Apple technology driving innovation in Digital Health and Care
Unless you have been holidaying on the moon in recent weeks, it can’t have escaped your notice that Apple “quietly” launched a number of new products and services, many of which could have an impact on the digital health market in the UK.
Many of our NHS clients are asking us what we think of these developments and what, if any, opportunities exist for them to make the most of these going forward. Sounds like the perfect subject for a blog post to me!
There is a lot going on the digital health space at the moment, especially in the development of wearable devices. We, like many other industry experts, believe this will see rapid developments and innovations in the coming months and years. Companies like Google are bringing technologies such as Google Fit online in the coming months but at the moment the big announcements are mostly coming from Apple, so for this blog post we will focus on the Cupertino based technology company and what opportunities may exist there for the UK Healthcare market.
Apple’s recent announcements covered both hardware and software, but four main products jump out as being worthy of focus when talking about digital health and care. Let’s look at each in turn, starting with the hardware.
The changes happened here started well over a year ago with the introduction of their M chip, which was loosely labelled as their movement chip but quickly more commonly referred to as their health chip. For years people have used their phones to track their regular exercise, such as running and cycling through third party services such as Runkeeper, Strava or Map My Run, myself included. The majority of these applications rely primarily on GPS to track your movements, with the possible fall back to the built-in accelerometer for indoor activity. However, both these technologies are pretty thirsty from a battery perspective and while OK for short focussed sessions were never suitable for all day tracking, such as that supported by devices such as the Nike Fuelband or Fitbit.
With the introduction of the M chip, Apple moved their accelerometer technology into a dedicated processor unit in the phone, which importantly used significantly less power than the previous version. Applications such a Moves could now be run in the background all day long without draining your phone’s battery by mid-afternoon, and many other developers started to make use of this technology.
With the latest iteration of the iPhone, this chip has been further enhanced to improve its performance and also to include a barometer, so that altitude gain can also be measured by the phone. This combined with a low power accelerometer, GPS and the ability to hook into third party hardware such as heart rate monitors using Bluetooth LE, means that the iPhone is a viable platform for tracking all manner of personal activity 24/7.
The big hardware announcement this year is of course the proposed launch of the Apple Watch in early 2015. At this stage we only have what Apple has shown us to go on, combined with information from select journalists who have had the limited opportunity to use the device. So what do we know at this stage?
- The Apple Watch will require an iPhone to deliver some of its function. GPS for instance will be provided by the phone but the watch will have its own accelerometers for pace counting etc.
- The Watch does include its own sensors for measuring heart rate and even uses contact with the skin as part of devices security.
- The Watch will include functionality to encourage more day to day activity tracking such as walking, standing etc. This is clearly aimed at the Fitbit market.
- Additionally the Watch will also include functionality aimed at the more serious athlete, to track running and cycling for instance.
- Battery life is expected to be a little over 24 hours, so it will need to be charged overnight, meaning sleep analysis is unlikely to be a feature in version one.
- It won’t be 100% waterproof putting its use for water based sports out the equation.
- It’s not the smallest or most feature packed smart watch on the market, but then neither was the iPhone when it first launched.
- It won’t be cheap!
It’s early days, but wearable devices are the next big area for development, in the same way that Tablets were in recent years. If the iPad is anything to go by, then you would expect Apple to really inject some vigour into this technology sector and drive it forward. We will be seeing lots of innovation and iterative develop in these areas, put simple the Apple Watch of 2018 will look nothing like what we are seeing today!
So that’s the hardware announcements covered. While these are the areas that get the majority of the presses attention, I believe it’s the software developments that are the most exciting and provide the real opportunity for development and innovation for companies such as Sitekit and our healthcare clients. The first of these is the introduction of HealthKit!
There has been a lot of talk in recent years about the use of PHR or Personal Health Records, both internationally and increasingly in the UK. Through our eRedbook project and also the work we have been doing as part of the dallas (delivering assisted living lifestyles at scale) programme, we have been at the forefront of this within the UK and are strong believers that the use of PHR’s will promote the free flow of patient information around the health and care system, encouraging patient choice, self-care and management of long term conditions and general well-being.
