Apple Watch Vs. Specialists

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As a professor of innovation, I am naturally interested in the response to new products, and the launch of the Apple Watch 4 and its cardiac monitoring features is a good prediction and modeling study of specialist feedback. medium to long term. In short, working intensively on a subject for a long time distorts views on what is positive or negative about an innovation, as well as about innovation in a particular context or process of innovation. social adoption.

How could we classify these answers? For starters, doubts can be raised in an open format just like Ethan Weiss, which I mentioned in my previous article on the subject, which during the presentation of Apple Watch commented on Twitter: "I can not know if it's the best day of the day." 39, history of cardiology or worse. in clear and neutral terms, by anticipating the kind of scenarios that one can expect from an experienced cardiologist: non-intrusive surveillance able to identify problems before they become critical and its potential to save lives against cardiologists' waiting rooms filled with data they do not understand

The next day, the Washington Post raised similar concerns, after speaking to several cardiologists, in an article titled "What cardiologists think about the Apple Watch's heart tracking function": unnecessary visits to the GP. The interpretation of an electrocardiogram requires some knowledge of the technique and parameters used, which could cause untrained people, faced with natural variations in their heart rate, to alarm or feed them. their hypochondria. There is no doubt that this is a minor problem in the context of the potential benefits of a technology that can quickly alert people to potential heart problems. The possibility for people without adequate readiness to regularly access a diagnostic tool such as an electrocardiogram can be alarming to the professionals responsible for making decisions with these same tools, but the question that we could usefully ask is to know unnecessary visits to the cardiologist or to people uninformed of their health.

The reliability of the device used to capture and process the data is a different issue. An article in Quartz, "The new heart monitoring capabilities on Apple Watch are not so impressive," points out that the electrocardiogram obtained by Apple Watch gives a much more flawed and rudimentary result than a hospital, where twelve electrodes are attached. at different areas of the chest, arms and legs. The clinical device offers a much higher accuracy, but in exchange for a much lower level of convenience. Even though it was possible that the Apple Watch was connected in this way, the idea that a lot of people use it regularly or daily is ridiculous. The clinical device provides highly reliable and rigorous measurements in a hospital environment, while the Apple Watch provides fewer indicators and with a much lower level of accuracy, but at any time and under any circumstances. Could this contribute to the health of patients with, for example, conditions that do not manifest themselves when they are in their doctor's office? I am sure we will see cardiologists reviewing the records obtained by Apple Watch from some of their patients. This does not mean, of course, that it is necessary or justified in all cases, or that we should put pressure on doctors to do so.

These issues have been raised by manufacturers of other consumer devices, such as WIWE, which I also mentioned in my previous article on Apple Watch 4. The company has been working for years to produce a device the size of a credit card by holding both thumbs, making sure your hands do not touch each other, this gives an electrocardiogram with data and complete charts recording arrhythmia, atrial fibrillation, l '; ventricular heterogeneity and oxygen saturation in the bloodstream; using … a watch. No wonder WIWE is skeptical:

Although we have not tested it yet, just look at the hardware configuration of the watch which can affect signal quality when recording the ECG. Although it is a common design element in single-conductor ECGs to allow users to place their fingers on the sensors for full contact and a powerful signal, the watch obviously does not offer this configuration.

A very common problem may arise from a simple thing: the furry wrist of the user may interfere with the sensor supposed to pick up the signals from that channel and its ability to gather reliable information for evaluation is therefore limited. Let's see the other channel. The user's pointing finger should be held in position long enough to risk shaking, feeling tension, etc. In other words, stable and peaceful contact is hard to reach. If you compare, you can place WIWE on a flat surface and put your fingers on the sensors for the duration of the measurement.

Regarding AF detection: we have not seen any information on its accuracy (WIWE reached an accuracy of 98.7% in tests on 10,000 clinical samples – our certificate is available on request ) and checks the atrial activation (by examining the "P" wave). as WIWE does), or is the evaluation based solely on the heart rate (distance RR?) As far as the published information can be seen, they do not analyze the wave. QRS, QTc, PQ, while WIWE offers all this to clinicians. If they rely solely on the heart rate, the result of the assessment can be confusing when detecting the FA and this is confirmed by the FDA statement: "L". ECG application is not intended for people under 22 years of age. with other known heart diseases that can disrupt your heart rate.

Having said that, it is a great achievement that they have got the support of the AHA and they have received authorization from the FDA. We obviously did not say that the watch could not detect AF, but there are concerns at this stage. "

Again: it seems clear that in the category of consumer products, the accuracy of a device designed specifically to obtain an electrocardiogram, with two sensors and a reasonably ergonomic configuration to keep the thumbs on them without problem get more reliable results than a watch designed for a wide variety of functions, including reading the time. But the counterpart, again, is obvious: with the WIWE device, I monitor my heart rate when I remember and usually not even every day. With the watch, I monitor myself at all times and in all circumstances.

Are the reactions to the innovation of physicians and designers of competing products justified? There are certainly reasonable grounds. However, they ignore another problem in their analysis: the measures, although less rigorous, can be taken at any time of the day. At the same time, we still do not know what Apple or other developers will be able to do with the right algorithms when they have measurements obtained regularly or in different contexts – we have to remember that the Apple Watch is also used, by example, for regular monitoring of physical activity.

Could the development of such devices be a tangible improvement in the medium term for research or for the practice of cardiology and medicine in general? All things considered, I must say that I am convinced that they will do it.

