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With Healthbook, Apple Asserts Itself as the Platform for Digital Health

The tech giant's moves raise new questions about its plans to develop medical sensors.

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Emerging details about Apple’s forthcoming Healthbook app suggest the tech giant is asserting itself as a platform for digital health, a clearinghouse for data that could potentially prove as useful, revealing and lucrative as the ad profiles that drive the online economy today.

The Cupertino company’s activities also raise questions about its plans to develop new medical sensors (possibly including a bloodless glucose monitor), integrate existing ones into forthcoming wearable devices or partner with companies developing these capabilities.

“I wouldn’t be surprised if Apple has grand designs,” said Skip Snow, a senior health care analyst at Forrester Research. “They don’t usually do things on a small scale.”

But he and others said it was unclear whether Apple would come to dominate this space, as other tech companies are equally eager to plant themselves at the center of the health ecosystem — a sector that adds up to 17.9 percent of the nation’s gross domestic product.

“We think that there’s going to be the battle of the bio-signal over the next few months and years,” said Stephane Marceau, CEO of OmSignal, which is creating undershirts with various sensors. “We think all the big guys — Google, Apple, Facebook, Amazon — will want to have biological signals in their cloud and they’ll go hard after the opportunity.”

It’s not certain how close to a final product Healthbook is or what it will look like when it hits the market. Early designs for the app appear to allow consumers to closely track health, fitness and activity information, as first reported by 9to5Mac and largely confirmed by Re/code’s own reporting. Apple declined to comment for this story.

Many of the categories could be populated with data from sensors already embedded in existing wearables like the Fitbit or other devices for the wrist, including the long-rumored Apple smartwatch. Any combination of accelerometers, altimeters and heart rate sensors can deduce pulse, sleep patterns, calories burned, stairs climbed and steps taken (though with disputed levels of accuracy).

But other categories in the app would seem to require sensors elsewhere on the body, at least with existing and approved technology today. That includes blood pressure, hydration, respiratory rate, oxygen saturation and blood sugar.

It’s not totally clear if Apple plans to build some or all of these capabilities itself, or allow third-party devices to integrate with Healthbook. But Marceau thinks no one company can do it all in this space.

“Over time there will be such a large variety and multitude of sensors and inputs that you want to draw from, that you’ll have to do this by building an ecosystem,” he said. “The notion that you’re going to have all the form factors in the world is hard to imagine.”

Devices exist that capture all of this information today, but few that are as passive and convenient as throwing on a wristband or watch. Among them:

  • Cambridge startup MC10 has developed a skin patch that can detect hydration levels.
  • Withings has created a blood pressure monitor that connects directly into the iPhone or iPad, but still requires strapping a band around your bicep, much as in your physician’s office.
  • iHealth Lab offers a series of wireless medical devices, including a blood pressure monitor that goes around the wrist, a pulse oximeter that detects oxygen saturation levels through the fingertip and a blood glucose monitor that uses drops of blood. (Re/code’s Walt Mossberg reviewed it and a competing offering from LifeScan late last year.)

The Long Game

Apple’s move into the space presents opportunities for companies building these tools and raises the profile for the sector more broadly, said Adam Lin, president of iHealth.

“The fact that Apple would commit to something like this shows we’re moving beyond just activity and fitness,” he said. “They’re looking at it as a holistic application for health.”

Another question is what part, if any, Apple’s M7 co-processor will play in the company’s foray into the health and fitness market. The M7 chip, existing in the iPhone 5s and newer iPads, allows for the passive gathering of motion and activity data. Health and fitness apps that are utilizing the new chip, such as Fitbit, Moves, RunKeeper and Strava, can get a more accurate reading on activities. The chip is also easier on batteries.

Since the developer community is critical to Apple’s success, it makes sense that Apple would introduce a chip that not only maximizes battery life but also moves the needle for developers of health and fitness trackers. But some in the industry believe that Apple may be playing a long game in which the M7 co-processor is potentially repurposed for Apple’s own wearable device.

