Empowering people
to live a healthier day
Innovation using Apple technology
to support personal health, research,
and care
July 2022
Updated in October 2023
2
Too often health is something we try not to think
about. We avoid talking about it. We put it off
for another day, a better time. Then, something
unexpected happens: an illness, an unfortunate
incident, or even, as we’ve seen these last few
years, a pandemic. Suddenly, health becomes
everything. Nothing matters more.
Apple is working to change how people think
about, talk about, monitor, and focus on their
health. We feel drawn to this work not only
because of the opportunity to help advance
human health but because we are driven by
our principles to devote talent, resources, and
expertise to where we can do the most good.
We believe passionately that technology can
play a role in improving health outcomes and
encouraging people to live a healthier day.
This report offers a snapshot of our work
to advance health. Since the beginning of our
journey, the health innovations we’ve pioneered
have aimed to help break down barriers between
users and their own everyday health data,
between health care providers and patients, and
between researchers and study participants.
Our work primarily falls into two categories,
described in two corresponding sections of this
report: personal health and fitness features on
Apple Watch, iPhone, and iPad and the work
we are doing with the medical community to
support research and care. With watchOS 10,
iOS 17, and iPadOS 17, Apple Watch, iPhone,
and iPad now offer features that focus on 18
areas of health and fitness, available in nearly
200 countries and territories around the world.
Users write to us nearly every day sharing how
our devices are helping them learn more about
their health. We’ve had the privilege to partner
with some of the world’s leading medical
institutions and researchers to support public
health studies, which have already provided
insights, while only in their early innings. And
we’re excited about the ways third-party
institutions and organizations are using Apple
technology to build new experiences to
improve physicians and patients’ conversations
and offer innovative wellness programs.
Our vision for the future is to continue to
create science-based technology that
equips people with even more information
and acts as an intelligent guardian for their
health, so they’re no longer passengers on
their own health journey. Instead, we want
people to be firmly in the driver’s seat with
meaningful, actionable insights. Our priority has
always been the trust of our users, and — in
keeping with our belief that privacy is a funda-
mental human right — every user should have
the option to choose who they share their data
with and what they share.
We intend to stay on this path, because nothing
matters more.
Introduction
– Jeff Williams
Chief Operating Officer
3
Nine years into Apple’s journey in health, a snapshot
of how Apple products are empowering people
to be at the center of their health and to live a better day
Executive Summary
Empowering users
on their personal
health journey
Supporting the health
ecosystem by collaborating
with the medical community
Supporting the health
ecosystem by collaborating
with the medical community
Strengthening the physician-patient
relationship with meaningful data
Equipping researchers to make
new scientific discoveries
Health organizations promoting
healthy lifestyles with Apple Watch
Supporting public health and
government initiatives
Intelligent guardian
for users’ health
Health data in one place
Features to improve
everyday health and fitness
Fueling innovative third-party
health and fitness apps
Apple’s work to advance health
4
Executive Summary
With watchOS 10, iOS 17, and iPadOS 17, Apple Watch, iPhone, and iPad now offer features that focus on 18 areas
of health and fitness, from heart health to sleep,women’s health, mental health, mobility, and more. These features,
available in nearly 200 countries and territories, provide users with high-quality data gathered throughout the day and
night and meaningful insights into their health. Apple believes that providing individuals with insights into their health and
fitness empowers them to set and stick to personal health goals and, when necessary, seek guidance and care from their
medical providers.
i
The Health app is available on every iPhone and iPad, and acts as a central and secure place for users to view all of their
health information. Users can now store over 150 different types of health data from Apple Watch, iPhone, iPad and
connected third-party apps and devices, in addition to available health records data from connected institutions in the
US, UK, and Canada. They can also choose to share certain types of this health data with loved ones.
Our APIs are enabling third-party developers to create new solutions that promote healthy lifestyles and innovation in
health. There are now tens of thousands of apps on the App Store that use our HealthKit API, so they can incorporate
data users choose to share from the Health app to offer innovative health and fitness experiences, with rigorous privacy
and data security protocols. With users’ permission, these apps can also contribute data back to the Health app.
A growing group of health and fitness features on Apple Watch, iPhone and iPad offer actionable, science-based
insights that break down barriers between users and their health information — all designed with privacy in mind.
They are all subject to rigorous scientific validation processes, in collaboration with medical community experts.
Our features put our users’ privacy at the center and provide users with protections including transparency and control.
Data privacy is critical for sensitive health data.
All of our health and fitness features have been developed with two overarching principles:
Apple collaborated with Stanford to build the Apple Heart Study, which was a first of its kind in the medical
community and the largest virtual cardiac clinical study during its time. It paved the way for Apple’s work with
some of the world’s leading institutions to build three first-of-their-kind research studies to advance the science
across women’s health, hearing health, heart health, and more. Apple features and technologies have made it easier for
researchers around the world to develop cutting-edge medical studies at unprecedented scale.
When users are equipped with their own everyday health data from Apple Watch, iPhone, and iPad,
they have the ability to share that data with researchers to help advance science.
Health institutions are using Apple devices, APIs, and frameworks to strengthen the relationship between physicians and
patients with meaningful data, and enable care from anywhere.
Health organizations and insurance companies around the world have collaborated with Apple to integrate Apple Watch
in their wellness programs to promote healthier behaviors and improve individual health at a large scale, with a focus
on privacy.
The medical and research communities are using our devices, APIs, and frameworks to pioneer
new ways of engaging with patients.
i. Some features may not be available in all regions or all languages, or on all devices.
Table of Contents
Section 1: Empowering users on their personal health journey .........................................................................6
Health data in one place .........................................................................................................................................8
Apple Watch acts as an intelligent guardian for users’ health .....................................................................9
Heart health ........................................................................................................................................................9
Mobility ...............................................................................................................................................................12
Hearing health ...................................................................................................................................................15
Safety .................................................................................................................................................................16
Features to improve everyday health and fitness ...........................................................................................17
Fueling innovative third-party health and fitness apps ................................................................................ 24
Section 2: Supporting the health ecosystem by collaborating with the medical community ................ 25
Equipping researchers to make new scientific discoveries ........................................................................26
ResearchKit ....................................................................................................................................................... 28
Apple Heart Study............................................................................................................................................28
Apple Research app ........................................................................................................................................29
Other studies Apple has supported ..............................................................................................................33
Strengthening the physician-patient relationship with meaningful data ................................................34
Technology to support care from anywhere ...............................................................................................36
Third-party developer innovation..................................................................................................................37
Augmenting patient experience in hospitals and using hospital resources more efficiently ..............38
Health organizations promoting healthy lifestyles with Apple Watch .....................................................40
Supporting public health and government initiatives ....................................................................................41
Contributions and voluntary relief efforts during health crises .................................................................41
Building apps and features to support public health authorities and disseminating
reliable health information during the COVID-19 health crises ................................................................
42
Extensions and Spotlights ...........................................................................................................................................43
Sources..............................................................................................................................................................................57
6
SECTION 1
Empowering users on their
personal health journey
Since the release of the Health app in 2014 and Apple Watch in 2015, Apple has
introduced a wide array of innovative health and fitness features to help our users
take care of their health every day. At Apple we believe health is the combination
of health and fitness, and the goal of these features is to provide users easy-to-
understand, meaningful insights so they can be empowered to live a healthier life.
Our in-house clinicians are deeply involved in the product development process
and work hand-in-hand with our engineers and product designers. This, combined
with our collaboration with experts from leading research institutions, ensures that
our products and features are grounded in science and user-friendly.
Below are the four categories in which we think about our health and fitness
features, with longer descriptions of each to follow.
Health data in one place. The Health app was Apple’s first health feature.
With the Health app, users can see their health and fitness data in one central
and secure place, including data from Apple Watch, iPhone, and iPad, connected
third-party apps and devices, and connected Health Records institutions. Health
data can be some of the most personal data people have, and in keeping with
Apple’s belief in privacy, we design all of our products and services so users are in
complete control of their data. Health app data is never shared with any third party
without the user’s explicit permission.
Apple Watch acts as an intelligent guardian for users’ health. Apple Watch is
equipped with features to notify users of possible underlying health conditions so
they have agency to act on this information. We leverage the powerful sensor tech-
nology in Apple Watch that millions of users worldwide are wearing on their wrists
every day, combined with iPhone and iPad, to create breakthrough capabilities in
heart health, mobility, hearing health, safety, and preventative health features.
Features to improve everyday health and fitness. Many aspects of people’s
health are the culmination of small lifestyle choices that they make every day, like
regularly exercising to improve cardio fitness, moving throughout the day, reaching
their sleep goals, keeping track of their menstrual cycle, reflecting on their state
of mind to better care for their mental health, or practicing behaviors that can help
reduce myopia risk. Apple Watch is a holistic health and fitness companion that
not only tracks daily activities, from activity to sleep, but over time also proactively
highlights important changes in health and fitness.
Fueling innovative third-party health and fitness apps. With our HealthKit
framework, we’ve also made it easier for third-party developers to create apps that
use Apple Watch and iPhone sensors and certain data types that users choose to
share from the Health app, to create new health and fitness experiences. By using
our tools to build innovative third-party health and fitness apps, developers expand
the opportunities for users to take control of their health and fitness.
7
An overview of health and fitness features
on Apple Watch, iPhone, and iPad
ACTIVITY
Activity rings
Activity coaching
Workout tracking with
validated metrics
Activity sharing
Activity competitions
Fitness+
Fitness app on iPhone
MOBILITY
Fall Detection
Walking Steadiness and notifications
Mobility metrics like double support time,
step length, six-minute walk, and more
MEDICATIONS
Set up a medications schedule
and reminders
Medications education and alerts
for potential critical interactions
RESPIRATORY
Respiratory rate during sleep
Blood Oxygen
WOMEN’S HEALTH
Cycle Tracking
Period prediction and
fertile window prediction
Symptom tracking
Cycle factors
Workouts for Pregnancy and
Get Back to Fitness After Having
a Baby Fitness+ programs
Retrospective Ovulation Estimates
Cycle Deviations
Cycle Detail view and PDF
VISION HEALTH
Time in Daylight
Screen Distance
EDUCATION
Articles in the Health app
Mobility exercises in the
Health app and Fitness+
MENTAL WELLBEING
State of mind logging
Anxiety and depression clinical
assessments and resources
Mindfulness app
Meditation in Fitness+
Focus
HEART HEALTH
High/low heart rate notifications
Resting, walking, and post-workout
heart rate
Heart rate variability
ECG app
Irregular rhythm notifications
Cardio Fitness
Cardio Recovery
AFib History
SAFETY
Emergency SOS
Medical ID
Crash Detection
RESEARCH
Research app, including
Apple Women’s Health Study,
Apple Heart and Movement Study,
Apple Hearing Study
ResearchKit
CareKit
HEARING HEALTH
Headphone audio levels and notifications
Noise app and notifications
Environmental sound reduction by
AirPods Pro
Adaptive Transparency on AirPods Pro
2nd Generation
HEALTH RECORDS
Immunizations
Allergies
Conditions
H
Medications Records
Clinical Vitals
Lab Results
H
Procedures
Clinical Notes
Export a PDF of all
available health records
SLEEP
Wind Down
Sleep tracking
Sleep stages
HEALTH SHARING
Sharing health data with
family, friends, and
healthcare providers
COVID-19 RELATED
Exposure notifications
Verifiable COVID-19 vaccination
and test result records
and many others...
