Apple Watch and Ayushman Bharat-What's the untapped market value no one is discussing? #applewatch #apple #google #bigdata #AI

If this is the era of big data, then the month of September has been one of the most significant periods in its recent advent. The debut of the Apple Watch with an embedded ECG, and the official inauguration by the Government of India (GOI) of its landmark program, Ayushman Bharat, the world’s largest healthcare scheme, are two milestones with interesting implications for consumers and policy makers.

Apple, a global leader in personal IT devices, recently announced the launch of the Apple Watch Series 4, which is one of the first consumer smartwatches with the ability to generate an electrocardiogram (ECG, or also called an EKG). If you’re not familiar with an ECG, it’s a device that allows a doctor to measure the rhythm and speed of the electrical activity of the heartbeat. Typically in a traditional consult a patient would exhibit signs of cardiac illness and a doctor would order an ECG to further evaluate the patient. The patient would then proceed to a cardiac lab and a technician would place electrodes on their chest and start the ECG machine to measure cardiac activity at rest as well as possibly “in stress”, when the heart rate is increased by the patient walking or jogging on a tread mill. The ECG results, or measure of the heart’s activity, would then be transmitted to a monitor and a record would be made, which would then be reviewed by the doctor and the patient to determine an appropriate next step. An ECG can indicate if parts of the heart are overworked or enlarged, thus signaling heart disease or heart valve problems. The new Apple watch allows the patient to bypass the doctor’s order and directly measure their own cardiac activity by using the sensors on the watch to record the same information as an ECG. No doctor, no cardiac lab, no waiting around for an appointment, no expensive capital equipment! This is one of the first personal devices that will be revolutionizing how patients interact with the medical system. While Apple isn’t the first company to launch a consumer-friendly or personalized ECG, they are the biggest by market capitalization, and that has implications.

On the other side of the planet from Apple’s home in Cupertino, CA, lies New Delhi, India, capitol city to the second largest country on earth by population strength. This year the GOI devised a new healthcare program called Ayushman Bharat to provide 1,350 types of surgery to about 40% of the country’s citizens who are determined to be Below Poverty Line (BPL), an official economic status as per the GOI Socio Economic and Caste Census database. Under this new healthcare scheme approximately 500 million Indians are eligible to receive a cashless benefit that entitles a family of up to $7,100 annually to avail secondary and tertiary care in either enrolled public or private hospitals. The GOI is partnering with most of the state and union territory governments to fund this ambitious program, and it has already delivered care to its first patient in Haryana state a few weeks ago. While there are still many details to be worked out-insurance companies to enroll patients and provide payments to providers in an agreed time frame, increasing the number of participating hospitals, strengthening primary care, ensuring patient eligibility-to name just a few, still, Ayushman Bharat is a potential health game-changer that will have significant policy ramifications for India and other low and middle income countries that may embark on a similar government-funded healthcare scheme. While Ayushman Bharat falls short of providing universal coverage to all Indians, it is still a significant step towards that goal.

So what do the Apple Watch Series 4 with embedded ECG and Ayushman Bharat, these two seemingly disparate September launches, share in common? Both of these programs could provide a wealth of information to policy makers and health planning officials if used as part of a sentinel surveillance and monitoring and evaluation systems.

Sentinel surveillance is the monitoring of changes (or stability) in the health levels of populations. It can also provide insights into disease trends of a particular geographic area or population cohort to estimate trends in a larger population. For example, while the Apple ECG results may drive consumers/potential patients by droves into cardiologists offices to follow-up on their personal health, the results, if aggregated by Apple or an independent research body like the American Heart Association, could provide unique insights and trends to help governments better understand where and why cardiovascular disease occurs, with the goal of providing early interventions to minimize disease and increase health. The Apple watch and competing devices have provided new tools to increase sentinel surveillance if the data it generates is properly analyzed and made available to all researchers. 

Likewise, as Ayushman Bharat removes some of the financial barriers to healthcare access, monitoring and evaluating program outcomes should also be part of its objective (it is not as of this writing). More importantly, as an investor in health, the GOI should not only want to know where they spent money and on what types of surgeries, but they should be interested in how the patient did post-intervention. The quality of the experience is just as important as the actual care that was provided. Clinical quality and its subsequent indicators tell policy makers, as well as individual hospitals, if the intervention or surgery had the intended outcome. For example, clinical quality indicators should be able to answer questions such as did the patient survive 30 days post-surgery, did they acquire a hospital-originated (nosocomial) infection, were they rehabilitated so they were able to return to activities of daily living? The list of potential questions can be tailored to the surgical care, but questions like these are some of the very basic inquiries that outcomes measurement should be able to address. If improved health is the objective, then simply accounting for performing a surgery isn’t enough; monitoring the patient post-surgery and reporting the outcome is the ultimate indicator of goal obtained.

The era of big data is here, but there’s still much work to be done to truly benefit from the information that’s being generated from personal devices as well as national health programs. Both the Apple Watch and Ayushman Bharat are unique experiments in increasing access, but if they fail to report their outcomes and create meaningful data sets that could help policy makers, payers and patients better understand how to target and manage care, they will have only gone half way. Is it time to fund independent data healthcare clearinghouses that collect, normalize and makes this data available to others? Scientific discovery could be enhanced by sentinel surveillance and outcomes measurement data. Patients who could benefit from early interventions, therapies, including clinical trials, and other rehabilitation programs could be better identified and engaged by reporting the explosion of data that the Apple watch and Ayushman Bharat are about to generate. The technology exists, but it will take commitment by business, governments and non-profits to work together and truly leverage this potential. Anything less would be a lost opportunity.