowing communication.  Many factors determine how these denuded lesions emerge, and how much they impose symptoms.  While we know these factors interact, measuring the interactions is difficult because they constantly change.  As a result, MSers have fragmented experiences that haven't been explained, let alone anticipated.  "MS Mosaic" is designed to gather the fragmented MS experiences together and use advanced computing methods to create the most comprehensive picture of MS to date.

The The University of North Carolina at Chapel Hill's PPD ACT is another:

PPD ACT is a research study developed by Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium, an international group of academic clinicians and scientists committed to understanding the interaction of genes and environment to predict which women are at risk of postpartum depression (PPD). The study aims to help researchers understand why some women suffer from PPD and postpartum psychosis (PPP) and others do not - critical knowledge that will improve detection, prevention and treatment of these conditions.Join the PPD ACT study by downloading the app in the App Store or Play Store to help find the cure.

'Play Store' there not a typo. Apple intended ResearchKit to help everyone, not just people using Apple devices.

I've had a chance to talk with several teams who've fielded these kinds of projects and all of them speak passionately not only about what they're doing, but how Apple's technologies are helping them reach more people, faster and more effectively, and obtain better results than ever before.

That's the fascinating duality of Apple's current approach: Solving healthcare problems for the individual with new watchOS features, and solving problems for healthcare itself with frameworks like ResearchKit and CareKit.

The future of Health

That's all well and good as far as features go, but what does it mean for the future of Apple services, especially in a post iPhone world?

Possibly everything. Apple's already nailed some important use-cases like communications and entertainment. Health could be every bit as big, if not bigger, and far, far more important.

Apple never discusses future projects, of course, but it feels like we're still at the very beginning of its health and fitness activities.

Additional sensors are the most often rumored. Blood sugar top of most lists, though there could be many others. Like most rumors, realizing them in a practical, mainstream way can be harder and take longer than typing them out in a blog post or talking about them in a video.

Apple's reportedly also working on its own custom health silicon, which if you've seen what those teams have done with everything from systems-on-chips to systems-in-package, from sensor fusion hubs to wireless connectors, is beyond exciting.

But it could be bigger than that as well. And that's where I get really interested: Apple can use its existing expertise in security and convenience not just to upend health monitoring but health procedure as well.

I can already tap my Apple Watch for Apple Pay, to connect to Gym equipment and, in some schools and at Apple Park itself, use it in place of Student ID cards or employee badges.

It's not hard to imagine that, one day, I might be able to walk into any clinic or hospital, tap my Apple Watch or iPhone, and immediately authorize the sharing of my health records, insurance information, current medications and conditions, allergies if any, and all the other relevant data they need and I need them to have. Things I'd otherwise have to spend precious time tediously filling out from scratch, each time. Or worse, forget about or accidentally leave off.

Having all of that tracked, privately, securely, and having sensors and reminders helping out when and as needed — that by itself would be a healthcare revolution.

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Rene Ritchie

Rene Ritchie is one of the most respected Apple analysts in the business, reaching a combined audience of over 40 million readers a month. His YouTube channel, Vector, has over 90 thousand subscribers and 14 million views and his podcasts, including Debug, have been downloaded over 20 million times. He also regularly co-hosts MacBreak Weekly for the TWiT network and co-hosted CES Live! and Talk Mobile. Based in Montreal, Rene is a former director of product marketing, web developer, and graphic designer. He's authored several books and appeared on numerous television and radio segments to discuss Apple and the technology industry. When not working, he likes to cook, grapple, and spend time with his friends and family.