HANDWASHING
Automatic handwashing detection
and reminders
DATA VISUALIZATION
AND INSIGHTS
Trends
Highlights and favorites
Access and log health
data with Siri
ii
ii. Available later in 2023
ACCESS TO DIVERSE AND INNOVATIVE THIRD-PARTY HEALTH AND FITNESS APPS
8
EMPOWERING USERS ON THEIR PERSONAL HEALTH JOURNEY
Health data in one place
The Health app is a secure place to collect and share health data.
The Health app was Apple’s first health and fitness feature, creating a central and
secure location for all of a user’s personal health information on iPhone. With the
introduction of Apple Watch, the quantity and quality of health insights available
to our users in the Health app significantly increased. Today the Health app is also
available on iPad, and users can store over 150 different types of health data from
Apple Watch, iPhone, iPad and third-party apps and devices in the Health app, in
addition to available health records data from connected institutions in the US, UK,
and Canada.
Data from the many health and fitness features described in this report is available
in one central view in the Health app, and features like Trends allow users to
identify important changes over time. With Health Sharing, users can also choose
to share certain types of this health data with a trusted partner or caregiver.
Privacy and control
over health data
At Apple, we believe that our
users’ data only belongs to them.
When iPhone and iPad are
locked with a passcode, Touch
ID, or Face ID, all health and
fitness data in the Health
app — other than Medical
ID — is encrypted, and any
health data synced to iCloud is
encrypted both in transit and
on Apple servers. And with a
recent version of watchOS, iOS,
and iPadOS with the default
two-factor authentication and
a passcode, health and activity
data will be stored in a way that
Apple can’t read it. Health app
data is never shared with any
third party without the user’s
explicit permission.
In keeping with Apple’s strong
stance on privacy, HealthKit lets
users control each health data
type read from and written to
the Health app, and HealthKit-
enabled apps are prohibited
from using or disclosing
that data to third parties for
advertising, marketing, or other
data mining purposes.
If users decide to share their
health data, the Health app
provides users with granular
control over the types of data
they share and who they share
it with, and they can review and
manage permissions at any time.
To learn more about the privacy
of our health features, visit
https://www.apple.com/privacy/
Empowering users on their personal health journey
Health data in one place
Trends in the Health app and Fitness app In the
Health app, users can view reports on trends analysis
for 20 types of data ranging from resting heart rate to
sleep to cardio fitness. Trends can highlight significant
changes in types of health data in a way that is easy
to understand. In the Fitness app, users can check
their fitness progress over time in a variety of metrics
like exercise minutes, stand hours, cardio fitness,
and more. If a goal is trending down, users receive
coaching on how to turn it around.
Access and log Health app
data with Siri In an update later
in 2023, Siri can be used on Apple
Watch Series 9, Apple Watch Ultra 2,
iPhone, or iPad to access and log
certain Health app data types. For
example, a user can ask how many
steps they’ve taken, about their blood
glucose if they have a connected
monitor, or to log data such as a
period or medications taken.
Health Sharing In the Health
app, users can securely share
their data with a loved one or a
caregiver, so that trusted partner
can follow important alerts and
changes over time, have more
meaningful conversations and
provide support from afar. Users
have complete control over which
data they share and with whom.
Health Records In the Health app, users can privately and securely access
their health records — including medications records, immunizations, clinical
notes, lab results and more — from participating health institutions in the US,
UK and Canada. This is available for patients at some of the largest health
systems, as well as veterans receiving care through the Veterans Health
Administration. Users can also create a PDF of their available health records
from connected health institutions, right from the Health app.
9
The prevalence
of cardiovascular
diseases
Cardiovascular diseases are
the leading cause of death
in the world. Almost 40% of
deaths of people under 70 due
to noncommunicable diseases
were caused by cardiovascular
diseases.
1
In North America,
about one in five people above
the age of 40 will develop heart
failure.
2
In Europe, over half
of all deaths are caused by
cardiovascular diseases.
3
Atrial fibrillation (AFib) is a
heartbeat irregularity that often
goes undiagnosed and is a
leading cause of stroke and
hospitalization.
4
Because some AFib episodes
can be intermittent and
unpredictable, it can be
difficult to capture in a clinical
environment.
5
In the US, an ECG can cost
hundreds of dollars at an urgent
care facility or at a hospital.
6,7
Heart health
Providing users with a range of features to learn
more about their heart health
Apple Watch offers an extensive set of features focused on heart
health. Over time, Apple Watch has alerted users around the world
of potential signs of atrial fibrillation (AFib), and helped many more
establish everyday habits to keep their heart healthy over the long term.
Heart Rate app The first Apple Watch included a heart rate sensor to allow users
to take heart rate measurements whenever they wanted, and offer them the most
accurate metrics during workouts that we could. When we released that first set of
features into the world, we started receiving letters and emails from users writing
about how seeing their heart rate measurements in the Heart Rate app helped
them realize that something might be wrong. Listening to this feedback from our
users, it accelerated our interest to continue to invest in technology that could help
them lead healthier lives.
EMPOWERING USERS ON THEIR PERSONAL HEALTH JOURNEY
Apple Watch acts as an intelligent
guardian for users’ health
Apple Watch is equipped with features to notify users of possible underlying health
conditions, giving them the agency to act on this information. Because Apple Watch
is always on the wrist, features like Fall Detection, Crash Detection, and Emergency
SOS can also help users call for help in the moment they need it.
Below is more information on our features focused on heart health, mobility,
hearing, and safety, which enable Apple Watch to act as an intelligent guardian for
users’ health.
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
10
High and Low Heart Rate Notifications Over the years, we have introduced
features that could help users identify signs of potentially serious underlying health
conditions. With high and low heart rate notifications, Apple Watch can notify users
if it detects a high heart rate when a user is at rest, which can be a sign of a serious
underlying condition. It can also notify users when their heart rate is notably low for
at least ten minutes, known as bradycardia.
ECG app The ECG app, launched with Apple Watch Series 4, uses an electrical
heart sensor on Apple Watch to record an electrocardiogram of the user’s heart to
help users identify signs of AFib. With the ECG app, Apple Watch users can record a
single lead electrocardiogram from their wrist in the moment they are experiencing
symptoms like a rapid or skipped heartbeat. The ECG app on Apple Watch also allows
users to make note of symptoms, and easily share the ECG result with their doctors.
Irregular Rhythm Notifications With the irregular rhythm notification feature,
Apple Watch can occasionally check heart rhythm in the background and send
a notification if an irregular heart rhythm that appears to be AFib is identified, so
users can seek medical evaluation.
The ECG app and irregular rhythm notification
feature are now available in over 160 countries
and territories around the world.
AFib History Research suggests that the
amount of time spent in AFib may impact a
person’s symptoms, overall quality of life,
and risk of complications, and according to
the American Heart Association, addressing
modifiable lifestyle factors may decrease
the amount of time spent in AFib.
16
Users
who are diagnosed with AFib can turn on the
FDA-cleared AFib History feature and access
important information including an estimate of
how frequently a user’s heart rhythm shows
signs of AFib, providing deeper insights into a
user’s condition. Users will also receive weekly
notifications and view a detailed history in the
Health app, including lifestyle factors that may
influence AFib like sleep, alcohol consumption,
and exercise minutes. Users can download a
PDF with a detailed history of their AFib and
lifestyle factors, which can easily be shared
with doctors and care providers for more
informed conversations.
“On her birthday, coming back
from the beach, my mom was
out of breath and not feeling
well. Her jaw was clenched.
The watch showed that her
heart was beating too fast
and detected AFib. I did the
same test with my own Apple
Watch, which showed the same
result. … This health issue could
have had a dramatic outcome.
Somehow, it likely saved my
mom’s life.”
14
Loïc, speaking about his
77-year-old mother, France
“The 47-year-old … is a yoga
therapist, works out every
day, and eats healthy, yet her
watch said her resting heart
rate was 126. ‘…It turned out I
was having heart failure.’ She
ended up needing open-heart
surgery to have her heart valve
repaired. ‘Thank goodness for
the Apple Watch because I felt
fine. I wonder if it hadn’t been
for the Apple Watch, I might
not even be here?’”
15
Amy, 47, US, Heart Failure
Cardio fitness as
an indicator
of overall health
The American Heart Association
(AHA) considers cardio fitness
as a reflection of total body
health and reports that it is a
strong predictor of mortality
similar to other risk factors like
cigarette smoking, hypertension,
high cholesterol, and type 2
diabetes. It has recognized a
growing link between low cardio
fitness and a higher risk of
developing heart disease, high
blood pressure, and obesity
later in life.
8
The AHA reports that
an estimated 80% of
cardiovascular disease is
preventable when detected
early and by leading a more
heart-healthy lifestyle.
9,10
Studies reveal that low cardio
fitness is a major risk factor for
cardiovascular disease. They
noted that the best predictor
of increased risk of death in
their participants was exercise
capacity, also known as Cardio
Fitness, followed by pack-years
of smoking cigarettes.
11,12
In the Health app, Cardio Fitness
Levels are classified as high,
above average, below average,
or low relative to people in the
same age group and same sex,
and these levels are derived
from the Fitness Registry and
Importance of Exercise National
Database.
13
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
11
Cardio Fitness To provide users with more information about their overall
health, we introduced Cardio Fitness and notifications. Cardio respiratory fitness,
as measured by VO
2
max, is the maximum amount of oxygen the body can use
during exercise.
Previously, direct measurement of VO
2
max typically required rigorous testing
usually done in a clinical setting. Apple Watch estimates cardio fitness, or VO
2
max,
using multiple sensors including the optical heart rate sensor, GPS, accelerometer,
gyroscope, and barometer, as well as user inputs like age, gender, and certain
medications that affect maximal heart rate. The estimate captures a wide range
of cardio fitness levels as users walk throughout the day, whether or not they are
tracking a workout.
Users can view their cardio fitness levels in the Health app on iPhone and iPad
along with information on what cardio fitness means and how to interpret the
information. They can also choose to receive a notification if their cardio fitness
falls within the low range for their age group and sex, along with guidance on how
to improve cardio fitness and have a conversation with their doctor.
To develop our heart health features, we have done extensive clinical validation to evaluate
their performance across a variety of conditions and user behaviors. We collaborated with
researchers at Stanford University School of Medicine to conduct the Apple Heart Study,
which used the irregular rhythm notification feature on Apple Watch to show that a wearable
can help with early detection of AFib. For more information on the science and clinical valida-
tion behind these heart health features and our collaboration with medical experts, including
an overview of the Apple Heart Study and our white papers that detail our methods and
processes, please see Extensions and Spotlights section 1.
