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Apple Watch: As smart watch's smart heart tracking features are turned on, Apple explains its turn to health and wellness

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David Phelan
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Since its launch in 2015, the Apple Watch has evolved with new features and capabilities. Now, thanks to a just-released software update, the latest model of Apple Watch, called Series 4, is capable of advanced heart measurements.

These features have been available to Watch users in the United States for the last few months but have now been cleared by authorities in Europe as well. From today, in 19 European countries including the UK, Watch wearers can take an electrocardiogram right on their wrist.

Apple has always had a strong interest in health and wellness, but the emphasis has grown in recent years and Apple Watch has been at the forefront.

Apple’s Chief Operating Officer Jeff Williams has been especially vocal about the importance of these aspects. He unveiled the ECG feature at a keynote last September alongside a striking new fall detection system.

If an Apple Watch detects that the wearer has fallen hard and not got up again a minute later, it can automatically call emergency services. That’s not something a regular timepiece can do. It’s an example of how much the focus on health, which CEO Tim Cook referred to, saying, “If you look back, and you ask the question, ‘What was Apple's greatest contribution to mankind,’ it will be about health.”

Jeff Williams is similarly passionate. I met him in the company’s Cupertino HQ. Williams is laid-back and relaxed, but he speaks with a thoughtful precision.

“We're excited about the opportunity in health,” he says. “We don't think the Watch is specifically a health device. It's important that it’s a thing of value across a range of areas. For some people it helps them be more present. for some it helps them with their fitness and for others it helps them discover health issues. If we were selling a heart rate monitor only, we would probably sell about 12 of them.”

Of course, the Apple Watch does more. It lets you make phone calls, alerts you to emails or text messages, gives you directions and tells you the weather. Oh, and it tells the time, accurate to 50 milliseconds.

But it’s the health features which are the most striking. As well as the capacity to take an ECG reading, it can monitor your heart rate in the background to spot if you may have atrial fibrillation, or AFib, an irregular heart rhythm which can lead to serious medical issues such as stroke. This new feature has also just gone live in the UK and is common to all Apple Watch models running the latest watchOS 5 software. Only the first-generation Apple Watch is not capable of using watchOS 5.

So, why is the Watch the right place for all this health focus? Williams explains, “Apple Watch is the most personal device we have ever created, and because you wear it, there’s an opportunity to understand more about your body. And I think there’s this subtle, but important, aspect of Apple Watch, where your relationship is different than with other devices. Apple Watch allows for an in-the-moment association, making it a more natural health companion to nudge you in a friendly way.”

Williams says that Apple receives letters every day about the Apple Watch. “Most of the letters we get from consumers start with a story. They say they bought the Watch because they wanted to keep track of something or ‘I bought the Watch because I wanted to work out more.’ Because there are tens of millions of heart rate monitors on people's wrists, it's allowed us to be an intelligent guardian. The opportunity to positively impact peoples’ health is unlimited here, and it’s more than an opportunity, it’s a responsibility we can’t squander.”

Taking an ECG is a simple process. You launch the new ECG app, touch the Digital Crown on the Watch and hold it there for 30 seconds. Because of an electrode in the Crown and another under the Watch touching your opposite wrist, you are completing an electrical circuit through your body and the Watch can measure your heart rhythm with great accuracy. An animation of a heart pulses on screen and when the ECG begins it turns into an elegantly drawn red line, mimicking what’s going on inside you, as Apple Designer Alan Dye explains.

(Apple)
(Apple)

“What we wanted to do is bring the visual experience of what the user sees on the screen in line with the physical experience. So, the animations that you're seeing respond precisely to not only your heart rate but also the softest touch on the Digital Crown. Once you see the ECG, that is actually your heart rhythm.”

At the end of 30 seconds the Watch screen shows one of several messages to indicate what it’s found. This could be Sinus Rhythm which indicates your heart is beating in a uniform pattern, Atrial Fibrillation, a low or high heart rate or an inconclusive reading. The ECG is saved in the Health app on the iPhone and can be sent to a medical professional as a PDF they can read and, crucially, interpret.

“We have a huge responsibility here as designers to try and put the data in context to make it accessible and displayed in a way that is easily understood by the user and then to give them agency over that data and the ability to access it but also to have a conversation with their medical professionals around it,” Dye explains.

“We want to make sure that we're not placing a point of view on that data. We've spent a lot of time trying to get the technology out of the way. So, users can have a greater understanding about their health and well-being really without having to do a whole lot of work. We know that this capability can have a profound effect on people's lives. I can't think of anything more motivating for a team to hopefully do our best work.”

I’ll be honest, the first time I took an ECG reading, it made me think hard. This is a serious thing and, as Williams points out, it’s not a toy. But the process is so simply, effectively done, it’s hard not to be affected, even moved, by it. One of the benefits is that you do it yourself, when you’re ready, a much less traumatic experience than visiting a doctor and being hooked up to machines. That’s much more stressful and if you have symptoms, they may not strike at that very moment, so your tests are inconclusive. Doing an ECG when you want to is much easier.

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Although the ECG is easy to do, when talking to Jeff Williams, I had a nagging feeling. Now that this procedure is possible on your Watch, isn’t there the chance that false positives will occur, causing extra work for the NHS and anger from your GP as you report it?

Apple has conducted an indepth examination, called the Apple Heart Study, in conjunction with Stanford. In that study, which covered more than 400,000 patients, the false positives only amounted to 0.5 per cent of the total. Williams confirms the examples of false results was very low. “We were very focused on that and we've been very conservative in how we've approached the algorithms.”

Sumbul Desai, Apple’s VP of Health, adds, “We look for the presence of AFib multiple times before we actually send a signal to a user. We want the ECG readings to provide a good reading and we ran a large study. We have over 98 per cent accuracy for detecting AFib.”

Williams again: “We realise that crossing into the medical world carries with it a great responsibility. We have approached our work in the space with the deepest rigour, and a great deal of deference for the things we didn’t know, working closely with the medical community. We could have shipped these products early, but we worked closely with the medical community to run the largest study of its kind.”

It’s also the case that before you can take an ECG, Apple provides several mandatory screens explaining what to expect and what the Watch can and can’t tell you – it can’t predict heart attacks, for instance.

Apple has made huge investments in researching health, including setting up an extensive secret fitness testing facility. “The facility was built originally to test calorie burn,” Williams reveals. “We could have implemented a standard solution, but at Apple, we obsess over the details and the science of everything we do and built this lab and ran over 10,000 tests to ensure accuracy in a variety of conditions. Today, we have expanded on that base to look at other elements of people’s health.”

When the Watch was first being devised, the heart rate sensor was included for a simpler reason, as Williams explains. “We originally put a heart rate monitor on Apple Watch to have an accurate calculation of calories. When customers started sharing their stories about the heart rate monitor helping them with their health, we were inspired see what else we could do. So, we said, well as long as some people are noticing their heart rate, why don't we have the Watch notify people and pull on that thread? Then we worked on irregular rhythm and ECG. So, this is all about empowering people with information about their health. We think we’re just at the beginning.”