The issue is that many of the UK population have never heard of PHRs or even understand their benefits. Those of us who are a certain age will remember the small brown envelopes our GPs had on their desks, stuffed full of notes and paper about us. These have since been replaced by computer systems, but when we think of our patient record it is this information we think of.
Many of us also think of the NHS as one large monolithic organisation, with our GP and maybe local hospital as the point of access to the service. We don’t think of it as a series of interconnected organisations, totally independent of one another, holding their own budgets and in many instances their own records about us. If you would like to get a feel for how complicated the NHS structure is, then this video by The Kings Fund explains the current NHS structure really well.
The issue is that there is no real driver for the UK population to sign-up for a PHR at present, unless it is associated with a particular product or service such as our eRedbook project. Likewise the vast majority of these services are entirely cloud based, with examples such as Microsoft’s HealthVault and Patients Know Best being popular choices at present.
So where does Apple’s HealthKit come into this? Well, HealthKit is a PHR, but one that is embedded directly into your phone. Like cloud based solutions such as HealthVault, there are a series of programming interfaces that developers can use to push information in and out of the PHR, with security controls so that you the user can grant or revoke the access that a particular application has. However unlike many PHRs at present, the user does not need to go through a complicated sign-up procedure to use it. It will just work out of the box, in many instances without the user even knowing it exists.
So how will it work in practice for the end user? Well I may be using my Withings scales to track my weight and body fat, which in addition to automatically pushing this to the Withings cloud service would also record this within Healthkit on my phone. All automatically without me needing to type anything in. When I next go for a run my Strava app is able to look into HealthKit and use that weight as part of its calorie burn calculation, again all automatically. Once the run is complete then Strava is able to push this information back into HealthKit, along with time, distance and maybe heart rate data if it was being recorded. Finally an application such as My Fitness Pal could use all of the above in calculating my total calorie requirements for the day. And on and on we go!
The introduction of HealthKit is a superb opportunity to educate the wider population about the benefits that a PHR can bring. The iPhone’s penetration in the UK market, combined with the fact that the vast majority of these are always running the latest version of iOS (90%+), means that by this time next year we are probably looking at 30–40% of the UK smartphone population carrying a PHR in their pocket. The introduction of Google Fit later this Autumn is only going to increase that number further.
So what does that mean to the NHS? Well education aside, there is a real opportunity to develop applications to both educate and monitor patients outside of a traditional healthcare setting. The major challenge is the integration of these applications with existing healthcare systems, something which organisations such as Sitekit are actively pursuing and already have technical solutions in place to help meet these challenges.
There was another announcement by Apple at their World Wide Developer Conference (WWDC) in June which has received little coverage, behind the bright lights that are the iPhone 6 and the upcoming Apple Watch, and that is HomeKit.
Similar to HealthKit, HomeKit is a software solution that allows developers to create applications that will allow users to control devices in their home directly from their mobile devices. This obviously has masses of potential but in the healthcare sector this offers some interesting opportunities for self-care in a home environment.
So as you can see, the hardware manufacturers are driving technology in this sector forwards and the prevalence of Apple technology means that functionality such as HealthKit will shortly be available amongst a large percentage of your patients.
If this sector develops at a comparable rate to both the smartphone and tablet sectors of recent years, you can bet that we will be seeing some really exciting developments and innovations in this area in the coming years.
There is a real opportunity for the NHS to lead the way in the development of software solutions that make the most of this hardware. These don’t have to be patient facing and could also be internal solutions developed to improve patient care within a hospital setting, such as that being developed by Cambridgeshire and Peterborough at present.
With funding available from sources such as the technical innovation funds, there is a real opportunity for NHS Trusts to work in partnership with organisations such as Sitekit to lead the development in this sector. I for one am really excited about what the coming years will hold in this area and hope you are too.
Posted on 31 March 2015
Super, just super.It really is a lovely post. Thanks for sharing..
Posted on 07 January 2015
Well, is this going to work?There's only one way to find out….
Posted on 07 January 2015