Timeline of heart health feature releases
“American Heart Association
science associates low
cardiorespiratory fitness
levels with a higher risk of
cardiovascular disease and all-
cause mortality. The American
Heart Association is focused
on helping all people equitably
achieve longer, healthier
lives, and we believe that
emerging technology solutions
can empower individuals to
manage their own health.”
17
Nancy Brown, American Heart
Association CEO
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
2015
Launch of first
Apple Watch
with optical
heart sensor and
Heart Rate app
2017
Launch of
Apple Heart Study
•
High heart rate
notification
•
Resting, walking,
recovery heart rate
•
Estimate of VO2 max
2018
ECG app to record
electrocardiograms
•
Irregular rhythm
notification
•
Low heart rate
notification
2019
Launch of
Apple Heart and
Movement Study
2022
AFib
History
2020
Cardio Fitness
and notifications
12
The prevalence and
high costs of falls
Falls are a leading cause of
injury and death amongst
Americans aged 65 and above
and 25% of older adults will fall
each year.
18
About 1 in 100 people in the US
has had a seizure or has been
diagnosed with epilepsy.
19
Falls contribute to 50 billion
in annual medical costs in the
US.
20
Half of Germans 80 years
and older fall at least once a
year, 10% of which result in
injuries that require treatment.
21
10,000 seniors die each year
from falls in France.
22
The risk of falling increases
sharply between the ages of 40
and 65, particularly in women,
making this time window a
critical stage for interventions
designed to prevent falls.
23
Mobility
Driving greater understanding and improvement
of a user’s mobility data
Our mobility features utilize the sensor technology on iPhone and Apple Watch to
help users stay aware of potential mobility issues before they result in a fall, and
help them get help if they do take a hard fall.
Mobility is a critical part of overall health that is often overlooked until it affects
a person’s day-to-day life or causes a serious health issue. Further, falls are a
major concern for older segments of the population and can have significant
consequences, particularly when people are on their own (see sidebar). This is true
among older adults and those impacted by certain conditions such as epilepsy who
experience seizures, or anyone living or exercising by themselves.
24
Fall Detection The advanced accelerometer and gyroscope in Apple Watch
Series 4 and later allow it to detect hard falls, using the motion sensors and an
algorithm to identify if a fall occurs based on wrist trajectory and impact acceler-
ation. These algorithms were initially
designed to identify and detect hard
falls that can occur in the day-to-day
living of older adults.
Fall Detection is paired with Emergency
SOS, a safety feature available on Apple
Watch and iPhone (see page 16). If a
hard fall is detected and the user is
immobile for about a minute, Apple
Watch’s Emergency SOS feature
automatically calls emergency services
and notifies the emergency contacts
registered in the user’s Medical ID with
a text message and the user’s location.
Fall Detection is available globally and
has helped people of all ages. On a
daily basis, it can provide peace of
mind to users.
Since its initial release, we have
expanded the scope of the fall
detection feature so users can choose
to have it automatically on during
workouts only. With watchOS 8, our
fall detection algorithms were updated
and optimized to better recognize the
unique motion and impact patterns
from different types of workouts,
including cycling.
“In February 2019, Toralv was staying
with friends just outside of Oslo,
Norway, where he lives. He wore his
Apple Watch Series 4 to bed that
night so he could test a sleep app, but
then things start to get blurry. He has
no memory of his fall later that night
and doesn’t remember getting back
into bed… Sometime around 4 a.m.,
he had got up to go to the bathroom
when he experienced a sudden drop in
blood pressure. He fainted and landed
face first on the bathroom floor. His
collapse triggered the fall detection
feature ... ‘Nobody heard my fall,’ he
says. ‘My friend and his wife didn’t
hear anything about it until the police
car came to their door.’”
25
Toralv, 68, Norway,
drop in blood pressure
“One day in early February, Yuewei was
riding his bike home from work at 10
p.m. … He fell down accidentally and
hit his head on the road pier. … [H]e was
still conscious but unable to move … At
this time the fall detection of his Apple
Watch played a role. After calling 120, ...
within 5 minutes, the ambulance
arrived, and Mr. Hu was promptly
treated. Later, his doctor told him that
there was a slight brain injury, and that
a little delay could have caused
irreversible damage.”
26
Yuewei, 23, China
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
13
Walking Steadiness Research shows that declines in
mobility take place gradually, sometimes years before
a serious issue ever arises.
27
In 2021, we introduced
Walking Steadiness in the Health app to leverage
the powerful sensors in iPhone along with custom algorithms to give users an
overall sense of their fall risk in the next twelve months. The walking steadiness
feature estimates balance, stability, and coordination. It uses mobility metrics
like walking speed, step length, double support time, and walking asymmetry to
determine a user’s walking steadiness and classification.
While walking may sound simple, it requires the coordination of multiple com-
plex physiological systems, and a single failure in any of them can affect one’s
walking. For example, a limp, or changes in the length of each step, can indicate
an increased risk of injury. Walking Steadiness can observe changes in walking
patterns outside of a clinical setting, capturing natural, everyday movements.
Developing this feature was possible because of data shared by more than
100,000 users across all ages participating in the Apple Heart and Movement
Study, in addition to findings from more focused studies with elderly populations
and post-operative orthopedic patients.
iii
The
data set from the Apple Heart and Movement
Study allowed us to estimate walking steadiness
across all segments of the population.
Users’ walking steadiness is classified as OK,
Low or Very Low to provide them with simplified
insights into their potential fall risk. Users can also
choose to receive a notification if their walking
steadiness is classified as Low or Very Low.
iii. Walking steadiness studies are typically validated for small samples of individuals above 65, only for data
gathered in a clinical setting.
“When I hurt my back in the fall,
I could tell I was not walking
well, [I] could barely walk a
quarter of a mile without lots
of pain. As I recovered, it was
nice to see a numeric metric
that showed me how I was
improving, and not just my
own personal feelings. It’s so
cool to have technology come
alongside and pick up on all the
little things that help you see
the bigger picture.”
Joshua, 34, Florida
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
14
To develop our mobility features, we have conducted extensive clinical validation to evaluate
the performance based on real-world movement patterns and falls. We are collaborating with
Brigham and Women’s Hospital and the American Heart Association to conduct the Apple
Heart and Movement Study. Results of this study are expanding the fall detection capabil-
ities of Apple Watch. For more information on the science and clinical validation behind our
mobility features and our collaboration with medical experts, including our white papers that
detail our methods and process, please see Extensions and Spotlights section 2.
The Health app also contains educational resources explaining, for example, what
walking steadiness is, why people should monitor it, and sample exercises on
how to improve it. In addition, the Health app offers sample exercises to improve
balance, stability, and coordination, which come with short instructional videos.
Fitness+ also offers a “Workouts for Older Adults” program that incorporates key
exercises that may improve walking steadiness.
28
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
15
The importance
of limiting noise
exposure for
hearing health
12% of the global population,
including nearly 25% of
Americans, 17% of Europeans,
and 14.5% of Australians, have
at least mild noise-induced
hearing loss.
29,30,31,32
Hearing health
Providing users with a range of features to help them
protect their hearing health
Apple Watch and iPhone can help users monitor for noise exposure that can
damage their hearing over the long term.
Hearing Health
Noise-induced hearing loss affects more than one in ten people in
the world to some degree, and could be preventable.
33
Using noise
exposure limits derived from World Health Organization (WHO)
recommendations, we introduced hearing health features to help
make our users aware of the hazards of noise exposure, and help them monitor
their environmental noise levels and headphone audio levels.
Headphone Audio Levels
Introduced in 2019, users can track
the volume of their headphone
audio levels over time in the Health
app. Users can see the volume of
their headphone audio measured
in A-weighted decibels and
whether they are surpassing audio
exposure limits derived from WHO
recommendations. They can also
receive a notification if they reach
a seven-day audio exposure limit
based on WHO recommendations.
Environmental sound
reduction by AirPods Pro Apple
Watch users can see when the
environmental sound level is
reduced while they are wearing
AirPods Pro and using Active
Noise Cancellation
or Adaptive Audio.
Noise app The Noise app
on Apple Watch uses the
microphone to measure the
ambient sound levels in a user’s
environment. Noise Notifications
alert users if the average sound
levels nearby are over a certain
noise threshold for three minutes.
Loud Sound Reduction on
AirPods Pro (2nd generation)
Using the the powerful H2
chip, the second generation of
AirPods Pro can enable on-device
processing that reduces loud
environmental noise — like a
passing vehicle siren, construction
tools, or even loud speakers at
a concert — to help intelligently
reduce noise exposure that could
affect your hearing.
iv
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
iv. Available for both AirPods Pro (2nd generation) with MagSafe Charging Case (USB-C) and AirPods Pro (2nd generation) with MagSafe Charging Case (Lightning).
Personalized Volume Personalized
Volume adjusts the media volume
on AirPods Pro (2nd generation)
based on environmental conditions
and a user’s volume preferences. It
learns a user’s listening preferences
over time to fine-tune their media
volume in response to your
surrounding environment, which can
be especially helpful when moving
from louder conditions to a quieter
environment.
iv
16
Emergency features
Emergency SOS Emergency SOS is available on every iPhone and Apple
Watch, allowing users to easily call for help and alert emergency contacts
if they need to. When a user makes an Emergency SOS call, it allows first
responders to access real-time location data from iPhone and Apple Watch to
quickly locate someone when they need help. In some regions users can choose
the service they need (for example, in mainland China, users can choose if they
need police, fire department, or ambulance assistance).
Emergency SOS via satellite is available on iPhone 14 and iPhone 15 models
in 16 countries and regions on three continents. Emergency SOS via satellite
allows an iPhone user to connect directly to a satellite, enabling messaging with
emergency services when outside of cellular or Wi-Fi coverage.
Medical ID When users set
up Medical ID in the Health
app, first responders can
access a user’s critical health
information — like allergies
and medical conditions —
from the Lock Screen of
iPhone or Apple Watch. They
can also see names and
contact information of the
user’s designated emergency
contacts.
In certain regions, users can
also choose to share their
Medical ID with emergency
responders during an
emergency call. By having
Emergency SOS and Medical
ID easily accessible on
iPhone and Apple Watch,
users have peace of mind
that they can easily call for
help when they need it.
Crash Detection The iPhone 14 and
iPhone 15 lineups, Apple Watch Series 8
and later, Apple Watch Ultra and Apple
Watch Ultra 2, and the new Apple Watch
SE use the accelerometer and new
gyroscope paired with existing sensors
and advanced motion algorithms to
detect severe car crashes, automatically
dialing emergency services and
alerting emergency contacts if a crash
is detected and a user is unconscious
or unable to reach their iPhone. Crash
Detection can work on its own on either
iPhone or Apple Watch, or seamlessly
leverages the unique strength of both
devices to get users help efficiently:
When a severe car crash is detected,
the emergency services call interface
will appear on Apple Watch, as it is most
likely to be in closer proximity to the
user, while the call is placed through
iPhone if it is paired and in range for the
best possible connection.