The blood sugar card in Healthbook, as shown on 9to5Mac, raises other interesting issues. Currently, glucose monitors require pricking the skin or stabbing into subcutaneous tissue, painful realities that mean people living with diabetes often don’t check levels as frequently as they should — and that few people would consider their use for a general health signal.

But various companies and researchers are working to change that. Google’s research division is testing a contact lens that could monitor glucose in tears, while others are exploring measuring levels in saliva, breath or though infrared light shined through the earlobe.

Continuous glucose monitoring would be the “killer app” for the quantified self, enabling the analysis of caloric intake and dangerous eating patterns, the noted computer scientist Larry Smarr recently told Re/code.

Apple has made some conspicuous hires in this area, too, as 9to5Mac and MobiHealthNews have pointed out.

Last year, the company picked up Todd Whitehurst, who previously led the product development team working on a continuous glucose monitor at Senseonics. In addition, it tapped Ueyn Block, the former director of optics at C8 MediSensors, which was developing a means of detecting glucose levels in the blood by shining light through the skin.

Apple also brought on experts across the broader wearables and medical sensor spaces, including Jay Blahnik, who helped develop the Nike FuelBand; Nancy Dougherty, who previously worked on a Band-Aid-like skin sensor, digestible “Smart Pills” and other wearables for Proteus Digital Health and more recently Sano Intelligence; Ravi Narasimhan, who was responsible for sensors monitoring electrocardiography, respiration and more at Vital Connect; and Michael O’Reilly from Masimo, which developed a sensor for the iPhone that measured blood oxygen levels.

These signs suggest the company is at least exploring some novel medical sensors on its own, rather than simply planning a slicker Apple spin on standard wearable fare.

But new sensors for medical purposes, rather than fitness or activity ones, are likely to face months, if not years, of Food and Drug Administration trials before they could reach the market. A team of Apple executives met with the FDA in December to discuss “mobile medical applications,” including O’Reilly, Senior Vice President Jeff Williams and others.

Consumerizing Health Care

Why is Apple making such a big play here?

Many observers believe we’re at the beginning of a transformation in health care, a consumerization of the space driven by the same online tools, apps and devices that have overhauled retail, media and finance. People have access to more information to make their own decisions about doctors, treatments and lifestyle choices.

“Given the fact that Apple is essentially a consumer company and given the fact that healthcare is moving toward the consumer, the convergence of Apple and health makes perfect sense,” Snow said.

The shift presents opportunities for new players to grab a piece of the nearly $3 trillion spent on health care just in the United States, not to mention a slice of the fitness market. But the data generated by the digitalization of health care — from electronic medical records to wearables and apps — can also potentially be leveraged to discover novel treatments for diseases, or applied to more quotidian matters like serving up ads when people are in a relaxed mood.

Of course, most of this is just potential for now.

To date, companies developing wearables have seen significant attrition rates and have struggled to translate raw health data into genuinely useful information for consumers.

According to the Consumer Electronics Association, 10.3 million health and fitness devices (excluding smartwatches) were sold in the United States last year, a figure expected to reach 29.5 million per year by 2017. Revenue is expected to leap from $854 million to $2.9 billion during the same period.

But a recent report from Forrester underscores that trackers are not yet mainstream: In January, the research firm said just five percent of U.S. online consumers reported using a wearable device to track their daily activity levels. A quarter of those surveyed expressed interest in fitness wearables — “at the right price.”

“No average consumer knows what to do with the blood oxygen content from their finger,” Forrester analyst Frank Gillett said. “What they really want is something like, ‘Hey, you need you to take a walk today, and if you do that every day we’ll knock $5 off your insurance’ or something.”

“So what we’re seeing,” he added, “are the foundation elements for something that may be more practical than the things we see in today’s activity-trackers.”

Re/code’s John Paczkowski contributed to this story.

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