Much like its predecessors, 2019 was yet another year in which Apple furthered its push into the healthcare market. Although headlined as always by the health tracking features of its consumer wearables, the company has also embraced a number of other projects that align its interests with long-time industry players and — in the words of its healthcare leaders — empower and democratize health for the consumer.

And the Cupertino company certainly seems like has the chance to make an impact. A recent Morgan Stanley report anticipates a $15 billion to $300 billion healthcare opportunity for Apple by 2027, and the company’s most recent quarterly report featured a bevy of digital health project highlights from the lips of CEO Tim Cook.

“As I've said before, my view is there will be a day in the future that we look back, and Apple's greatest contribution will be to people's health,” he said during the company's October investors call.

From wearables-based research projects to personal health records, new Watch features to published patents, read on below for a roundup of Apple’s digital health efforts during 2019.

Apple goes big on clinical research

Apple shook off the frost of winter near the top of the year with the highly publicized release of its Apple Heart Study results in March. Launched in 2017 in collaboration with Stanford, the research project enrolled 419,297 Apple Watch and iPhone owners and ultimately suggested that atrial fibrillations alerts from the Watch app were rare, but fairly inline with paired readings from an ECG patch.

Apple and its collaborators must have been pleased with the project, as the company would go on to announce three more Apple Watch health studies headlined by major partners like the World Health Organization and Brigham and Women’s Hospital. These studies aim to capture participants’ sound exposure, menstrual cycles, heart rate and physical activity, and openly enrolled US Apple Watch-owning consumers through a new Research app made available in November.

Announcements around these research projects may have made the biggest splash in 2019, but they were far from the only studies Apple participated in this year. As early as January, Johnson & Johnson was touting a pragmatic multi-year RCT that is investigating whether irregular rhythm notifications and a custom-built medication adherence app could improve outcomes among older US adults.

The end of the summer also saw one of these pharma collaboration studies bear fruit, with Apple, Eli Lilly and real-world data startup Evidation Health jointly presenting data from a device-based health monitoring feasibility study. This 12-week effort offered proof that common consumer devices are collecting enough data to differentiate between users with or without cognitive decline, the researchers wrote.

The Watch continues

The Apple Watch wasn’t solely an instrument for clinical research. This year was marked by the continued approval and rollout of the latest Apple smartwatch’s signature ECG feature across a number of new regions. As of the company’s late-October earnings call, that tally was up to 32 international markets, including India.

Meanwhile, the WatchOS6 firmware update brought with it a handful of new health tracking features. These updates were focused on providing wearers with more information about their personal activity trends, menstrual cycles and daily noise exposure.

As the device comes into its own as a bonafide health tracking tool, more payers are starting to take note. Along with forming the cornerstone of a new wellness rewards program with Aetna, the company has reportedly been speaking with a number of private Medicare plans on the benefits a subsidized Apple Watch could bring members. We perhaps saw the opening salvo of this new business opportunity in the fall with startup Devoted Health’s Medicare Advantage plan offering free watches to its members as a benefit.

Year two of Apple Health Records

After its unveiling last year, Apple spent much of its 2019 ensuring that Apple Health Records was supported by as many industry stakeholders as possible. In June a self-registry for the feature was made available to all US health care organizations with compatible EHRs (the list of which was expanded two months later with the integration of Apple’s tool and several Allscripts EHR platforms).

Meanwhile, all eyes were on whether the Department of Veterans Affairs would begin supporting the personal health record tool in the wake of swirling 2018 rumors. Apple and the VA were finally able to pop the cork in November with the announcement that Apple Health Records had been rolled out to more than 1,200 VA health centers. This allowed patients using iOS access to a portable aggregated record of their allergies, immunizations, lab results, procedures and other health measures.

Not to be lost in all of this was Apple’s plans to join 19 other industry stakeholders in test driving a new health record interoperability initiative called CARIN. This coalition released a draft implementation at the White House Blue Button Developer Conference in July. The guidance spelled out 240 different claims elements that will be mapped onto HL7 FHIR.

Patents outline new options

It wouldn’t be a new calendar year without a haul of new Apple patents ripe for speculation, and 2019 was hardly any different.

Kicking off the year was news of an Apple patent application that seemed to suggest miniature sensors for poisonous gas may be a feature of future Apple devices. The application’s diagrams demonstrated a potential application within an Apple watch, and described detection capabilities for ozone, nitrogen dioxide, nitrogen monoxide, sulfur dioxide, carbon monoxide, methane and other volatile organic compounds.

Following this were two patents suggesting that the company might be working on chemical smell sensors. The healthcare application of this technology varied, but one patent suggested that it could be used to analyze sweat particles in the air to deduce a person’s blood sugar levels.

Thanks to the acquisition of small respiratory health company Tueo Health, Apple also acquired worldwide rights to a patent that could fit well into its budding sleep health efforts. Using sensors placed near a sleeping user, this system would be able to monitor their rest without the need of a smart device like an iPhone, iPad or Apple Watch.

And the company doesn’t seem content with limiting its ECG tech to Apple Watches alone. A patent published in the fall described a fabric-based piece of clothing that would be able to measure blood pressure, respiration and ECG, and then wirelessly communicate with external electronic equipment. While it is unclear what exactly this stretchable band would look like on the market, the patent gave examples of potential use cases including a headband, hat, undergarments, socks, pants, shorts and belt.

Other odds and ends

Apple has its toes dipped in a broad variety of health care strategies, based both in devices and services. In July, for instance, the company began carrying One Drop’s wireless blood glucose monitor was made available for sale in certain US Apple Stores. Integrated with Apple Health Records, the platform is the first time since 2012 that the company has stocked a diabetes management offering at its brick-and-mortar storefronts.

However, it was at the start of the year news broke that Apple had finally managed to put a longstanding legal dispute with Valencell regarding patent disputes and alleged deceptive trade practices to bed. The case, first filed in early 2016 and settled by both companies in late 2018, centered on the heart rate sensor technology core to the Apple Watch.

Over on the other end of the calendar, Apple recently took a stand against vaping apps being offered through the App Store by pulling 181 such offerings off the digital storefront. The apps pulled down were mainly social networks, news, games and hardware companions, according to the tech giant. While this is new effort means a ban on related apps, the app store has always prohibited sales of vaping cartridges.