Apple Watch: Creating a Connected Health Ecosystem

The BTC Team

The healthcare industry is moving toward the value-based care approach by delivering treatment and medication beyond the confines of hospital settings. Clinicians can provide personalized and quality care by monitoring patients in their homes. 

Today, we have connected healthcare delivery models that encompass a wide array of technologies utilized for patient care, including mobile, wireless, digital, and telemedicine. Wearable devices, in particular, have achieved advancements and help collect critical data, ensuring better care and coordination.

At the forefront of these industry-disrupting innovations is Apple Watch. With numerous next-gen technology-enabled features, Apple Watch is becoming an integral part of healthcare services. Providers can now connect with their patients outside their regular visits. This helps provide better care and improved patient outcomes, ultimately a great healthcare experience for all.

A health journal for patients

The Apple Watch is no longer an arm candy. The Watch is now a wrist-worn wearable device included in the connected health ecosystem for saving patient lives.

This AI-powered wearable device is empowering healthcare providers with critical patient health data to make informed decisions. It also helps patients become more mindful about their health behaviors and play a crucial role in the treatment.

For users, the Apple Watch becomes a fitness partner to measure their activities, provide meaningful insights, and have care teams at their fingertips. The Watch also helps to check up on themselves in a non-intrusive way, such as through notifications or emails. The health data collected are then sent to providers to help them monitor patients’ lifestyle, habits, and treatment adherence.

Here’s an example. Take the case of a cardiac patient discharged after experiencing a stroke. The Apple Watch includes an ECG app that checks a patient’s heart rate and notifies the care team regularly. And if there’s an emergency, the Watch notifies emergency contacts and the health system.

An ecosystem of care and betterment

Apple Watch is part of Apple’s healthcare devices and applications ecosystem for ensuring a holistic and personalized care experience. At the core of this efficient ecosystem is the HealthKit API that allows users to share patient information with apps installed on devices. HealthKit facilitates a central repository for health and fitness data of patients on iPhone and Apple Watch. Apps within different devices can communicate with the HealthKit store to access and share patient data with the user’s permission. 

Apart from storing data, analyzing and visualizing the data is also possible using the Health app. The app consolidates data from iPhone, the built-in sensors on Apple Watch, compatible medical devices, and apps that use HealthKit and provide information in user-friendly dashboards. Users can take actions such as adding data, deleting data, and changing app permissions within the Health app. 

The patient data collected can also be sent to healthcare professionals for treatment and medication. In case of an emergency, the Apple Watch automatically calls emergency services.

Apple Watch also gives peace of mind by keeping data secure and protecting privacy. Whatever data is collected stays within the devices and is encrypted when the device is locked with a passcode. Patients always have control of their health information, and they can provide access permission as they wish.

Myriad set of features to stay healthy

The Apple Watch has powerful and intuitive apps that provide patients and caregivers with critical information concerning their health. ECG app is a great tool for health monitoring as there are chances of catching a medical episode that may be undiscovered or an abnormality that’s undetected before it becomes a life-threatening disease.

Here are a few features of the Apple Watch:

Activity Tracking

This is the most obvious and also important health feature on Apple Watch. It goes without saying how effective our daily activities can be if monitored well. Regular exercise can relieve stress, improve emotional well-being, gain muscles, and improve overall wellness. The Apple Watch has activity rings that show daily activities. From a 6-minAdvanced-Research-and-Careute walk to pilates or cardio, it helps users to track workout and their progress. The Watch also provides awards, personalized coaching, and activity competitions to keep users motivated. 

Healthcare providers can regularly check the health metrics of patients and offer customized care. The patient information from Apple Watch can be used to make adjustments to diet and medication and assist patients at every step of their recovery. Another use case involves helping insurance companies to calculate insurance premiums. 

Abnormal Heart Rhythm

A unique feature of the Apple Watch is its ability to generate an electrocardiogram (ECG) which represents the electrical pulses of heartbeat and checks if the heart rate is in rhythm. The Watch’s ECG app detects atrial fibrillation (aka AFib), one of the most common irregular heart rhythms, through a 30-second test. Afib can cause complications such as stroke, blood clots, and sometimes heart failure. 