Empowering users on their personal health journey
Apple Watch acts as an intelligent guardian for users’ health
Safety
Helping users seek help when they need it
Since iPhone and Apple Watch are with users every day, they offer safety features
that can help users call for help in an emergency.
v. Emergency SOS via satellite and Roadside Assistance via satellite were designed for use in open spaces
with a clear line of sight to the sky. Performance may be impacted by obstructions such as trees or
surrounding buildings.
vi. Roadside Assistance via satellite is launching in the U.S. with AAA and is included for free for two years
starting at the time of activation of a new iPhone 15, iPhone 15 Plus, iPhone 15 Pro, iPhone 15 Pro Max,
iPhone 14, iPhone 14 Plus, iPhone 14 Pro, or iPhone 14 Pro Max. This satellite service requires iOS 17. AAA
may charge for roadside assistance services. iPhone 15 and iPhone 14 users who are not AAA members
can take advantage of Roadside Assistance via satellite on a pay-per-use basis for AAA’s roadside
assistance services.
17
EMPOWERING USERS ON THEIR PERSONAL HEALTH JOURNEY
Features to improve everyday
health and fitness
Offering users meaningful insights to encourage
healthier behaviors every day
In many ways, health is the compilation of small lifestyle choices people make
every day. When people develop positive habits they repeat consistently, their
overall health can significantly improve.
With the features built into Apple Watch, iPhone and iPad, our users are able to
see a more complete picture of their health and are empowered with actionable
insights to help them reach their personal health and fitness goals. Articles and
descriptions in the Health app provide users with accessible explanations sur-
rounding important health topics.
Studies show
Providing an Apple Watch
and incentives to participants
helped increase their activity by
30-40%.
34
In various randomized control
trials, mindfulness apps like
Calm on iPhone and Apple
Watch were found to lead to
reduced stress and decrease in
fatigue, daytime sleepiness, as
well as improvements in sleep
quality.
35
Empowering users on their personal health journey
Features to improve everyday health and fitness
18
The high cost of a
sedentary lifestyle
A sedentary lifestyle leads to all
kinds of health risks, increasing
the likelihood of cardiovascular
disease, diabetes, high blood
pressure, obesity, osteoporosis,
depression, and anxiety,
including mortality risk.
Researchers estimate the
global yearly cost of sedentary
lifestyles at 68 billion in direct
healthcare costs, productivity
losses, and disability-adjusted
life-years.
36
Another study that
includes the indirect costs of
inactivity-related mood and
anxiety disorders estimates the
economic costs of inactivity in
the EU regions alone at more
than 70 billion.
37
According to the World Obesity
Federation, 800 million adults
live with obesity. By 2025,
the estimated annual cost of
treating the negative effects of
obesity is projected to be over
1.2 trillion.
38
The WHO estimates that, in
Europe, 25% of adults and 80%
of adolescents are insufficiently
active. Insufficient activity is
estimated to lead to 500,000
deaths per year in Europe.
39
Activity and fitness on Apple Watch: Activity rings, sharing
activity with friends, coaching, competitions, awards, Fitness+
Throughout the years, we have introduced a host of new features
to encourage users to stay active and work out. We designed
these features on Apple Watch to cater to a range of fitness
levels, from the experienced athlete to the newcomer to fitness,
and each goal is customizable.
Activity Rings Users can view their
daily physical activity as tracked by
Apple Watch sensors in an intuitive
manner on three dimensions, (1) Move:
active calories burned, (2) Exercise:
time spent engaging in workouts or
brisk activities, and (3) Stand: number of
hours in which the user stood and moved
for at least a minute. Users can set a
different goal that suits their lifestyle and
health goals. The Fitness app is available
to all iPhone users, even if they don’t
have an Apple Watch, so they can set
up a daily Move goal with iPhone motion
sensors tracking steps, distance, flights
climbed, and workouts from third-party
apps to estimate active calories to
contribute to the Move goal.
Workout app The Workout app
is one of the most popular apps
on Apple Watch, using advance
motion sensors to accurately
track performance data across
a wide range of modalities
and to automatically detect
popular activities like walking,
running, cycling, swimming
and more. Users also have
access to informative metrics
like running power, stride
length and vertical oscillation,
and powerful training
experiences like Heart Rate
Zones and Custom Workouts
to help them reach their goals.
Activity Sharing Apple Watch
users can share workouts, Activity
rings, and Activity achievements
with friends and receive
notifications when a friend has
completed a workout, closed their
Activity rings, or has achieved a
new goal.
Daily Coaching Hourly stand
reminders, monthly challenges
customized to the user’s previous
month fitness data, and friendly
reminders about whether their daily
activity is on track, encourage users
to complete daily activity goals and
monthly challenges.
Empowering users on their personal health journey
Features to improve everyday health and fitness
19
“I fell into a deep depression
and weighed 250 pounds.
I ran my first Spartan Race
in December and ran a full
marathon in February.”
42,43
Arthur, 34, Mississippi, US,
commenting on his use
of Apple Watch
Activity Competitions Apple
Watch users can compete in a
seven-day competition with their
friends, where each person earns
points by filling their Activity rings.
At the end of the competition, the
one with the most points wins, and
earns an award.
Activity Awards Users can earn
awards for personal records,
streaks, and major milestones
using their Apple Watch. Apple
Watch serves as an accountability
partner and motivates users with
opportunities to earn awards for
personal records, streaks, and
major milestones. Users also
win awards for competitions
against other users, for monthly
challenges that are customized
for each user, as well as for
limited edition challenges that
are offered on special occasions
such as major holidays and other
important events throughout the
year like Earth Day, International
Women’s Day, and Yoga Day.
The importance
of taking care of
the many aspects
of one’s health
Researchers estimate the
economic burden from
insufficient sleep at 680 billion
of economic output every year
for five large OECD countries.
40
Mindfulness intervention
programs have been shown
to have positive effects on
mental as well as physical
health. Numerous studies have
shown meditation can lead
to improvements in patients
with high blood pressure,
inflammatory bowel disease,
and rheumatoid arthritis.
41
Empowering users on their personal health journey
Features to improve everyday health and fitness
Apple Fitness+ Apple Fitness+ is an award-winning fitness and wellness
service with studio-style workouts and meditations, designed to be welcoming
to all wherever they are in their fitness journey, and to help users live a healthier
day. Subscribers have access to the largest library of workout content in 4K
Ultra High Definition, all led by a diverse and inclusive team of trainers. Fitness+
helps users train their body and mind with a one-of-a-kind personalized and
engaging experience that can be done anytime, anywhere and motivates users
from start to finish with music from today’s top artists. Users also have access
to inspiring audio experiences including Time to Walk, featuring some of the
world’s most interesting and influential people, and Time to Run, designed to
help users become more consistent and better runners. Fitness+ is now available
for iPhone users to subscribe to and enjoy in the 21 countries it is available in,
and those with an Apple Watch can continue to take their experience to the next
level with personalized real-time metrics that display on iPhone, iPad, and Apple
TV. Fitness+ workouts display onscreen guidance along with trainer coaching,
including Intensity for HIIT, Cycling, Rowing, and Treadmill; Strokes per Minute
(SPM) for Rowing; Revolutions per Minute (RPM) for Cycling; and Incline for
walkers and runners in Treadmill.
With watchOS 10 and iOS 17, Fitness+ introduces Custom Plans, a new way
to receive a custom workout or meditation schedule based on day, duration,
workout type, and more, and Stacks, which allows users to select multiple
workouts and meditations to do seamlessly back to back. Audio Focus, which
gives users the ability to prioritize the volume of the music or the trainers’ voices,
will be available later in 2023.
20
Women’s health
The menstrual cycle is an important marker of health, so much so,
that it is often considered a vital sign because it represents the
coordination of so much physiology and gives a window into overall
health. Since cycles vary from month to month and person to
person, the best way to understand what is normal for an individual user is to track
their menstrual cycle.
Since menstrual cycles have been under-researched, we also launched the Apple
Women’s Health Study with Harvard T.H. Chan School of Public Health and the
NIH’s National Institution of Environmental Health Sciences to help scientists learn
more about women’s health (for more, see page 30).
Cycle Tracking and Cycle Factors
To help give users insight into their
menstrual cycle, we built the Cycle
Tracking feature. Users can easily
track their menstrual cycle using
iPhone, iPad and Apple Watch, to
help them understand their cycle
history over time, including cycle
length and period length. The
feature uses users’ logged periods
and heart rate data from Apple
Watch to offer predictions and
notifications alerting them when
their next period or fertile window
may be approaching. People can
also add cycle factors that influence
the timing and length of their
cycle, such as birth control pills
or pregnancy.
Retrospective Ovulation
Estimates Utilizing the
temperature-sensing capabilities
in Apple Watch Series 8 and
Series 9 and Apple Watch
Ultra and Ultra 2, users can
receive retrospective ovulation
estimates. Knowing when
ovulation has occurred can be
helpful for family planning, and
Apple Watch makes it easy and
convenient by providing users
with a notification of when they
likely ovulated. Temperature
sensing also enables improved
period predictions.
Cycle Detail view and PDF
Cycle Tracking users can review
logged periods, symptoms,
fertile window estimates, wrist
temperature data, and more
with the new Cycle Detail view.
And to help facilitate richer
conversations, users can share
their cycle history as a PDF with
their healthcare provider.
Cycle Deviations All Cycle
Tracking users can now receive
a notification if their logged cycle
history shows a possible deviation,
such as irregular, infrequent, or
prolonged periods, and persistent
spotting, which can be symptoms
of underlying health conditions.
This feature was developed using
insights from the Apple Women’s
Health Study, including that 16%
of participants were experiencing
deviations in their cycles.
Empowering users on their personal health journey
Features to improve everyday health and fitness
21
Empowering users on their personal health journey
Features to improve everyday health and fitness
Vision health
With iOS 17 and iPadOS 17, Screen Distance encourages younger
users to engage in healthy viewing habits that can lower their risk
of myopia. Apple Watch can measure time spent in daylight with
watchOS 10, empowering children and their parents to track another
behavior that can help reduce myopia risk.
Screen Distance Viewing something
like a device or a book at too close
of a distance is a well-documented
myopia risk factor. The new Screen
Distance feature uses the same
TrueDepth camera that powers Face
ID on iPhone and iPad to encourage
users to move their device farther
away after holding it closer than
12 inches for an extended period of
time. Screen Distance can remind
younger users to engage in healthy
viewing habits that can lower their
risk of myopia, and it gives adult
users the opportunity to reduce
digital eyestrain.
