Sumbul Desai, MD, Vice President of Apple Health talks to CardioPulse Digital about her fascination for Digital Health and Apple’s involvement and developments in healthcare.
What attracted you to Digital Health?
At Apple, we are focused on creating products and features that enrich people’s lives. Our teams operate at the intersection of technology, design, and science in such a unique way. And while we are still early in our journey in health, I am so proud of the things that we have done to date.
I am one of several physicians who work at Apple and I believe we all come with a similar passion for making a positive impact—it is the reason that we became physicians ourselves. To empower people to engage in their health in ways that they have not thought about before, at scale, is an incredible opportunity at Apple. Much of my inspiration in this area started in residency when I began noticing areas of opportunity both from continuum of care and even within the hospital around teams’ communication technology. We have a lot more to do, but I think the ability to serve as a nexus point—bringing technology to the medical community through features and products that are usable, understandable, and impactful was what was really exciting to me.
Sumbul Desai, MD, serves as Vice President of Health at Apple, overseeing health initiatives including clinical product development, medical research, and innovative clinical partnerships. She also leads the regulatory and quality teams at Apple. Apple is also working with the best in the medical field, including Harvard T.H. Chan School of Public Health, the American Heart Association, Brigham and Women’s Hospital, and Johns Hopkins University, to conduct landmark health studies and advance discovery with the ResearchKit and CareKit platforms. Apple recently launched its Health Sharing and Walking Steadiness features, adding to the many consumer health tools available on Apple Watch and iPhone including ECG, Irregular Heart Rhythm, Cycle Tracking, and Hearing Health. Dr Desai recently served as Vice Chair of Strategy and Innovation in the Department of Medicine at Stanford Medicine, as well as Associate Chief Medical Officer at Stanford Healthcare. She also serves as Clinical Associate Professor in the Department of Medicine at Stanford School of Medicine.
In our everyday lives, smartphones have become a necessity. When shopping, our finances, navigating, etc. we can no longer do without. However, we are not there yet in healthcare. What are some of the trends you are seeing in digital health?
We have a deep-seated belief that access to one’s health information empowers people to take a more active role in their own health and wellbeing, particularly when it is offered in a way that preserves privacy. We already see innovative ways this information can be used to help guide people to seek appropriate care and how it can augment patient–provider interactions, especially when people cannot be in a room together.
Also, reflecting on these past 2 years, family, communication, and health have become more important than ever. Through new features on iPhone, users around the world are able to connect with loved ones and caregivers and are able to choose to share their health data, providing a trusted partner on their health journey from anywhere, anytime.
Is there any specific domain of the spectrum of healthcare that Apple has a particular interest in?
Our approach at Apple has been very organic and we are driven by a belief to focus our efforts where we can make the most impact for our users, which often span across the spectrum. For many, that means helping them be more physically active through our Activity rings and services like Fitness+, while tracking their health data such as resting heart rate, Sleep, or Cardio Fitness on Apple Watch through the Health app. For others, it is about working with their doctor on the discovery of a new condition or diagnosis such as atrial fibrillation, and potentially getting care earlier.
We are excited about recent features that launched with iOS 15, such as Walking Steadiness, which is focused on identifying gait characteristics that signify an individual may be at risk of falling in the next 12 months. Finally, it is also about building the tools, like ResearchKit and CareKit, to help enable the clinical community with new medical discoveries and continue innovating clinical care.
Cardiology is a specialty in which remote monitoring (arrhythmia, heart failure) and speed/communication (acute myocardial infarction) are essential. With the iPhone and Apple Watch, the capabilities of which are increasing every year, Apple has the opportunity to develop into a key element in the healthcare chain. How do you see this developing further?
iPhone and Apple Watch are often with our users all the time, and, as people increasingly use them in their everyday lives for things like payments, navigation, and, of course, communication, they become more essential. I think that presence with a user everyday frames our opportunity—how can something that is with you everyday help an individual better manage their own health?
I see this already taking shape in our features today, for example, we are giving users insight into their cardiorespiratory fitness and how it changes over time. We have also designed some features specifically to support the patient–provider relationship, like generating a PDF for ECG tracings so that users can easily share information with their cardiologist.
How is Apple collaborating with the medical community?
We have a history of enabling the medical community through our products and APIs to help researchers produce medical insights and discoveries from epilepsy to multiple sclerosis at a pace and scale never seen before. We do this by collaborating with the medical community in a number of ways.
We never want to create technology in a silo and throw it over the wall for people to use. There is a tremendous commitment to the science that underpins all of our health features, and we work with clinicians and medical researchers to design and conduct the studies that power those features.
We also support researchers in pursuit of their own interests by providing users with the ability to contribute data and health information for research, providing tools like ResearchKit and CareKit which continue to make building apps for research and care easier than ever. We encourage other researchers to use our products as well in their discoveries. Through our Investigator-Initiated Research Program, we provide Apple Watch in support of health research.
How are you seeing technology change and improve the patient experience?
We are seeing incredible ways providers are pursuing our technology to help improve patient care and enhance the patient and provider experience in the hospital and after discharge. Simple examples include giving patients control of their room environment from an iPad to connecting a patient in isolation to their provider and family via FaceTime in order to preserve a personal connection while reducing the risk of spreading an infection. The team at Ochsner Health in the USA has established a number of remote care programs, including their Connected MOM (Maternity Online Monitoring) program, which enables expectant mothers to connect to care teams through pregnancy, using iPhone and Apple Watch. They have told us that this program has resulted in reduction in visits and identifying pre-eclampsia weeks earlier. Another example is Dr Benjamin Meder and his team at Heidelberg University Hospital in Germany are using Apple Watch to assess the impact of a home exercise program in individuals with dilated cardiomyopathy. We hope this will prove to be beneficial to the long-term health of these patients and are excited to see the outcome of their research.
How is privacy integrated into your work in health?
Pivotal to our mission in health has been our dedication to privacy. For many of us, there is nothing more sensitive than our health data. We have seen how critical it is in the financial world to protect the privacy of a person’s financial data. Health data are just as, if not more, a priority to protect.
Privacy really is fundamental to the design and development of our features. Users won’t have to sacrifice their own privacy in order to access their health data or share it with loved ones. The user is always in charge, with granular control over data types they choose to share, and with whom. All of a user’s data are encrypted and only accessible with their passcode, Touch ID, or Face ID. So, however, they use the Health app, they are always in control.
Can you talk about the development of your health features, in regard to accuracy and understanding?
We develop health products and features based on clinical science, with a careful consideration of the implications of sensitivity and specificity. Our features are designed to ensure a high positive predictive value for users who receive a positive result. For example, the ECG app algorithm classification achieved a 98.3% sensitivity and 99.6% specificity. We regularly share white papers on the development and validation of our features to help our clinical communities further understand our approach.
We also do user testing with the aim of educating people about what a feature detects and does not, and that our software is not replacing medical care. In order to also make sure the clinical and research community, as well as our users, are aware of the development and performance of our features, we continue to publish research and white papers to enable informed integration of that data.