The Apple Watch’s irregular rhythm notification feature occasionally checks the heartbeat and its heart rate sensor automatically keeps track of heart rate. Users can view and export ECG waveform, rhythm classification, and any reported symptoms using the iPhone Health app and send snapshots as a PDF to clinicians. If the Watch detects AFib classification, it will alert the user to go to a doctor. 

Heart rate notifications

Similar to abnormal heart rhythm detection, Apple Watch can also check for high heart rates (tachycardia) and low heart rates (bradycardia). Once the user has entered high and low heart rates in the Watch app, it can detect abnormalities in the heart rates. In the case of the Watch detecting heart rates above or below the chosen beats per minute (BPM) while the user has been inactive for a period of 10 minutes, it will notify and prompt them to take necessary action. This feature has been beneficial for numerous people and saved many lives. 

Blood oxygen level

The Apple Watch has a dedicated app to measure and monitor the blood oxygen level or saturation (SpO2) in our body. SpO2 level represents the percentage of oxygen carried by red blood cells from the lungs to the rest of the body. Monitoring SpO2 ensures that we know how well-oxygenated blood is delivered throughout the body and understand the overall wellness of the user. It can also help identify any lung-related diseases and guide medical treatment if necessary.

Fall detection

This is a popular feature of the Apple Watch that has been credited for saving numerous lives since its debut. 

When a hard fall is detected, the Watch sends a push notification asking if the user is OK or not. The alert gets louder so that someone nearby can hear it. If the user is unresponsive for about a minute, it automatically calls emergency services and sends a message to the user’s predesignated emergency contacts for help. The falls are recorded in the Health app and can be viewed for insights. Fall detection is especially useful for remote monitoring of elderly patients. BTC had developed a fall detection app for one of the largest health systems in the US.

Menstrual cycle

Focusing on women’s health, the Apple Watch includes a menstrual cycle tracking feature. The irregular menstrual cycle can indicate numerous conditions such as osteoporosis, polycystic ovary syndrome, infertility, and menopause. By monitoring the cycle, women can understand their body changes and be confident about their health. 

Medical ID

The Apple Watch allows patients to provide essential health data by setting up an emergency Medical ID in their Health app. This can include their allergies, medications, conditions, emergency contacts, and donor preferences.

In the case of an emergency, emergency personnel and clinicians can access critical health information from the patient’s Watch without requiring a passcode. Apple Watch ensures that this is done without compromising patient privacy. 

Managing Chronic diseases Simplified

Chronic diseases are among the most prevalent and expensive medical conditions in the US. Several studies show that nearly half of all Americans suffer from at least one chronic disease, and this is growing. Chronic diseases can lead to adverse effects such as long-term disability and hospitalization, reduced quality of life, and death. Currently, more than two-thirds of all deaths are caused by five chronic diseases—heart disease, stroke, cancer, diabetes, and chronic obstructive pulmonary disease (COPD). 

Image source: Catapult Health Study-Aging and Chronic Disease

With the continuous monitoring of health variables such as heart rate, SpO2, and activities, healthcare providers can uncover critical information to the care of patients with chronic diseases. This also helps them to manage these diseases and prevent any life-threatening conditions. 

Apple Watch is found to be able to efficiently and accurately monitor health variables and help with chronic disease management. According to a recent clinical study, “Comparison of SpO2 and heart rate values on Apple Watch and conventional commercial oximeters devices in patients with lung disease”, the Apple Watch is a reliable method to measure SpO2 in patients suffering from lung diseases under controlled conditions.

This cross-section study was conducted with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from an outpatient pneumology clinic. Its objective was to evaluate the precision of the Apple Watch Series 6 smartwatch. The study was held in an outpatient and controlled environment by gathering data synchronously obtained from patients with two widely used conventional oximeters and the smartwatch. 

Hypoxemic patients are advised to utilize oxygen therapy to prolong their survival; however high oxygen saturation levels can also have adverse effects. Therefore continuous monitoring helps to control the oxygen saturation level and lung disease complications.

