The consumer technology companies that own desktop software, Web search, and mobile phones have set themselves a new goal. They’re aiming to carve themselves a slice of health care, the US $3 trillion industry that represents nearly a fifth of the U.S. economy.
There’s a lot at stake here, and not just financially. Pundits have described a future in which your body is minutely and continuously monitored. Your wearables and assorted wireless-enabled gadgets—your bathroom scale, perhaps a blood-glucose monitor—would gather torrents of physiological data. Someday, the data might even come from biosensors worn on the body, like tattoos, or ultimately, from implanted devices. This flood of info would sluice to your smartphone before streaming off to the cloud. Apps could continuously monitor the data and, if it took an alarming turn, bring it to the attention of a medical professional. Although the quantities of data might well be huge, this vision could be realized with technologies available now or anticipated soon.
The heavyweight corporate muscle behind the vision comes from Apple, Google, Microsoft, and Samsung, which have all launched e-health initiatives, mostly based around smartphones and wearables. Indeed, the fast-growing health care business would seem a natural next step for the tech giants. Technology, including the sort of high-volume digital technology inside smartphones, is playing an increasingly important role in health care. And billions of dollars are now being spent converting the paper-based charts that doctors have long used into modern digital records. Devices, digital data—that’s what these tech giants do. Why shouldn’t they do it in health care, too?
Well, start with the fact that Google’s, Microsoft’s, and Samsung’s initiatives have all been around for a couple of years, without any discernible impact on the market. Nevertheless, they’re now being joined by Apple. In connection with its new Apple Watch, the company has announced HealthKit, its own approach to aggregating information from various fitness devices. Apple is pushing HealthKit with a stylish, full-glitz marketing campaign, and its top executives are extolling it in high-profile forums. “We believe we’re just at the beginning of amazing new health and wellness solutions for our customers,” Apple CEO Tim Cook told investors during a recent conference call.
Can Apple succeed where its cohorts have—so far—struggled? It’s common in Silicon Valley these days to hear about the many ways that these new technologies are going to “disrupt” the world of health care. The problem is that most medical professionals aren’t buying in, arguing that there’s scant evidence that these consumer technologies will be of much use.
Many experts argue that the significant challenges facing the U.S. health care system, such as obesity, can’t be solved with apps and trackers. For all the excitement inside the technology world about wearable digital devices and personalized health data, many doctors regard these gadgets as toys for the well-off and fit.
“Every new technology goes through a period of initial enthusiasm,” says Steven Ommen, a professor of medicine at the Mayo Clinic. “And then the daunting realities set in.”
The tech giants’ only hope would seem to be to find an entrée that enables them to gain a footing amid the harsh realities of the slow-moving health-data business, as well as the skepticism of doctors. In fact, and despite those obstacles, experiments on chronically ill people, notably patients with diabetes, have already shown that there are benefits from smartphone-based health monitoring. It’s a niche, at least, and it raises the question of whether the tech giants will stay interested long enough to try to parlay it into something larger.
Consumer indifference will be yet another hurdle. “All the companies are looking to be the aggregators of consumer health data,” notes Lynne Dunbrack, who covers personal monitoring devices and related areas as research vice president for IDC Health Insights. The problem, though, is that with a few exceptions, “consumers just aren’t that interested in managing their health or reviewing their health records that closely,” she says, adding that providers find it challenging to get patients to use their patient portals, through which users can enter their own health data.
As with any movement there are true believers: “Self quantification” enthusiasts believe so strongly in better living through gadgetry that they routinely post their personal fitness data online for all to see. But that kind of zeal is unusual, and for many who buy a fitness tracker, the typical usage pattern mimics closely the ones for diets, gym memberships, and other efforts to get in shape: It starts strong and then fizzles out. A third of the people who buy a wearable fitness device stop using it within six months, according to market researchers Endeavour Partners of Cambridge, Mass. Many other studies have reached the same conclusion.
Although Google, Microsoft, and Samsung haven’t officially abandoned their health efforts, Roeen Roashan, a medical technology analyst at IHS Technology, said their projects appear to be on the back burner.
But Apple’s media department forwarded a barrage of stories and press releases involving HealthKit, including announcements involving partnerships with prestigious medical institutions like the Mayo Clinic. Still, Apple is likely to face the same challenges that vexed its predecessors.
One challenge is demographic. The kinds of people who are attracted to digital health products tend to be upscale and educated—the “worried well” who least need medical attention. Those with chronic medical problems, especially ones associated with obesity, are likelier to be poor and uneducated. “The average type 2 diabetic is not going out and buying a $600 mobile phone and a $300 Apple watch,” says Sean Wieland, who follows stocks in the health information industry for the brokerage firm Piper Jaffrey.
A second issue is that doctors don’t share the tech industry’s “more is better” approach to data. “There is a big concern that health care providers will be getting a huge amount of new information that they don’t want,” says Bill Hanson, chief medical information officer for the health care system at the University of Pennsylvania. This would include, he said, hour-by-hour readouts of weight, pulse, blood pressure, and the like.
