Daniel Esgardo Rangel Barón: 5 Reasons We’re Unprepared for Apple Watch ECG

Today Apple released the Apple Watch Series 4 watch. Later this year they will add functionality that allows users to record an ECG. This would make Apple Watch one of the first FDA-cleared over-the-counter devices with an electrocardiogram.

Here are 5 reasons we’re not ready for this.

1. No bandwidth

Right now the idea of individuals taking personal tracings is all fun and games. But once ECGs begin to appear from every wrist, local healthcare systems won’t have the bandwidth to handle the problems that mass screening delivers. The more concerning consequence is how the influx from the worried well will impact our ability to care for those with serious disease.

2. Apple Watch ECG puts technology ahead of process

Related to the bandwidth issue, it’s not clear how an abnormal Apple Watch ECG from a patient will fit into an internist’s workflow. How will an influx of digitally recorded ECGs play on a typical practice that may already be operating with slim margins and a slimmer staff? And when does an unnecessary study initiated by a patient become the responsibility of her provider?

This is similar to the problem of 23 and Me data presented to the average family doctor. Unprepared and untrained to help the patient understand, it represents the new problem of data confrontation. We’re facing technology and data ahead of process.

3. Iatrogenesis

The core concern among cardiologists and electrophysiologists is the overutilization that will invariably occur with personally-initiated ECGs. When something we measure is identified as abnormal, we take it to the doctor. A lot of these patients will wind up with a cardiologist and a boatload of testing or, iatrogenesis, as mentioned last week on Twitter by cardiologist John Mandrola.

4. EHRs are not prepared

Apple’s health applications are creating a weird third space for health information. To date it’s unclear how well an Apple Watch ECG will play with legacy EHRs. Where will these studies live and how will Apple information be integrated with our current systems.

5. Patients have no idea what they will do with their ECG

I’m not aware of any resources available to help patients through the process of an Apple Watch warning. So, it’s off to the PCP.

It doesn’t mean we won’t be prepared in the future. I’m bullish on the idea that interpretation and contextualization of most data like this will comfortably fall into the realm of AI. And until our current system of care can catch up, I wouldn’t be surprised to see the emergence of a cottage industry driven by Apple Watch ECG data.

@chrisworsham had this to say: Glad I’m not a cardiologist right now … though it’s probably just a matter of time before they introduce iSpirometry.

Image via RJ on Flickr.

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