Time in Daylight The
International Myopia Institute
recommends children spend
at least 80-120 minutes a day
outdoors. With watchOS 10,
Apple Watch introduces the
ability to measure time spent
in daylight using the ambient
light sensor. Users can view the
amount of time spent in daylight
measured by their Apple Watch
in the Health app in iOS 17 and
iPadOS 17. Children who do not
have their own iPhone can use
Family Setup to pair their Apple
Watch to their parent’s iPhone,
giving parents visibility into the
amount of time their kids are
spending in daylight with Health
Sharing. Time spent in daylight
can provide additional benefits
to physical and mental health,
so this feature is available to all
watchOS 10 users.
The global rise of
myopia
Myopia, or nearsightedness, is
becoming more prevalent and
is one of the leading causes
of vision impairment around
the world. According to the
International Myopia Institute,
it’s estimated that on average,
30% of the global population
is affected by myopia, and the
number is expected to grow
to 50% by 2050. Myopia rates
in Asia are especially high,
with some countries having a
prevalence of 80 to 90%.
44
Myopia commonly starts
between age 5 and 15. A
number of factors contribute to
myopia, including genetics, but
the increase in myopia rates is
something experts believe is
due to changes in our lifestyle,
specifically spending more time
indoors and doing near work,
such as viewing books and
devices too closely.
45
22
Empowering users on their personal health journey
Features to improve everyday health and fitness
Mindfulness app Users can
perform guided deep-breathing
exercises assisted by visuals and
haptic feedback, as well as take a
moment to pause and reflect on a
thought or an action, using Apple
Watch. Users can have their watch
remind them to breathe or reflect
throughout the day.
State of mind logging Research shows that reflecting on one’s own mental
state can help build emotional awareness and resilience. Multiple studies by
researchers have shown that identifying feelings reduces emotions like sadness
and anger, and positively impacts our body by slowing our heart rate.
46, 47, 48, 49, 50, 51
Additionally, in a survey of participants in the UCLA Digital Mental Health Study,
initial results showed more than 80% of participants found reflecting on their
mood in the study app increased emotional awareness, and about half said it
increased wellbeing.
The Health app in iOS 17 and iPadOS 17, and the Mindfulness app in watchOS
10, bring an engaging and intuitive way for users to reflect on their state of mind.
Users can scroll through multidimensional shapes and choose how they are
feeling in a range from Very Pleasant to Very Unpleasant. Then, they can choose
what is having the biggest impact on their feelings, like Travel or Family, and
further describe their feelings, such as Grateful or Worried.
In the Health app, users can see valuable insights to identify what might be
contributing to their state of mind — whether it’s associations or lifestyle factors,
such as sleep or exercise — and can use these insights to better manage their
overall health.
Focus When users want to
concentrate on a specific activity,
they can turn on a Focus option
for work, personal time, sleep,
fitness, mindfulness, gaming,
reading, or driving. Users can
reduce distractions across all of
their devices by allowing only
notifications from the people and
apps they choose.
Fitness+ guided meditations
and mindful cooldowns Fitness+
offers Meditation to help users
develop a regular meditation
routine and improve their overall
sense of well-being. Users can
choose from several meditation
themes alongside the Fitness+
trainers or as an audio-only
experience right on their Apple
Watch. Fitness+ also offers Mindful
Cooldowns to reduce stress and
improve flexibility and focus.
Anxiety and depression
clinical assessments in the
Health app Standardized,
clinically-validated depression
and anxiety self-assessments are
now easily accessible in the Health
app and can be taken anytime.
These assessments can help users
determine their risk level, connect
to resources available in their
region, and create a PDF to share
with their doctor.
vii
vii. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were
developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an
educational grant from Pfizer Inc. The PHQ-9 is available in the Health app to persons 13 years old and
above, and the GAD-7 is available in the Health App for persons 18 years old and above.
Mental Wellbeing
Mental health is as important as physical health and affects people
every day in how they think, feel, and act. We have introduced features
and apps to help users reflect on their state of mind and take action to
improve their overall wellbeing.
23
Empowering users on their personal health journey
Features to improve everyday health and fitness
Reaching sleep goals: Sleep tracking, Wind Down
and setting a sleep schedule
Given that sleep plays an important role in a person’s overall
health, we have developed features to help our users understand
their sleep.
Sleep tracking Apple Watch
estimates time spent in bed and time
spent asleep by detecting micro-
movements from the accelerometer
and analyzing changes in activity and
movement during the night. Using
signals from the accelerometer, Apple
Watch can detect when users are in
Core, REM, or Deep sleep, and users
can view sleep comparison charts in
the Health app on iPhone and iPad.
Without Apple Watch, users can also
track time in bed using iPhone based
on whether or not they pick up and
use their iPhone during the night.
Sleep Schedule Users can
create personalized sleep
schedules that help them meet
their sleep goals and improve
their overall health.
Wind Down Users can start
winding down before bedtime and
can create shortcuts that quickly
begin a Wind Down activity such
as playing music or a podcast, or
beginning a meditation, yoga or
stretching session.
Other healthy habits
Features on Apple Watch, iPhone, and iPad also help users develop other everyday
healthy behaviors, like washing their hands for the recommended amount of time,
and helping them track and manage the medications they take.
Medications The Medications
experience on Apple Watch,
iPhone, and iPad helps users
manage and track medications,
vitamins, and supplements they take by
allowing them to create a medications list
and set up schedules and reminders. In
the US, users can simply point their iPhone
camera at a label to add a medication,
read about the medications they’re taking,
and receive an alert if there are potential
interactions for their medications.
Handwashing Apple
Watch can automatically
detect when users begin
washing their hands and
start a 20-second timer.
Through Handwashing
reminders, Apple Watch
can remind users to
wash their hands after
returning home.
24
EMPOWERING USERS ON THEIR PERSONAL HEALTH JOURNEY
Fueling innovative third-party
health and fitness apps
HealthKit empowers developers to create new experiences
for users everywhere
Apple makes available a number of tools and core technologies to all developers to
help them create innovative apps, including more than 250,000 software develop-
ment building blocks called APIs. With the HealthKit API, Apple makes it possible
for third-party developers to develop health and fitness apps that take advantage
of the sophisticated sensors on iPhone and Apple Watch and are compatible with
the Health app. HealthKit provides a framework for developers of health and fitness
apps to integrate users’ health data, with permission, into their apps’ features, and
for apps to contribute data to the Health app (which users can then see in one
place and with permission, other apps can use for their own features). Importantly,
we developed HealthKit to provide users access to and granular control of their
health data, and we designed HealthKit with privacy and security at its core.
Many HealthKit-enabled apps are popular with users worldwide, providing a host
of health and fitness experiences to users. They include running apps like Nike Run
Club, fitness apps like MyFitnessPal, sleep apps like Rise: Energy & Sleep Tracker,
SnoreLab, and Pillow, meditation and mindfulness apps like Calm, Headspace,
and Ten Percent Happier, hearing-related apps like SonicCloud, nutrition apps like
WeightWatchers or Lose It, and medications
and symptoms tracking apps like Pt Pal Pro
and Medisafe Medication Management.
In addition, an increasing number of Health-
Kit-enabled apps use connected accessories
to allow our users to track and monitor even
more aspects of their health, including blood
pressure (e.g., Qardio heart health), weight
(e.g., Withings Health Mate), blood glucose
level (e.g., Dexcom, One Drop), and respiratory
health metrics (e.g., MIR Smart One).
With iPadOS 17, health and fitness developers
can now also use HealthKit on iPad, opening
up new opportunities to create innovative
health and fitness experiences.
“Having the 10% Happier app
on my iPhone is like having my
therapist in my back pocket. It
grounds me.”
Kristi, 54, US,
Ten Percent Happier user
“[HealthKit] is the enabler of the
Rise experience. The motion-
activity and steps data that
HealthKit collects passively
is what enables us to help our
users focus on reducing their
sleep debt and having more
energy every day.”
Jeff Kahn, CEO and co-founder
of Rise Science
For more information on the APIs available for third-party developers — HealthKit, Research-
Kit, CareKit, SensorKit, Movement Disorder, and Fall Detection — please see the Extensions
and Spotlights section 3.
Empowering users on their personal health journey
Fueling innovative third-party health & fitness apps
25
SECTION 2
Supporting the health
ecosystem by collaborating
with the medical community
A core principle of Apple’s work to advance health has always been that the stron-
gest innovation is possible when we work directly with the medical community.
Since the start of our work in this field, the teams building our health products have
included in-house clinicians who collaborate with experts from leading research
institutions, to ensure all of our health and fitness features are grounded in science.
Over time, our close collaboration with institutions has led to our development
of features that leverage our ecosystem to help researchers advance science
and healthcare providers deliver better and more efficient care. Apple is proud to
provide new and innovative features to the medical community so that they can
push the frontier of what is possible in health.
Below are the four main categories of our collaboration with the medical commu-
nity, with longer descriptions of each to follow.
Equipping researchers to make new scientific discoveries. iPhone and Apple
Watch give researchers the opportunity to recruit participants from a large user
base, and for participants to choose to share health data they collect throughout
their lives to help advance science. Through the Research app, Apple has collab-
orated with Harvard T.H. Chan School of Public Health, Brigham and Women’s
Hospital, the University of Michigan, and others to offer users across the US the
opportunity to participate in the Apple Women’s Health Study, the Apple Heart and
Movement Study, and the Apple Hearing Study. In addition, Apple is supporting a
number of other studies, and ResearchKit makes it easier for researchers around
the world to build apps for innovative studies at unprecedented scale.
Strengthening the physician-patient relationship with meaningful data.
Health Records in the Health app on iPhone and iPad, along with apps and devices
developed by third parties using Apple developer tools, are helping improve
physicians and patients’ conversations. They are also enabling a more effective
use of hospital resources.
Health organizations promoting healthy lifestyles with Apple Watch. Health
organizations and insurance companies around the world have collaborated with
Apple to integrate Apple Watch in their wellness programs.
Supporting public health and government initiatives. Apple partners with
clinicians and local governments on unique ways to support their crucial work
to promote public health, and regularly donates to relief efforts and non-profit
organizations. We have also built apps and features to support public health during
the COVID-19 health crisis.
26
ENABLING RESEARCH
Apple’s advanced features and
technologies are empowering
researchers around the world to
collect data from study participants
who have chosen to share it, more
frequently and at a broader scale
than ever before.
HEALTH RECORDS ON
iPHONE AND iPAD
Creates an encrypted connection
between participating health
institutions and a patient’s iPhone or
iPad so patients can view their
allergies, conditions, immunizations,
lab results, medications records,
procedures, vitals, and clinical notes
directly within the Health app.
DOCTOR VISITS
Apple Watch, iPhone and third-
party apps are allowing patients
to gather a more complete
picture of their health, so they
can have better conversations
with their doctor.
