iOS 15 Health Features: Apple's Advances & Future of Health Tech

Apple's Expanding Role in Personal Health Technology

The recent Apple Worldwide Developers Conference (WWDC) keynote revealed numerous advancements for iPhones, Macs, and iPads. Consistent with its trajectory since the initial launch of the Health app in 2014, these updates encompassed enhancements dedicated to individual health and wellness.

Evaluating the full scope of Apple’s contributions to this field is often challenging immediately following announcements. Health-focused feature reveals typically don’t generate the same level of excitement as significant changes to the user interfaces of Apple’s device operating systems.

However, considering the broader picture, Apple has developed what is arguably the most robust and readily available collection of personal health tools for individual use, and its development continues unabated.

Insights from Kevin Lynch, Apple VP of Technology

A conversation with Kevin Lynch, Apple’s Vice President of Technology, offered valuable perspective. He originally showcased the Apple Watch during the September 2014 Apple keynote.

Lynch has witnessed the substantial growth of the Apple Watch throughout his tenure at the company and has been a key figure in the advancement of its health-related features.

He detailed the evolution of the platform and offered some indications regarding its potential future direction.

“The evolution over time has been remarkable,” Lynch stated, referencing the original Health app. “It actually originated with the Apple Watch, where we were collecting heart rate data for activity and calorie expenditure, and for completing the [Activity] rings. We needed a repository for this heart rate data, and thus the Health app was created.”

The Apple Health app initially served as a simple companion to store activity data from the Apple Watch in 2014. Image: Apple

Following this initial step, Lynch explained that Apple recognized the potential of a centralized data location. They could then develop a system capable of storing diverse data types.

Furthermore, they could establish an API and architecture that would allow developers to store related data while upholding user privacy.

Initially, the Health app functioned primarily as a passive data storage solution, providing users with a single access point for various health-related metrics. However, the company soon began exploring additional functionalities, drawing inspiration directly from its user base.

The Evolution of Health Features at Apple

A pivotal moment in Apple’s health strategy occurred when the company observed users utilizing Apple Watch functionalities in ways beyond the original design, as explained by Lynch.

Initially, the device displayed heart rate data primarily for activity tracking and calorie expenditure. However, individuals began monitoring their heart rates during periods of inactivity and identified irregularities. These observations prompted medical consultations, resulting in diagnoses of underlying heart conditions, and subsequently, correspondence directed to Apple. This feedback continues to be received, demonstrating the impact of their technology, but early communications signaled a potential for proactive health monitoring.

Consequently, Apple implemented high heart rate alert notifications, informing users when the Apple Watch detects an elevated heart rate during periods of low movement. Elevated resting heart rates can indicate potential health concerns, and Apple later expanded this feature to include alerts for unusually low heart rates. This information, already accessible to users, was now proactively delivered, mirroring the benefits experienced by the most health-conscious Apple Watch users.

Apple Watch introduced high heart rate notifications in 2017. Image: Apple

Following this, Apple significantly increased investment in exploring additional areas for similar insights. While user behavior remains a valuable source of inspiration, the company broadened its team to include more clinicians and medical researchers to guide the future development of its Health features.

A prime example of this approach was unveiled at WWDC: Walking Steadiness, a new metric that provides a straightforward assessment of an Apple Watch wearer’s gait stability.

“The development of Walking Steadiness […] stemmed from the work on fall detection,” Lynch stated. The initial focus was on detecting falls and providing assistance, but the team began to consider preventative measures – how to help individuals avoid falls altogether. Intervention during a fall is challenging, as immediate action is limited.

Lynch refers to the fall detection capability introduced in 2018, which leverages motion sensor data to identify potential falls and automatically initiate emergency alerts. Apple analyzed data from its 100,000-participant Heart and Movement study, combined with iPhone-gathered walking metrics, to refine this technology.

“[Data from the Heart and Movement study] proved invaluable in the application of machine learning,” Lynch explained. “Furthermore, a dedicated study focused on falls and walking steadiness utilized traditional walking steadiness measurements – questionnaires, clinical observations, and doctor assessments – as a benchmark. By analyzing metrics collected over a year or two prior to falls experienced by study participants, we identified key predictors of potential falls and developed a predictive model.”