Analysis and results

The study incorporated data including age, gender, underlying disease, oxygen use, skin color, the circumference of wrist, presence of hair at the wrist, enamel nail, and digital clubbing. The data of SpO2 and heart rate was analyzed using graphs of frequency distribution and dispersion diagrams. Two tests were used for assessment: The Pearson test to assess correlations between groups (COPD and ILD patients and healthy volunteers) and the Bland–Altman method was used to determine the accuracy and bias of the data. 

Comparison of SpO2 and heart rate values

The study showed strong positive correlations between the Apple Watch device and commercial oximeters when evaluating heart rate measurements (r = 0.995, p < 0.001) and oximetry measurements (r = 0.81, p < 0.00).

Bland–Altman plots of SpO2 and heart rate of COPD and ILD patients and healthy volunteers

Out of the two lines, solid lines represent the mean bias and dashed lines show upper and lower limits of agreement. The Apple Watch tends to show higher SpO2 values than commercial oximeters based on the mean differences. However, measurements of heart rates were similar in both cases.

This demonstrated that despite a tendency to present higher values when compared to conventional oximetry devices, the Apple Watch device was accurate and similar.

Advanced Research and Care through Apple Health

Apple empowers care providers and researchers across the globe to drive healthcare innovation. ResearchKit and CareKit are open-source code modules by Apple to develop apps for medical discoveries and advanced patient care. Using elements of both frameworks, healthcare organizations can create an app for a research study or tracking medical conditions. This offers a diverse set of benefits for care teams around the world.

Optimize Research

Using customized apps, researchers can enroll more participants and conduct studies at a scale never seen before. By reaching people wherever they are through wireless devices such as Apple Watch, they can engage with robust, real-world cohorts and save costs.  

Collect informed consent

Study participants can provide signatures directly on their devices, enabling researchers to collect informed consent quickly. This ensures that a diverse population is enrolled for studies, and a significant amount of time is reduced.

Conduct surveys digitally

No longer need to rely on pen and paper methods. Organizations can now create surveys that are easy to access and complete from any iOS device. Apple Watch can collect real-time data of participants and share it with research teams without any hassle. The built-in sensors measure a variety of tasks such as motor skills, cognition, speech, and vision.

Deliver personalized care plans

Care providers can track the daily activities of patients using Apple Watch and deliver care plans customized to their needs. This ensures better patient care and improved health outcomes. With the Health app, users can view meaningful insights and trends extracted from the data collected by Apple Watch. 

Connect with patients

Healthcare providers can stay connected to their patients with a single touch. This ensures that patients get proper guidance whenever needed and also immediate help in case of emergency.

Apple Health data integration solutions by BTC

Health data from Apple Watch can help uncover crucial insights to improve the quality of care. BTC’s team has extensive knowledge and experience in integrating data from Apple’s product portfolio, including Health app, iPhone, iPad, and building a care ecosystem for patients.

BTC has helped Cincinnati Children’s hospital to build the MyAction Tracker app within Apple Watch. The app helped providers to monitor daily activities and collect data of heart transplant patients before surgery. This included distance walked and sleep analysis of patients.

The MyAction Tracker app also provided a reminder to the patient to carry out specific tasks and record input periodically, such as ECG reading, 6-minute walk test, and weight. The information is then pushed to the hospital’s database server.

Likewise, we have developed a fall detection system for one of the largest health systems in the US. It consisted of an iPhone app and a companion Apple Watch app to manage the fall response of patients. When the Watch OS detects a fall, it sends out a push notification and notifies all apps registered. The app will use the details provided by the OS and then send the details to the hospital’s 24/7 monitoring center via a REST API.

It also tracks and stores patients’ health information, including activity, sleep, 6-minute walk, and GPS data. This is then sent to the hospital’s data center (monitoring center and database) for further use.

Next-gen Innovation in Healthcare

With numerous such feature sets and benefits, Apple Watch is positively disrupting the healthcare industry. The entire care continuum can utilize the Apple Watch and its connected health ecosystem to provide better care and improve healthcare. 

Boston Technology Corporation (BTC) has demonstrable experience working with healthcare organizations to implement customized Apple Watch apps. We can also help you create HIPAA-compliant solutions to reap the benefits of the Apple Watch and its functionalities. To see how BTC can help you achieve this, contact us.


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