DEVELOPER INNOVATION
Some examples of third-party
developer innovation that work
with Apple technologies are
Stryker’s Triton AI — a real time
measure of blood loss and
hemorrhaging during labor and
delivery that is reducing the need
for postpartum blood transfu-
sions — and Butterfly iQ+ — a
portable ultrasound device that is
opening new possibilities for
point-of-care ultrasounds.
CLINICIAN MOBILITY
AND WORKFLOW
With our products and
electronic health records apps,
clinicians can read and write
patient records on the go,
receive urgent lab notifications
on Apple Watch, and access
on-demand decision support
reference materials.
SECURE COMMUNICATION
AMONG NURSES AND
PHYSICIANS
Apple Watch, iPhone, iPad, and
clinical communication apps
streamline how nurses communicate
with physicians, other care team
members, patients, and patients’
families while delivering care.
REMOTE CARE
Hospitals, clinics, physicians,
and more are relying on iOS apps
built using HealthKit and CareKit
to keep patients connected to
care teams, resulting in better
patient outcomes.
Partnering with the medical community
to move research and care forward
26
27
SUPPORTING THE HEALTH ECOSYSTEM BY COLLABORATING
WITH THE MEDICAL COMMUNITY
Equipping researchers to make
new scientific discoveries
Apple’s work to advance health is grounded in the belief that all innovation in
health should be grounded in science. Today, Apple’s advanced features and
technologies are empowering researchers around the world to collect data more
frequently and at a broader scale than ever before, so they can continue to move
science forward. With iPhone and Apple Watch, study participants are collecting
their health data every day, throughout the day, and participants can then choose
to contribute data to research anywhere and anytime, lowering the barriers to
study entry and participation. As a result, researchers can obtain high-quality,
varied, and frequent data at greater scale.
The ubiquity of iPhone and Apple Watch gives researchers the opportunity to
recruit participants from a large-scale user base, thereby alleviating one of the
biggest challenges medical researchers face: recruiting participants. Millions of
users have Apple Watch on their wrists and millions more use iPhone every day.
We also believe in offering all iPhone and Apple Watch users an opportunity to
contribute to science through the Research app, while providing them with trans-
parency and control over their data. Users can easily see how their data will be
used in research studies and have the ability to toggle on and off their participation
in these studies as they see fit. With these contributions, and leveraging our sensor
technology, researchers can study large and varied groups, obtain frequent data,
and, ultimately, analyze data from a broader representation of the population.
ResearchKit and the Research app are
designed to help researchers advance
toward potentially groundbreaking advance-
ments, using our products in areas where
they can have the greatest impact.
Apple’s Investigator
Support Program
Inspired by the innovative
ways the research, clinical,
and developer communities
leverage our products and
platforms, we launched the
Investigator Support Program
that provides researchers with
the opportunities to receive
Apple Watch to include in
their research study. We
have witnessed firsthand how
researchers and clinicians are
able to accomplish even more
with the addition of Apple
Watch to their research and
care programs, and through this
program we hope even more
people can have the same kind
of success. Currently, studies
around the globe are integrating
Apple Watch into their research
across heart, mobility, activity,
and other focus areas. For
more information, visit www.
researchandcare.org/resources/
investigator-support-program/
“We‘ve gone as far as we can with
traditional research. Now we
have technology in our pockets
that lets us go even further.”
Dr. Helen Link Egger, Duke
University Medical Center
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
28
ResearchKit
As an open-source framework for building apps, ResearchKit
enables developers to build apps to enroll participants in bigger
numbers than ever before, collect data with far more regularity, and
give researchers an opportunity to more easily access groups that
are harder to enroll in clinical research. ResearchKit also streamlines the process
to gather informed consent from participants, allows developers to easily build
questionnaires, and provides them with a large variety of active tasks to capture
participants’ sensor information.
Many research projects, some now completed, ongoing or starting, have been
made possible by ResearchKit, including Apple’s first-of-its-kind Apple Heart
Study to detect irregular heart rhythms, Mom Genes Fight Post-partum
Depression at UNC to explore a genetic cause to post-partum depression,
the Heart Failure Study at UHN exploring population-level indicators of heart
failure, the Mount Sinai Warrior Watch
Study studying the psychological effects
of COVID-19 on healthcare workers,
research underway at UCLA exploring
greater insights into anxiety and depres-
sion, the Autism & Beyond study by
Duke University to better understand and
identify risks for development in young
children, and Japan’s Keio University
study on heart health.
Apple Heart Study
Apple is committed to the science that
underpins all of our health features, and we
work closely with clinicians and medical
researchers to design and conduct studies
that help us develop the next generation
of scientifically-based health products to
offer our users around the world.
In 2017, Apple scientists collaborated in
research led by the Stanford University
School of Medicine to conduct the Apple
Heart Study on AFib detection. This study
evaluated whether irregular pulse data
detected via Apple Watch could identify
irregular heart rhythms, including AFib and
other serious heart conditions.
“This study offers us even
greater potential for meaningful
breakthroughs that could someday
impact countless lives, helping us
meet our goal of cutting the burden
of depression in half by 2050.”
Chancellor Gene D. Block,
University of California,
Los Angeles
“The idea really is how do we
provide a continuous-style
monitoring of patients in a relatively
unobtrusive way that will allow
us to detect a change in a patient
status before they end up actually
coming into hospital. So this is
where the opportunity with Apple is
tremendous.”
Dr. Heather Ross, Head of the
Division of Cardiology at the Peter
Munk Cardiac Centre, University
Health Network, leading the Heart
Failure Study
”The goal of my research is to
connect healthcare data and
medicine in order to help with early
detection of some types of disease.
Apple Watch collects a huge amount
of healthcare data that enables us
to analyze the relationship of health
outcomes to lifestyle.”
Dr. Takehiro Kimura, Assistant
Professor, Department of
Cardiology, Keio University School
of Medicine
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
29
The unprecedented study enrolled more than 400,000 Apple Watch users from all
50 states in a span of only eight months.
The study was published in the New England Journal of Medicine in 2019: Large-
Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. The first-of-its-
kind virtual study was able to enroll more than 400,000 participants and helped to
demonstrate the feasibility of conducting a real-world study in an everyday setting.
The study led Apple to develop and validate the irregular rhythm notification
feature on Apple Watch.
Apple Research app
Following the success of the Apple Heart Study, we saw an opportu-
nity to use Apple features to support advancements in science, both in
areas that are understudied or have only been researched on smaller
scales, and in areas where the incorporation of new technologies can
dramatically increase the pace of scientific discovery.
Apple introduced the Research app to broaden the scope of what research could
be done digitally by giving researchers the tools to help them uncover new insights,
and furthering our ability to create new features grounded in science in the pro-
cess. Built on the ResearchKit framework, the Research app gives our diverse and
large user base an opportunity to participate in landmark studies, all in a way that
protects the users’ privacy and gives the participants full control over their data.
By downloading the Research app from the App Store, users can easily enroll in
health studies from their iPhone, while maintaining control over which data types
they choose to share with the study team. Users can also choose to stop contribut-
ing to any study at any point in time.
As of October 2023, we are currently collaborating with researchers on three
longitudinal, public studies to help advance science in the areas of women’s health
— gaining insights into the relationship between menstrual cycles and health
conditions with the Apple Women’s Health Study in collaboration with the Harvard
T.H. Chan School of Public Health and the NIH’s National Institute of Environmental
Health Sciences — mobility and heart health — exploring the link with the Apple
Heart and Movement Study in collaboration with the American Heart Association
and Brigham and Women’s Hospital — and hearing health — examining how
everyday sound levels can affect hearing, stress levels, and heart health with the
Apple Hearing Study in collaboration with the University of Michigan. See below
for more information on each study, and their interim research findings.
“We are excited about the
future of the study as a
means to fill the research
gap by diving deeper into
understanding how periods
and menstrual cycles can
be a window into overall
health. This study with Apple,
unprecedented in scope,
will greatly advance our
understanding of the biological
and social determinants of
women’s health, and lead to
better health outcomes.”
Dr. Michelle Williams,
Dean of the faculty,
Harvard T.H. Chan School
“It is clear that large scale
data on cardiovascular and
musculoskeletal physiology
offer insights which have
simply not been accessible
in the past and can empower
individuals with information
on their personal health and
wellness.”
Dr. Calum MacRae, PhD,
Professor of Medicine
at Harvard Medical School
“The scale and types of
information about noise and
hearing ability that we are
collecting in this study through
iPhone and Apple Watch are
yielding insights into exposures
and hearing health impacts
that have never before been
possible.”
Rick Neitzel, PhD, MS, CIH,
FAIHA, Associate Professor of
Environmental Health Sciences
at the University of Michigan
School of Public Health
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
All three Research app studies are longitudinal. They have already produced
some interim insights and early learnings about the studies, included on the
following pages.
30
Apple Women’s Health Study
52,53
Many physicians regard women’s menstrual
cycles as an important window into their overall health, however, the topic has
been under-researched. Medical research on menstruation has often been limited
to studies of smaller sizes, which are not representative of the broader population.
In fact, prior to 1993, women were not required to be included in clinical trials in
the US.
54
Our Apple Women’s Health Study team worked with the Harvard T.H. Chan School
of Public Health and the NIH’s National Institute of Environmental Health Sciences
to launch a long-term study focused on menstrual cycles. Through the Research
app, participants answer surveys and can share tracked personal health data and
sensor data with the study team. The researchers then have access to large-scale
cycle tracking, environmental, behavioral, and social information. This data can be
used to learn more about women’s health, their menstrual cycles, and their rela-
tionship to various health conditions, including polycystic ovary syndrome (PCOS),
infertility, osteoporosis, and menopausal transition.
Data from this study can also help develop innovative features. Most recently, data
from this study was used to update our Cycle Tacking feature to integrate heart
rate for improved cycle tracking predictions.
Interim analysis from the study has already shared new insights around menstrual
symptoms, and PCOS, an under-diagnosed condition
55
that can cause symptoms
such as long menstrual cycles and heavy periods and that is linked to heart and
circulatory health.
The Apple Women’s Health Study is a longitudinal study, and we’ve already shared
some interim, early insights. We’re looking to share more as the study progresses.
Interim research from Apple Women’s Health Study:
• Helping to remove stigma around how common menstrual symptoms really
are, researchers found the most frequently tracked symptoms were abdominal
cramps, bloating, and tiredness, all of which were experienced by more than
60% of participants who logged symptoms. More than half of the participants
who logged symptoms reported acne and headaches. Some less widely
recognized symptoms, like diarrhea and sleep changes, were also tracked by
37% of participants logging symptoms.
56
• Survey data from over 30,000 participants was used to better understand
PCOS. Interim results showed that 12% of participants reported a diagnosis of
PCOS, with the median age of diagnosis of 22 years old. Those with PCOS were
more likely to have unpredictable or irregular cycles, with nearly half (49%)
reporting never having regular menstrual cycles or only having regular cycles
after using hormones. Participants with PCOS also saw a higher prevalence of
conditions that can negatively impact heart health.
