eHealth is a tool, not a replacement for HCPs


  • eHealth reality doesn’t quite live up to the promise.
  • Even the Apple Watch studies are in doubt.
  • We need data on what people do as a result of eHealth apps and devices.
  • Only HCPs can diagnose and treat patients based on medical history.

According to the NY Times, “only 450 of the 2,161 people who were notified about having an irregular pulse returned their sensor patches for evaluation. This means that among those who signed up for the study, wore the watch and got a health alert, almost 80 percent ignored it”. That’s a problem.

Today healthcare for most people has become a burdensome process. You make an appointment with your doctor, you visit your doctor and get a prescription and then have it filled. Today HCPs treat conditions, they really don’t treat people and as a result, more and more people are seeking out ways to expedite the “process”. But that can be a problem.

When I visit my doctor she has my full medical history with her via her laptop. She first reviews my last labs and history before we talk about why I’m visiting her today. A patient’s medical history is essential to diagnosing and recommending treatments. Do people really divulge their full medical history when they visit walk-in clinics or use eHealth apps and devices?

Flawed Apple Watch Studies

Stanford researchers published a paper in the New England Journal of Medicine about the Apple project, “Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation.”

Researchers concluded that the Watch is pretty good at detecting irregular heartbeat, which is a significant advance in medical technology. That’s great for people who have their own Apple Watch as well as the people who can get a watch through their Medicare plan.


About half of the people in the study were under 40. Only 6% were over 65. Atrial fibrillation is most common in people over 65, meaning this study may be “the opposite of a desirable age profile for a study of atrial fibrillation,” as Edward W. Campion, M.D., and John A. Jarcho, M.D. wrote in an editorial about the research paper.

As soon as the heart health study got real, people started dropping out. When an individual got an alert about an irregular heart rhythm, he or she had to do more than wear the Apple Watch. The person was supposed to attend a telemedicine visit and wear an electrocardiography (ECG) patch for up to seven days. These two additional tasks were still convenient but even those two responsibilities were too much. 

According to Business Insider, about 79% of people who got an initial notice of an irregular heartbeat didn’t complete the study or were later excluded from it. People either dropped out or didn’t do the telemedicine visit.

In the Apple Watch study, people who got an alert about an irregular heart rhythm didn’t get a second alert or any kind of follow-up. Undoubtedly, some of those alerts were false alarms, and rightly dismissed but not all of them.

Is this true for all eHealth devices and apps? Of course not. We are at the very beginning of eHealth initiatives and there are going to be more failures than successes. However, studies need to focus on what patients do with the data and how the data impacts patient outcomes.

In the past, I have called on pharma to get involved in eHealth but that pesky “what’s the ROI?” gets in the way. The future of eHealth is a tool for patients, not a replacement for a qualified HCP.