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The Apple Watch, in 2014, started as a style accessory and symbol for tech-savvy Apple fans. Over the years, the Apple Watch has emerged as the ultimate wearable for tracking health. The advanced sensors, health features along with reliable data has made some doctors even include the Apple Watch in their patient-care toolkit. While there are plenty of health trackers in the market, for the Apple Watch, it was always more than just providing sensors and through raw health data to users.

From getting instant ECG reports at any time and now with Health trends, Apple is trying to help users understand the ‘health hints’ their bodies keep providing at times. But how did health become the core focus for Apple or what is Apple trying to do differently?

Sumbul Desai, Vice President, Apple Health in an exclusive interview with Debashis Sarkar, Editor, News18 Tech shares some insights as to how things are decoded at Apple.

It’s very organic. You know, we never sat back and said, okay, one day we’re going to do health. The transition is very organic. And what happened was, when we introduced the Apple Watch, we put the heart rate sensor on because of our focus on accuracy, to make sure that we were accurate in measuring calories. And as a result of that, what happened just by virtue of now people wearing a watch all the time, they basically wearing a heart rate monitor. And so by virtue of that, we started getting letters. And the letter said things like, Hey, I was wearing my Apple watch, and I noticed my heart rate was elevated. I went to the doctor and I found out I had an infection or I had an allergy or had AFib.

At Apple, we never sat back and said, okay, one day we’re going to do health.

Then we (at Apple) said, Okay, well can we do next? So then we introduced the high heart rate notification and we got even more letters. People started writing to us saying: I ended up getting a high heart rate elevation. One of my favourite stories was a mom who is pregnant, got a high heart rate notification, went to the hospital in a thyroid storm, which actually can be deadly for the foetus and ended up basically saving her foetus’ life because she was notified and was able to get there sooner.

We then introduced low heart rate notification, a lot of letters we got when we launched high heart rate notification were around AFib. So we said, Okay, well, we can tell you the speed of your heart. Now let’s look at the rhythm of the heart. And so then we started pulling on that thread, and we dug into the AFib notification. And we introduced irregular heart rate notifications in the ECG feature.

We got even more letters about how people noticed AFib which basically notified people of things like blockages in their arteries. And then we introduced ‘AFib Burden’, it’s not in India yet, but it’s a feature that will tell you how much time you’re in AFib. So the essence of that story really is that we were pulling the thread as we received more letters and heard from customers, and it was a very organic journey.

It’s a multifactorial process. Often, just as I said, we get letters, right. And those letters allow us to then think and maybe hint us that we should dig into that a little bit more. So we definitely use that as a mechanism. We have a very cross functional team. So everybody on the team will kind of come up with ideas.

What’s really great about working in a company like Apple is that ideas come from all levels.

What’s really great about working in a company like Apple is that ideas come from all levels. And then we will then evaluate whether we think we can scientifically actually deliver on that idea. If we think we can, then we start doing early engineering feasibility studies, then if we learn from that data that we think there’s a possibility to do this, we then do validation study, so you start developing the algorithms, then we do even more validation studies. And then once we have the validation studies, we feel good about the metrics, then we start designing the features.

It’s a very long process. But really what it’s grounded in, is the belief that we need to provide actionable insights that are grounded in science that we can do live or in a privacy preserving way and that empower the user to live a healthier life. So that really helps drive our selection of what to work on next.

We are very cross functional at Apple. We work with clinicians on my team, we have designers, we have engineers, we have algorithm engineers, we collaborate with external partners. Sometimes we collaborate with key opinion leaders who are experts in certain types of medicine or science. We collaborate with institutions. Basically, what we say is, almost everybody at Apple touches every product we deliver, and it’s very, very cross functional.

…almost everybody at Apple touches every product we deliver, and it’s very, very cross functional.

It’s something that I think we’re still early in our process on. You know, the ‘Health’ app, if you notice, there’s a feature called ‘Trends’. The real purpose of ‘Trends’ is to start getting users to see insights that might motivate them. So for example, if I look at my trend, I haven’t been sleeping much because of travel. So, the Health app showed that I have a decreased number of hours of sleep. So, the idea is that as I start seeing the connections of changes in data, like, we’re trying to do more to be able to translate the data so that the user can actually get more health insights.

The real purpose of ‘Trends’ is to start getting users to see insights that might motivate them.

But you know, we need to take care that we balance the health notifications and end up over-notifying. And, as you know, people tend to ignore health notifications, providing insights that are actionable and actually engage the user makes more sense. So that’s something that we’re thinking a lot about, but I would say we’re still really early, much more we can do there.

I think most physicians will agree that if you educate people, the fear goes away. Fear comes from not understanding the ‘why’ behind things. And we spend a lot of time, if you look at our health features, the articles that we always release in conjunction with the feature, right? So for example, if you go into the Apple Health app, there’ll be an article on why sleep is important, or like what does cardio fitness mean? Actually, that’s what I think is so powerful about what we do at Apple. It is the element of educating customers on areas of health that they may not have understood before.

Fear comes from not understanding the ‘why’ behind things.

And really the hope is, the more you educate, I’ll say this as a physician, the more you spend time in educating people, the less afraid they are of it, it’s more approachable. And the more they understand the why behind it, and then they’re doing their motivations are really around, you know, improving for the right reasons.

There’s always at risk with any data, right? So the way we get to that threshold (high heart rate above 100 bpm) is based on medical science. So the threshold isn’t a threshold that Apple develops, it’s a threshold that we use kind of clinical science to guide us. And the reality is, if you’re above 110, you’re tachycardic. So you’re clinically tachycardic. Now, you may or may not have a condition, you may be having anxiety, which you could breathe your way and get it lowered. Or you may be having shortness of breath that causes a high heart rate. We’re just there to provide information. What’s really important is that that information should be used in conjunction with other factors.

We’re not trying to replace the doctor. What we at Apple are telling you to do is say: Am I feeling abnormal?

So, we’re not trying to replace the doctor. What we at Apple are telling you to do is say: Am I feeling abnormal? Because if you notice, when it says a high heart rate notification, it says, If this is an unusual thing for you, you should contact a doctor. So we think a lot about that language. We don’t just say go to the doctor. And so I think we mitigate that the best we can. And we try to educate the user on what this means so that they can take the rights to next steps.

So privacy is never a sacrifice in anything we do at Apple. We think that you should expect the same privacy from your technology as you would from your doctor, period. We enable the use of our metrics through the health kit. And privacy is built into how those metrics are used. So ultimately, we are very focused on making sure that even within our developer ecosystem, that privacy is number one, and that’s how we think about it. We have some rules that we put into place in order to make sure that happens.

Privacy is never a sacrifice in anything we do at Apple.

We are really laser focused on empowering customers to really take the health in their own hands because ultimately, health is such a personal thing that it’s really important to make sure that you as an individual is, are really understanding the ‘why’ behind your health, that we provide actionable insights that are grounded in science that have privacy at the core of that. And our approach really is focusing on the customer. We have research studies through our investigated initiated research programme where the Apple Watches are used in clinical health settings. And we’re really excited to see what we learn there.

There’s some examples of life insurance companies using the watch, and we’re really excited to see what we learn there.

We have some initiatives that we’ve done kind of, you know, vitality, there’s some examples of life insurance companies using the watch, and we’re really excited to see what we learn there. But when we design our, you know, our features and products, we’re really thinking about you– the user.

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