57
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
31
Apple Heart and Movement Study
58,viii
Conducted in collaboration with the
American Heart Association and Brigham and Women’s Hospital, the Apple Heart
and Movement Study explores factors that affect heart health and potentially
cause deterioration in mobility or overall well-being, in an effort to promote
healthy movement and improved cardiovascular health. By collecting heart health,
workout, mobility and activity data from Apple Watch and iPhone users, as well
as survey data, this study will provide insights on heart health and potential early
warning signs in ways that were not possible before.
Information gathered through the Apple Heart and Movement Study has provided
teams at Apple with more information about mobility and falls, which led to the
development of our Walking Steadiness feature. Walking Steadiness classifications
were developed using the Apple Heart and Movement Study, from data provided
by more than 100,000 participants of all ages — the largest data set ever used to
study fall risk. Researchers studied people of all age groups who reported more
than 12,000 falls, demonstrating that these falls occur during many different
activities, regardless of age. This feature is an example of the research and science
coming together with actionable recommendations that empower the user with
timely information. Additionally, insights from the study have helped power the
health Trends feature which provides ways to intelligently and proactively highlight
important changes for users, presenting the information in a way that’s easy to
understand. For many key fitness metrics, cohorts within the study are now 10
times larger than any prior studies.
viii. For more information on Apple Heart and Movement Study, visit www.heart.org/en/get- involved/
apple-heart-and-movement-study.
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
32
Apple Hearing Study
ix
Apple is collaborating with the University of Michigan
to examine factors that impact hearing health. The impact of sound exposure
on hearing health and stress levels over time is not well understood. The Apple
Hearing Study collects headphone usage and environmental sound exposure data
through iPhone and the Noise app on Apple Watch, along with several types of
hearing tests measured through iPhone, in order to explore how both can impact
hearing over time. The study is also investigating how long-term sound exposure
can impact stress levels and cardiovascular health.
As part of the study, users have also consented to share their data with the World
Health Organization as a contribution toward its Make Listening Safe initiative.
The information collected can also help guide public health policy and prevention
programs designed to protect and promote hearing health.
Interim indications from Apple Hearing Study:
• 25% of participants experience a daily average environmental sound exposure
(which can include traffic, machinery, public transport, among other things)
that is higher than the World Health Organization’s recommended limit.
• 20% of study participants have hearing loss according to World Health
Organization standards, and 10% have hearing loss that is consistent with
noise exposure.
• Younger participants (18-24 years old) are exposed to both higher
environmental and headphone sound levels than other age groups.
ix. For more information on Apple Hearing Study, visit https://sph.umich.edu/applehearingstudy/index.html.
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
For more information on the Principal Investigators of the Apple Women’s Health Study,
Apple Heart and Movement Study, and Apple Hearing Study, please see the Extensions and
Spotlights section 4.
33
Other studies Apple has supported
In addition to the studies in the Research app, Apple has supported a number of
other research efforts focused on heart health, mental health, and more. See below
for several examples.
Heart Failure Study (University Health Network, Canada) This study, in
collaboration with Dr. Heather Ross at the University of Toronto in Canada, is
exploring how data collected using Apple Watch can provide early indicators of
worsening heart failure. While ongoing, the goal of the study is to understand how
remote monitoring through Apple Watch could drive better clinical outcomes for
heart failure patients.
59
Digital Mental Health Study (UCLA, US) Using devices including iPhone and
Apple Watch, UCLA experts in behavioral health are collaborating with Apple to
obtain objective measures of factors such as sleep, physical activity, heart rate and
daily routines to illuminate the relationship between these factors and symptoms
of depression and anxiety. Making the connection between quantifiable data and
symptoms of anxiety and depression could enable health care providers to note
warning signs, prevent the onset of depressive episodes and track the effective-
ness of treatment. In addition, these objective measures will help medical science
to better understand depression and anxiety, leading to more effective treatments
in the future.
60
For more information on studies that have been made possible by ResearchKit, please
see the Extensions and Spotlights section 5.
Supporting the health ecosystem by collaborating with the medical community
Equipping researchers to make new scientific discoveries
34
The typical
physician-patient
relationship in
numbers
According to 2017 OECD data,
Americans consult a doctor
4 times per year, while the
OECD average is about 7 visits
a year.
61
The average doctor’s
appointment is 18 minutes.
62
Some conditions may be difficult
to assess while at the doctor’s
office, making continuous and/
or on-demand health data
tracking very valuable.
SUPPORTING THE HEALTH ECOSYSTEM BY COLLABORATING
WITH THE MEDICAL COMMUNITY
Strengthening the physician-patient
relationship with meaningful data
Supporting more informed conversations by offering
comprehensive data insights
Most physician-patient relationships are built through interactions that occur in a
clinical setting — at the doctor’s office or at the hospital. On average, individuals see
their doctors at most a few times per year, and during visits, physicians have limited
insight into patients’ everyday activities, which can be highly relevant to their overall
health and care. Historically, most of the data needed to effectively assess behaviors
and risks outside of the clinical setting has been difficult to obtain and interpret. Apple
Watch, iPhone, iPad and third-party apps are allowing patients to give their doctors a
more complete picture of their health.
Our advances in tracking, storing, analyzing, and visualizing health data on Apple
Watch, iPhone, and iPad allow patients to gain insights into their health in between
doctors’ visits and to be alerted when there
is something they should discuss with their
doctor, leading to more informed and mean-
ingful conversations between patients and
their healthcare providers.
Stronger physician-patient relationships
are linked with improved patient health
outcomes.
63
When healthcare providers have
more insight into how patients are doing
outside of their office, it helps them under-
stand the unique challenges their patients face
in everyday life. Apple Watch, iPhone, and iPad
data allow patients to engage in conversations
with doctors with access to data in the Health
app that can provide a better picture of how
they are doing on a daily basis — not just on
the day of their visit.
“Looking at data from wearables
such as Apple Watch, and
partnering to understand the
patient experience, coupled
with the information from sensor
technology, is a way for us to
develop the knowledge that will
allow us to take better care of
patients. This is the future.”
Dr. Heather Ross, Head of the
Division of Cardiology at the
Peter Munk Cardiac Centre,
University Health Networks,
leading the Heart Failure Study
“I’m inspired by the life-saving
potential of technology and
applaud Apple’s innovation and
commitment to health. Capturing
meaningful data about a person’s
heart in real time is changing the
way we practice medicine.”
Dr. Ivor J. Benjamin, FAHA,
Past President of the American
Heart Association
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
35
In addition to having conversations in person around data from the Health app,
patients can also easily export a PDF of their ECG app results on Apple Watch to
share with their doctor.
x
And at participating institutions in the US, patients can use
the Health Sharing feature in the Health app to share categories of Health app data
with their physician. When patients choose
to share this data, their healthcare team can
view the shared data in a web-based view
in their own EHR system and review trends
and changes over time. This feature builds
on Health Records, which creates a direct,
encrypted connection between participating
health institutions and a patient’s iPhone or
iPad so patients can see a central view of
their allergies, conditions, immunizations, lab
results, medications, procedures, vitals, and
clinical notes directly within the Health app
(See sidebar).
Apps and devices developed by third parties,
built using developer tools such as HealthKit
and CareKit, have provided additional ways
to strengthen patient-physician relationships
through at-home monitoring programs. This
data can be shared with physicians and care-
givers who can easily and securely remotely
monitor different aspects of their patients’
health and share personalized care plans that
include instructions and reminders, which
can be adjusted as the patient’s condition
evolves.
xi
As discussed in the section below,
at-home monitoring programs based on
Apple Watch, iPhone, and iPad have shown
promising results.
“We’re excited to partner
[with Apple] in that space and
we appreciate the ongoing
relationship. FHIR is the new
standard that would allow
[health records] interfaces
to be developed without
prior programming which is
a big deal from a health care
standpoint. Smartphones are
ubiquitous and it took us four
hours to set the whole thing up
with Health Records and FHIR
integration.”
Dr. Christopher Longhurst,
Chief Medical Officer and
Chief Digital Officer, UC San
Diego Health
“Improving our services to
patients while protecting
their privacy and security is
of paramount importance to
us. This exciting development
provides a more convenient
option for patients to access
their health records. Patients
retain control over their own
health information at all times.”
Professor Sir Jonathan
Montgomery, chair of
Oxford University Hospitals
NHS Foundation Trust and
professor of healthcare law at
University College London
x. To read more about the experience of 27-year-old Simone Deriu, whose ECG readings from Apple Watch
were instrumental to his diagnosis of AFib, consult this La Repubblica article. https://www.repubblica.it/
tecnologia/2021/10/24/news/il_lato_bello_della_tecnologia_cosi_l_apple_watch_mi_ha_salvato_la_
vita_-323204108/
xi. For example, HealthSteps provides a digital personalized care plan: https://apps.apple.com/us/app/
healthsteps-your-care-plan/id1175003973.
Access to health
records
Our features and technologies
also contribute to paving the
way for users to control their
own health records.
Within the Health app on
iPhone and iPad users in the
US, Canada, and the UK can
download their medical records
from multiple participating
institutions and see them
next to all of their other health
information in the Health
app. Health Records is now
available to patients at over 900
institutions, across over 13,000
locations.
Health Records uses FHIR (Fast
Healthcare Interoperability
Resources), a standard for
transferring electronic medical
records. In the US, the 21st
Century Cures Act requires
that institutions allow patients
to electronically access their
health records from their health
institution and now requires
they certify they use publicly
available FHIR APIs. FHIR APIs
are already incorporated into
the Health app for the Health
Records feature, so thousands
more institutions will be eligible
to be listed in the Health app
and those using supporting
EHR vendors can be added
automatically over time.
Continued on the following page
For more information on the studies and data that are showing how technology is being used
to support care from anywhere, please see Extensions and Spotlights section 6.
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
36
Technology to support care from anywhere
Patient care does not stop once the patient leaves the doctor’s office or the hospital,
it continues into the home. Home care is particularly important for diseases and
conditions that are chronic, such as diabetes or high blood pressure, or require
rehabilitation, such as strokes. Hospitals, clinics, physicians, and more are relying on
iOS apps built using HealthKit and CareKit to keep patients connected to care teams.
Using iPhone or iPad, patients can follow personalized treatment plans, practice
healthy behaviors from home, and record and securely share their own vitals.
By having up-to-date accurate information, the care team can monitor progress
remotely and, if needed, engage with their patients.
Multiple health institutions use third-party apps that leverage Apple’s technology
across a variety of settings. Research has shown that connecting patients with
their care teams remotely is resulting in better
outcomes with the Corrie Health app, UVA
Health care at home programs, and the US
Department of Veterans Affairs loaning Apple
devices to Veterans to connect them with
their VA health care services. Care teams are
better able to help patients with chronic
conditions at Ochsner Health System and
NHS Sunderland, and remote monitoring is
reducing the cost and length of stays in
the NICU at Odense University Hospital and
the University of Virginia Children’s Hospital,
where premature babies can come home to
be with the parents, but still connected to the
care teams remotely.