Apple’s Walking Steadiness metric in Apple Health in iOS 15. Image: Apple

Apple achieved a notable accomplishment with its Walking Steadiness feature: the creation of a clinically validated, meaningful metric for individual health assessment. The Health app assigns a score ranging from Very Low to Low or OK, based on passively collected motion data from Apple’s iPhone sensors, which are optimally positioned for accurate detection, according to Lynch. Importantly, the data provides actionable insights for users.

“A significant aspect is its practicality,” he added. “Some health factors are difficult to modify, but walking steadiness can be improved through targeted exercises. We’ve integrated these exercises into the Health app, allowing users to view instructional videos and work towards enhancing their stability and reducing fall risk.”

Walking steadiness exemplifies Apple’s evolving focus in health: transforming everyday devices into proactive health guardians.

‘The Intelligent Guardian’

Apple’s Health application delivers a comprehensive view of the health metrics users may wish to monitor. The company has consistently expanded its collection of verified, contextual information. This enhancement simplifies the understanding of collected data, including updated lab result displays in iOS 15 which translate complex findings into easily understood language.

However, a key area for innovation lies in proactive and preventative healthcare. Jeff Williams highlighted that the walking steadiness feature represents a continuation of these developmental efforts.

“The development of walking steadiness falls within what we term ‘Intelligent Guardian’,” Williams explained. “This focuses on how we can proactively monitor individuals using data they might not typically review or even be aware of, alerting them to potential health changes.”

Evolving Focus

Williams acknowledged that the ‘Intelligent Guardian’ concept wasn’t a primary consideration during the initial stages of Apple Watch and health feature development.

“Initially, we didn’t prioritize the ‘Intelligent Guardian’ approach to the extent we do now,” he stated. “However, early user feedback proved incredibly valuable, demonstrating our capacity to inform people about genuinely significant health insights.”

Fall detection on Apple Watch. Image: Apple

These user stories continue to inspire the health features team, providing motivation and validating their work. Williams shared an example where an Apple Watch purchased for a father alerted emergency services after he was thrown from his bicycle into a gully.

The Watch detected the fall and the user’s unconscious state, automatically notifying emergency contacts and 911. Crucially, it also provided the son with the father’s precise location, enabling a rapid response. Paramedics were already on the scene when the son arrived, preparing to transport his father, who ultimately recovered.

“This experience sparked further consideration: ‘What other aspects of a person’s health could we potentially detect and communicate?’” Williams said. “Our health initiatives involve a continuous dialogue between clinical needs and scientific feasibility.”

This involves exploring what clinically relevant information can be gleaned from existing data, and investigating the potential for new sensors to gather data that addresses key clinical questions.

• The goal is to identify what we can realistically know and extract from the data.
• It also includes exploring new sensor technologies.

Ultimately, the aim is to build tools that provide clinically valid and actionable health insights.

A Collaborative Perspective on Personal Wellbeing

A significant enhancement arriving with iOS 15 for Apple Health centers around data sharing. Apple will facilitate the private and secure exchange of health information between users and their close contacts, including family members and medical professionals. Individuals retain complete control over the specific health data shared, with the ability to revoke access at any time. Importantly, Apple does not access this data; it remains encrypted on the user’s device and is decrypted only in the recipient’s device memory.

Apple Health Sharing functionality within iOS 15. Image: Apple

This health sharing capability represents a logical progression from Apple’s work on the Intelligent Guardian feature. It acknowledges that personal healthcare is fundamentally a network-based activity, supported and improved by contemporary technology and sensing capabilities.

According to Lynch, the recipient can monitor shared information and receive notifications regarding changes, while the sharing user benefits from a consolidated data overview. “We anticipate this will be particularly valuable for those providing care to elderly relatives or partners, enabling mutual support throughout their health journeys,” Lynch explained.

Lynch emphasized that this feature isn’t solely about revealing data that might otherwise remain hidden, but rather about fostering more open communication regarding health within families and personal networks. Conversations that might not naturally occur are now made possible.

“It encourages dialogue, perhaps about daily walking habits or sleep patterns, which individuals might not typically discuss,” he stated. “Sharing this information can initiate conversations that wouldn’t have happened otherwise.” He further noted the potential to enrich doctor-patient interactions, providing physicians with a more comprehensive view of a patient’s daily health beyond isolated measurements like blood pressure.

