It seems like Apple gets more involved in healthcare every year, and 2018 was no exception. The two big stories of the year — the Apple Watch ECG and Apple Health Records — were both the culmination of years of rumors and reports. And the company made health news in myriad smaller ways as well.

Read up for a roundup of Apple’s 2018, including a taste of what we might expect in 2019 and beyond.

Heart health features

The single biggest and most interesting thread of Apple news running through the year was the company’s long-rumored FDA-cleared cardiac monitoring product, an over-the-counter ECG built into the Apple Watch. Additionally, the company announced a passive irregular rhythm detection feature.

Just two days into the year, Bloomberg and the New York Times leaked the news of the device, adding to a growing body of rumors. More hints came to the fore in February when the informed consent document for Apple’s Heart Study with Stanford revealed that data from the study would be used in an FDA submission.

Another hint of what was to come came in March, when a study in JAMA, part of the Health eHeart Study, demonstrated that the Apple Watch could detect atrial fibrillation with the help of a deep neural network.

But despite all these hints and warnings, Apple COO Jeff William’s announcement of the feature in September, and its remarkably speedy FDA clearance, still caused quite a stir, with many questioning whether the feature would lead to unnecessary medical visits.

The jury’s still out on the impact of the feature, which went live in the United States December 6th. Click here to check out a MobiHealthNews video demo of the ECG.

Apple’s news wasn’t all good around the heart rate space— the company also faced a lawsuit in April (still ongoing) alleging that its heart rate monitoring technology infringed on a patern owned by Ann Arbor, Michigan-based Omni MedSci.

Apple Health Records

The other primary news thread around Apple and healthcare this quarter was Apple Health Records, a bold move by the tech giant to connect its Apple Health app with emergency medical record systems around the country.

After many months of rumors, Apple announced in January that it was launching a personal health record (PHR) feature with iOS 11.3. The feature, called Health Records, aggregates existing patient-generated data in the Health app with data from a user's electronic medical record — if the user is a patient at a participating hospital. At launch, Apple announced that it was working with 12 hospitals across the country, including Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.

Throughout the year, that number continued to grow, with 39 hospitals on board by the time the feature came out of beta in March. In August, Apple announced that more than 75 hospitals were using Health Records.

Digital health pundits have gone back and forth over how important this initiative is, comparing it to past PHR failures like Google Health and Microsoft HealthVault. In the wake of the announcement, the merits of the platform were a hot topic on Twitter.

In June, Apple opened up the API for Apple Health Records, allowing developers to create apps that can, with permission, use data from patients’ electronic health records to help people manage care, medications, nutrition, and more. Medication adherence app Medisafe demonstrated the potential of the API with an early integration.

And in October, partnerships with house call app Heal and lab testing service LabCorp showed that it's not just hospitals that can benefit from the platform. 

Other Apple Watch updates

The ECG wasn’t the only health-related feature added to the Apple Watch this year. At WWDC in June, the company added the ability to automatically detect a workout based on heart rate, gyroscope, and other sensor readings.

In addition, Apple expanded the Watch's Activity Sharing feature to allow users to start seven-day competitions with one another and see in real time how their competitor is stacking up, complete with an in-app badge for the winner. They also added two new kinds of workout: yoga, which is mostly based on heart rate, and hiking, which uses heart rate, GPS, and elevation. In addition, runners will add two new metrics they can track: rolling mile pace and cadence. Runners can also set pace alerts, which will allow the watch to tell them when they've dropped below or above a chosen pace. 

And in September, alongside the ECG announcement, Apple also announced a fall detection feature for the Apple Watch Series 4.

Using the accelerator and gyroscope, the Watch analyzes wrist trajectory and impact acceleration to identify a fall in progress. When the Watch detects the fall, it will give the user an opportunity to call an emergency contact. But if it detects that the user is immobile for one minute after the fall, it will automatically reach out to authorities using Apple's emergency alert system. It also sends a message to emergency contacts in that situation.

High-profile partnerships

Apple also made healthcare news a number of times through partnerships. For instance, in an earnings call Apple CEO Tim Cook highlighted the company’s relationship with LensCrafters, which is using more than 7,000 iPad Pros to enable digital eye exams and digital optical measurements.

In June, Apple announced a collaboration with RapidSOS that will allow iPhones to more easily send detailed location data to first responders in the event of an emergency. Since 2015, Apple has used a protocol called HELO (Hybridized Emergency Location) to estimate a caller's location based on GPS, cell tower data, and wifi access points. But RapidSOS has perfected the data pipeline to send that information securely and efficiently to many 911 call centers in a way that's compatible with their existing software.

In October, Apple partnered with Zimmer Biomet to enroll 10,000 US knee and hip replacement surgery patients in a new trial involving the Apple Watch and a specialized app called mymobility. The app includes educational tools and videos that will assist patients throughout their surgery experience, while the Watch will allow for activity and heart rate tracking that can be shared with the care team. Each of these features is intended to help researchers and orthopedic practitioners better understand the factors that impact surgery recovery.

On the retail side, Apple supported the launch of L’Oréal’s new wearable, the La Roche-Posay My Skin Track UV, a clip-on sensor for tracking ultraviolet light exposure. The device is on sale through Apple’s website and physical retail stores, and also integrates with Apple Health.

Finally, the Wall Street Journal reported last month that the Department of Veterans Affairs is in talks with Apple about the creation of a portable EHR specifically for veterans. According to the WSJ, who reviewed emails and spoke with unnamed sources about the initiative, what’s currently on the table is a new Apple software that would let the VA patients enrolled in the system transfer their records to their iPhone — a functionality that would likely be achieved via a version of Apple's Health Records app.

Other miscellaneous news

In February, news broke that Apple is making plans to launch its own care centers for employees under the name AC Wellness. It’s not clear from the group’s bare bones website whether the clinics have launched yet, though they were supposed to go live in the Spring. Apple still has open positions posted.

June’s WWDC event saw a slew of updates to Apple ResearchKit including hearing, vision, and speech tests; an updated UI; and a new research API for monitoring Parkinson's tremors and dyskinesia.

And just this month Apple secured FCC permissions for, and just a few days later launched, a new version of Beddit, a sleep monitoring device it acquired a few years ago. It’s not clear what improvements, if any, it features over the last version of the device and according to a few customer reviews, it has actually lost some features since the previous version.

Finally, the year saw a few interesting personnel moves, namely the departure of Stephen Friend late last year (of which news broke in February) and the recent hire of Mango founder Jason Oberfest.

Patents and rumors

Of course it wouldn’t be reporting on Apple without a healthy helping of speculation along with the news. Here’s a few things we might (or might not) see out of Cupertino down the road.

• In January, the New York Times reported that Apple has been quietly working on noninvasive glucose monitoring since before Steve Jobs’s death. This rumor has been reported on before.
• In June, Apple filed a patent for a wearable, connected blood pressure monitor, at least the third patent the company has filed in the blood pressure monitoring space.
• In July, another patent came to light, this one for a "sunscreen detector" that could be incorporated into the Apple Watch or the iPhone and could even include augmented reality functionality.
• In August, CNBC reported based on a job posting that Apple was looking to develop a proprietary chip for more sophisticated health tracking.
• In November, a new Hong Kong and European trademark updated the classification of Apple’s AirPods to include health, fitness, exercise and wellness sensors. The updated classification also includes language concerning the transmission of biometric data, heart rate, body movement and burned calories.