One of the problems with at-home data, Hanson adds, is that doctors have no context for the information. “When I have a patient in front of me, I can look and see that blood pressure has increased because the patient is nervous. But I don’t have that sort of knowledge about data from outside a medical setting. Someone might have had a weight gain simply because they ate food with a lot of salt and retained fluids.”
Another problem with data-hungry diagnostics is that they’re based on the assumptions of preventive medicine, some of which have recently been upended. The conventional wisdom used to be that frequent screenings for diseases allowed doctors to catch and treat pathologies like prostate and breast cancer while they were still nascent. Instead, medical researchers have discovered that overscreening can cause more trouble than it solves by inflicting risky procedures on “false positives”—patients who test positive for an ailment they don’t have.
There’s also a liability issue, Hanson says. Plaintiff’s attorneys in medical malpractice suits routinely subpoena all of a patient’s health records. Should those records include copious real-time data involving heart rate, for example, a lawyer could zero in on a single anomalous reading and attempt to blow it out of proportion. “They’re getting increasingly sophisticated about using medical records,” says Hanson.
Companies like samsung and Apple may also struggle with the software technologies used in connection with electronic medical records (EMR), which are produced with different corporate cultures and customer relationships than those that consumer companies are used to.
An EMR system replaces the racks of bulging charts that were once a familiar sight in doctors’ offices; each patient’s record contains clinical notes, lab results, and other information. The EMR market is highly regulated, not only for privacy reasons but also because the U.S. federal government is now spending billions of dollars subsidizing what it hopes will be an industry-wide transition to EMR-based record keeping and is trying to make sure the money is well spent.
The EMR market, at least for big hospitals and health clinics, is highly concentrated, with a few companies controlling most of the business. These big EMR providers tend to maintain a much lower profile than the Apples and Googles of the world. Ever heard of Epic Systems Corp., of Verona, Wis.? It’s the biggest of the lot, and it’s not even a public company.
When they discuss their coming role in health care, Apple and the others tend to talk of complementing the technology provided by big EMR vendors rather than replacing it. Consider what Apple is doing with the Mayo Clinic, one of HealthKit’s premier customers.
Mayo designed a smartphone app based on software from Epic, of which Mayo is a customer. Patients use the app to e-mail their doctors, schedule appointments, and check on test results. When Mayo patients first sign up for the app, they can allow Mayo to access their Apple HealthKit data—if they have it—and present it alongside their Epic data. As the app is still in its early days, few people have signed up, according to Ommen, the Mayo medical professor.
Analysts who follow the multibillion-dollar-a-year EMR market say the consumer companies have little chance of making a major impact on it. “Health care requires a tremendous amount of domain expertise,” said Wieland, of Piper Jaffrey. While consumer companies tend to be closely followed in the media, meaning their health care announcements usually get a great deal of coverage in the general interest press, “they actually don’t have a very strong track record. It’s still the Epics of the world that end up the winners.”
The final issue is regulatory. The U.S. Food and Drug Administration recently clarified the extent to which it will regulate digital devices. It said that, in general, fitness-oriented devices that record straightforward information, like how much a wearer walks in a given day, won’t be in its purview.
But “medical grade” devices—for example, sleep-apnea technologies that regulate breathing—must get FDA approval and typically require a doctor’s prescription. And if these devices collect information that might play a significant role in how a doctor treats a patient, a prescription would usually be required for those too. But the companies that make such systems don’t seem interested in using a consumer-oriented platform, such as a smartphone, for handling the data they gather.
One example is iRhythm Technologies of San Francisco, which makes a patch that heart patients wear for two weeks to help cardiologists detect arrhythmias. Although the data could be stored in, say, Apple’s iCloud, iRhythm instead uses Amazon.com’s servers because of the regulatory compliance they offer, says Kevin King, the company’s president and CEO.
Although medical professionals have doubts about using consumer-grade health monitors in the general population, they believe that patients with chronic conditions might benefit enormously from them. Such patients often get admitted to hospitals as a result of an avoidable development. Often, the patient’s relapse is preceded by an easily detectable signal, like a surge in blood sugar or blood pressure—one that no one notices because the patient is at home. Wearable digital devices would take the surprise out of such episodes, doctors say, enabling them to track these patients after discharge and to intervene with a phone call. In many—if not most—cases, patients could be kept out of the hospital with a relatively simple step, like an increase in medication.
U.S. hospitals are under great pressure to reduce readmissions, because of changing federal reimbursement policies that penalize hospitals when patients are readmitted too quickly after a discharge. “There is a lot of potential promise in using digital home monitoring in these cases to catch these things while they’re happening,” says Penn’s Hanson. “And being able to intervene early is a holy grail.”
Monitoring a select group of chronically ill patients to prevent their early readmission to the hospital isn’t quite the same as turning every sensor suite and smartphone into a fitness coach, let alone a sophisticated and continuous health monitor. But its usefulness can be clinically proved, and tens of billions of health care dollars could be saved. That’s a worthy goal in itself. And if it’s the start of something more ambitious, so much the better.
This article originally appeared in print as “Tech Giants Bet on Biometrics.”