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As a professor of innovation, I am naturally interested in the response to new products, and the launch of the Apple Watch 4 and its cardiac monitoring features is a good prediction and modeling study of specialist feedback. medium to long term. In short, working intensively on a subject for a long time distorts views on what is positive or negative about an innovation, as well as about innovation in a particular context or process of innovation. social adoption.

How could we classify these answers? For starters, doubts can be raised in an open format just like Ethan Weiss, which I mentioned in my previous article on the subject, which during the presentation of Apple Watch commented on Twitter: "I can not know if it's the best day of the day." 39, history of cardiology or worse. in clear and neutral terms, by anticipating the kind of scenarios that one can expect from an experienced cardiologist: non-intrusive surveillance able to identify problems before they become critical and its potential to save lives against cardiologists' waiting rooms filled with data they do not understand

The next day, the Washington Post raised similar concerns, after speaking to several cardiologists, in an article titled "What cardiologists think about the Apple Watch's heart tracking function": unnecessary visits to the GP. The interpretation of an electrocardiogram requires some knowledge of the technique and parameters used, which could cause untrained people, faced with natural variations in their heart rate, to alarm or feed them. their hypochondria. There is no doubt that this is a minor problem in the context of the potential benefits of a technology that can quickly alert people to potential heart problems. The possibility for people without adequate readiness to regularly access a diagnostic tool such as an electrocardiogram can be alarming to the professionals responsible for making decisions with these same tools, but the question that we could usefully ask is to know unnecessary visits to the cardiologist or to people uninformed of their health.

The reliability of the device used to capture and process the data is a different issue. An article in Quartz, "The new heart monitoring capabilities on Apple Watch are not so impressive," points out that the electrocardiogram obtained by Apple Watch gives a much more flawed and rudimentary result than a hospital, where twelve electrodes are attached. at different areas of the chest, arms and legs. The clinical device offers a much higher accuracy, but in exchange for a much lower level of convenience. Even though it was possible that the Apple Watch was connected in this way, the idea that a lot of people use it regularly or daily is ridiculous. The clinical device provides highly reliable and rigorous measurements in a hospital environment, while the Apple Watch provides fewer indicators and with a much lower level of accuracy, but at any time and under any circumstances. Could this contribute to the health of patients with, for example, conditions that do not manifest themselves when they are in their doctor's office? I am sure we will see cardiologists reviewing the records obtained by Apple Watch from some of their patients. This does not mean, of course, that it is necessary or justified in all cases, or that we should put pressure on doctors to do so.

These issues have been raised by manufacturers of other consumer devices, such as WIWE, which I also mentioned in my previous article on Apple Watch 4. The company has been working for years to produce a device the size of a credit card by holding both thumbs, making sure your hands do not touch each other, this gives an electrocardiogram with data and complete charts recording arrhythmia, atrial fibrillation, l '; ventricular heterogeneity and oxygen saturation in the bloodstream; using … a watch. No wonder WIWE is skeptical:

Although we have not tested it yet, just look at the hardware configuration of the watch which can affect signal quality when recording the ECG. Although it is a common design element in single-conductor ECGs to allow users to place their fingers on the sensors for full contact and a powerful signal, the watch obviously does not offer this configuration.

A very common problem may arise from a simple thing: the furry wrist of the user may interfere with the sensor supposed to pick up the signals from that channel and its ability to gather reliable information for evaluation is therefore limited. Let's see the other channel. The user's pointing finger should be held in position long enough to risk shaking, feeling tension, etc. In other words, stable and peaceful contact is hard to reach. If you compare, you can place WIWE on a flat surface and put your fingers on the sensors for the duration of the measurement.

Regarding AF detection: we have not seen any information on its accuracy (WIWE reached an accuracy of 98.7% in tests on 10,000 clinical samples – our certificate is available on request ) and checks the atrial activation (by examining the "P" wave). as WIWE does), or is the evaluation based solely on the heart rate (distance RR?) As far as the published information can be seen, they do not analyze the wave. QRS, QTc, PQ, while WIWE offers all this to clinicians. If they rely solely on the heart rate, the result of the assessment can be confusing when detecting the FA and this is confirmed by the FDA statement: "L". ECG application is not intended for people under 22 years of age. with other known heart diseases that can disrupt your heart rate.

Having said that, it is a great achievement that they have got the support of the AHA and they have received authorization from the FDA. We obviously did not say that the watch could not detect AF, but there are concerns at this stage. "

Again: it seems clear that in the category of consumer products, the accuracy of a device designed specifically to obtain an electrocardiogram, with two sensors and a reasonably ergonomic configuration to keep the thumbs on them without problem get more reliable results than a watch designed for a wide variety of functions, including reading the time. But the counterpart, again, is obvious: with the WIWE device, I monitor my heart rate when I remember and usually not even every day. With the watch, I monitor myself at all times and in all circumstances.

Are the reactions to the innovation of physicians and designers of competing products justified? There are certainly reasonable grounds. However, they ignore another problem in their analysis: the measures, although less rigorous, can be taken at any time of the day. At the same time, we still do not know what Apple or other developers will be able to do with the right algorithms when they have measurements obtained regularly or in different contexts – we have to remember that the Apple Watch is also used, by example, for regular monitoring of physical activity.

Could the development of such devices be a tangible improvement in the medium term for research or for the practice of cardiology and medicine in general? All things considered, I must say that I am convinced that they will do it.