Doctor-patient data sharing relies on integration with a healthcare provider’s electronic health record (EHR) system. Apple is utilizing universally compatible standards to ensure seamless functionality, and has already secured participation from numerous large healthcare providers at launch. Healthcare professionals will access shared data through a web interface within their existing EHR system. While the data is initially shared temporarily, they can readily annotate and permanently store specific readings within the patient’s EHR to support diagnoses or treatment plans.

I inquired about the current status of EHR systems, acknowledging their historically challenging adoption and interoperability. Lynch conceded that initial efforts years ago would have demanded a substantial technical investment from Apple. Fortunately, the industry has increasingly embraced more open standards.

“There’s been a demonstrable shift towards standardized connections to EHRs,” he said. “And we’ve actively collaborated with all providers to facilitate this advancement.”

• Data Privacy: User control over shared data is paramount.
• Encryption: Data remains encrypted both in transit and at rest.
• Interoperability: Apple utilizes open standards for EHR integration.

This new feature aims to improve the quality of healthcare through better communication and a more holistic understanding of a patient’s wellbeing.

The Advantages of Sustained Engagement with Apple Health

A significant advantage of the Apple Health platform, for both individuals and their healthcare providers, lies in the extensive data accumulation possible over extended periods. Apple device users who have consistently utilized the Health app have been recording data, including heart rate, for approximately seven years.

Consequently, the introduction of the Health Trends feature in iOS 15 holds considerable promise for future impact.

Apple Health Trends in iOS 15. Image: Apple

Understanding Long-Term Health Patterns

“Health Trends analyzes changes over time, identifying statistically significant variations in approximately 20 different health metrics,” stated Lynch. “Should notable trends emerge, users will be alerted and presented with comparisons, such as changes in resting heart rate over the past year.”

This capability stems directly from the ongoing analysis conducted during the Apple Heart and Movement study.

Refining Insight Delivery

Throughout the study, Apple prioritized the optimization of how insights are delivered to users. The goal was to provide actionable information without causing information overload or confusion.

A key focus was on striking a balance between providing relevant data and avoiding unnecessary alerts. Extensive tuning was performed using data from the Heart and Movement study to achieve this.

Iterative Improvement and Future Potential

“Developing a feature like Health Trends requires careful calibration,” Lynch explained. “We aim to avoid overwhelming users while ensuring that important information isn’t suppressed.”

Apple is eager to observe the feature’s performance following its public release and plans to continue refining it based on user feedback. The company believes this will become a valuable tool for individuals seeking to understand their long-term health changes.

• Long-term data tracking provides a comprehensive health overview.
• Health Trends identifies statistically significant changes.
• The Apple Heart and Movement study informed the feature’s development.

The ability to monitor resting heart rate over time is just one example of the insights available.

Fusion: The Next Frontier in Apple Health

Apple's journey in health technology has largely been defined by discovering the health-related potential of sensors initially designed for other functions within the iPhone and Apple Watch. Continuous health monitoring, previously impractical, has become a reality through these devices.

This realization has spurred a deliberate effort to incorporate new sensor technologies into Apple’s products, addressing a wider range of daily health needs. Apple is also continually refining its use of existing sensors – the introduction of sleep respiratory rate tracking in iOS 15 exemplifies this – while simultaneously developing future hardware advancements.

The Power of Combined Data

Sensor fusion represents a significant area for future health capabilities. Assessing walking steadiness, for instance, isn’t solely dependent on the iPhone or Apple Watch functioning alone.

Instead, it’s the combined power of these devices working in unison that unlocks new possibilities. Apple’s integrated software and hardware ecosystem provides a distinct advantage in this area, and its benefits will amplify as the company’s device network – and the sensors within them – expands.

Expanding the Ecosystem: AirPods and Beyond

The potential for health monitoring extends beyond the iPhone and Apple Watch. AirPods, equipped with their own unique sensors, collect data that could enhance the insights gained from the iPhone and Apple Watch.

During a recent interview, Kevin Lynch discussed the opportunities presented by this expanded sensor network.

“Sensor fusion is already implemented across several of our devices, and I believe the potential here is substantial,” Lynch stated.

This suggests Apple is actively exploring ways to leverage data from all its devices to provide a more comprehensive and nuanced understanding of user health.