“We can now deliver the same
high-level quality of care that
we’re used to delivering in the
inpatient setting to patients at
home. That is something we’ve
never really been able to do.”
Dr. Jeff Vergales, University of
Virginia Children’s Hospital
“We’ve created a new program
of monitoring a patient’s blood
pressure in their home using
iPhone and the Health app, and
we’ve been able to dramatically
improve how many people
got it under control in a short
period of time.”
Dr. Richard Milani, Chief
Clinical Transformation Officer
Ochsner Health
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
Continued from the previous page
Health Records now supports
the latest version of FHIR, called
R4. This latest version of the
standard includes clinical notes
as a new data type. EHR vendors
and health institutions can
support this data type on Health
Records so users connected to
a participating institution may
see clinical notes in a variety
of formats such as text or PDF
directly within the Health app.
In a first-of-its-kind feature,
users will be able to search the
Health app for clinical notes
content to surface relevant
notes, even notes in handwritten
format (subject to language
availability), that have been
downloaded to their iPhone. In a
recent survey of users who had
access to their health records
on their smartphones, 90%
responded that this improved
their understanding of their own
health, facilitated conversations
with their clinicians, or improved
sharing of personal health
information with friends and
family.
64
37
Third-party developer innovation
By offering access to sophisticated sensors on iPhone and Apple Watch, technical
tools such as our health SDKs and APIs and artificial intelligence and machine
learning algorithms, we strive to offer developers the tools to innovate in the
medical field and improve affordability and accessibility in health.
The following are some examples of innovative medical technologies developed by
third parties using Apple products and technologies that have helped lead to better
patient outcomes, increased cost savings, and improved efficiency in hospitals,
clinicals, and other healthcare institutions.
The importance of
portable ultrasounds
Pneumonia is a leading cause
of death of children in poor
countries and is frequently
misdiagnosed.
Portable ultrasounds such as
the Butterfly iQ+ are used to
screen children in more than 13
low-income countries.
Increasing accessibility to
ultrasounds with Butterfly
iQ+
65
Butterfly iQ+ is a hand-
held, portable ultrasound
device that works in
tandem with iPhone and iPad.
It has expanded accessibility of
ultrasound imaging in low-resource,
emergency, and remote settings
and is opening new possibilities
for point-of-care ultrasound at
much lower price point. Butterfly
iQ+ is built using Apple developer
tools such as Metal, Core ML and
SceneKit, and leverages the power
of iPhone and iPad to process
images on-device which enhances
privacy and security.
Reducing post-partum
transfusions using Stryker’s
Triton AI
66
Triton AI uses iPhone’s
infrared cameras and
Core ML (an Apple
machine learning framework) to
estimate surgical blood loss in real
time and is currently being used
in labor and delivery protocols.
The use of Triton AI has been
associated with early recognition
of hemorrhage, decreased
postpartum transfusions, and cost
savings in labor and delivery.
Helping Military Personnel and
Veterans with PTSD to reduce
nightmares with NightWare
67
The NightWare system
uses Apple Watch’s heart
monitor sensor and other
biometric sensors and creates
a personalized algorithm using
artificial intelligence to help patients
with PTSD and trauma who suffer
from severe nightmares improve
sleep quality.
Improving remote post-
operative care with Zimmer
Biomet’s mymobility®
68
mymobility allows
patients scheduled for an
orthopedic procedure to
better connect with their surgical
teams, delivering continuous data
and patient-reported feedback to
facilitate care and recovery.
Monitoring Parkinson’s
Disease with the StrivePD app
on Apple Watch
69
Rune Labs offers an FDA-
cleared Apple Watch app
called StrivePD, which uses
Apple’s Movement Disorder API to
provide a power-efficient approach
to measuring and recording tremors
and dyskinetic symptoms common
in patients with Parkinson’s Disease.
The app enables a data-driven
approach to care management and
clinical trial design.
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
38
Augmenting patient experience in hospitals and
using hospital resources more efficiently
We support nurses, physicians, and healthcare professionals on their mission to
deliver the best care to their patients. Our technologies, devices, and clinical apps
help enable hospitals, clinics, and other providers to deliver better care for their
patients by helping communication and workflow within the care team and by
enhancing the patient experience from registration all the way through discharge.
Apple Watch, iPhone, iPad, and clinical communication apps enhance nurses’
workflow and streamline how nurses communicate with physicians, other care
team members, patients and the patients’ family while delivering care and per-
forming a multitude of other tasks. Beyond communication, they also help improve
nursing care, productivity, and patient safety as nurses have access the patients’
protected health information, can receive, triage, and escalate alerts, can adminis-
ter medication, record clinical observations, and receive ongoing training.
Apple technology has also empowered clinicians to be more mobile, leading to
times savings and more time spent taking care of patients. With iPhone, iPad, and
Mac and electronic health records (EHR) apps, clinicians can read and write patient
records on the go, receive urgent lab notifications on Apple Watch, access on-de-
mand decision support reference materials, and use third-party innovative devices
like Butterfly IQ+ for imaging patients by the bedside.
Our products, such as iPhone, iPad, and Apple TV, streamline the patient journey in
hospitals and clinics starting with the check-in process and continuing through to
providing test results and progress updates. An improved patient experience con-
tributes to more engagement with their health, facilitates better planning for home
care once they are discharged, and helps lead to improved treatment adherence.
We take a comprehensive approach to security, meaning we think about security
every step of the way when it comes to supporting the healthcare industry with our
devices. From the systems itself, through the data on the device and the network,
through to the apps created and installed, iOS, iPadOS, and macOS devices are
secure by design with integrated hardware, software, and services.
Technology can
empower clinicians
Nurses in 100% of the US top
20 hospitals use iPhone for
clinical communication (as of
April 2023).
About 90% of US physicians
stated they would derive
value from technologies that
streamline patients’ health
record-related tasks (e.g., vitals
reading, visit notes, patient
intake and triage).
70
In 2020, 83% of US physicians
expected that patient-generated
data integrated with care
delivery will be standard
practice in the next 5-10 years.
71
For more information on the studies and data that are showing how hospitals are augment-
ing the patient experience and using hospital resources more efficiently, please see the
Extensions and Spotlights section 7.
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
39
There are many examples around the world that highlight the use of Apple devices
and technology in the medical community to improve patient care. This includes
better communication and care coordination among nurses with iPhone at
Parkview Medical Center and Rush University Medical Center, generating efficien-
cies and streamlining workflows at NYU Langone Health’s Emergency Department,
Stanford Children’s Health, and NHS Ambulance Services, personalizing the
patient experience with iPad at NHS Greater Glasgow and Clyde, UCSD, and Ann
and Robert H. Lurie Children’s Hospital of Chicago, and leveraging technology
during COVID-19 at Mass General Brigham Hospital, the UCHealth, and with the
University Health Network in Toronto.
Spotlight: Leveraging Apple’s health platform to care for patients in the
hospital and at home — How Ochsner Health has incorporated digital
technologies to take care of patients.
Ochsner Health in Louisiana, USA has implemented several programs that rely on Apple
technology to improve care for remote patients.
• Digital chronic disease programs: Chief Transformation Officer Dr. Milani and his
team provide remote digital medicine programs for patients with hypertension and
diabetes. Participants can track their conditions from the comfort of their homes
using blood pressure cuffs and glucose monitors. And Ochsner’s “O Bar” - staffed
by full-time technology specialists - help patients set up devices. Data from the
devices is collected via the Epic MyChart app on iPhone (built using HealthKit), and
automatically populates for the physician to see in their patient’s chart in the EMR.
Care teams receive alerts when key thresholds are crossed and adjustments are made
to the patients’ care plan. Studies have shown that these digital medicine programs
led to 79% of patients better controlling their blood pressure within 180 days.
72
Patients in the Digital Diabetes program saw a reduction of 57% for hyperglycemia
and 74% reduction in hypoglycemic episodes,
73
usual care patients over the same
period had no change in either hyperglycemia or hypoglycemia indexes.
• Connected MOM program: Expectant mothers at Ochsner Health can use the
Connected MOM program to stay connected to their care teams throughout
pregnancy. Patients can use a connected blood pressure cuff, connected weight
scale, and urine test strips to keep track of their health remotely, and share their
results with their care team. This program led to a reduction of three OB visits on
average (out of 14) and allowed care teams to identify pre-eclampsia weeks earlier.
• Detecting early warning signs in hospitalized patients: Health care providers in
Ochsner Health’s Rapid Response Team (“RRT”) rely on the Epic Haiku app and Apple
Watch notifications, with artificial intelligence to get early warning alerts of possible
deterioration of hospitalized patients. When an RRT member gets a notification,
they can quickly assess the patient and take immediate action, such as transferring
them to the ICU. Based on a 90-day pilot study, this program successfully reduced
adverse events outside of the ICU by 44%.
74
It is now being used in 15 hospitals
across Ochsner’s health system.
“Because of push notifications,
we get patients in the ER home
quicker, move them to rooms
quicker, to the next level of
treatment in the OR quicker. By
being able to just glance at my
Apple Watch, it has been a total
game changer in the ER.”
Dr. Paul Testa, MD, Chief
Medical Information Officer,
NYU Langone
Supporting the health ecosystem by collaborating with the medical community
Strengthening the physician-patient relationship with meaningful data
40
SUPPORTING THE HEALTH ECOSYSTEM BY COLLABORATING
WITH THE MEDICAL COMMUNITY
Health organizations promoting
healthy lifestyles with Apple Watch
Scaling the opportunity for health insights to drive healthy choices
Health organizations and insurance companies around the world have collabo-
rated with Apple to integrate Apple Watch in their wellness programs to promote
healthier behaviors and improve individual health at a large scale, all while keeping
privacy in mind. There are currently 55 programs running in 17 countries with over
a million users taking part in an incentive program leveraging Apple Watch. These
programs and platforms include Paceline in the US, Vitality Active Rewards in
the US, UK, South Africa, and Australia, and LumiHealth in Singapore.
These health engagement programs have been successful in increasing participants
physical activity levels and uptake of health behaviors, such as aiming for more regular
sleep patterns, focusing on mindfulness, and swapping in healthier food options.
In addition, many of these programs offer participants ways to earn part of or all
of the cost of Apple Watch through their progress, creating the opportunity for
even more people to benefit from Apple Watch’s health, fitness, and wellness
features and become healthier in the long term. Programs can also offer other
rewards like gift cards as participants track
healthy habits.
We have also worked with global fitness
clubs to support members’ health journeys
by integrating Apple Watch and iPhone into
fitness experiences, from easier member
check-in to the ability to earn rewards by
closing Activity rings. For example, Life Time
has integrated Apple Watch into its check-in
experience, allowing members to seamlessly
connect Apple Watch to GymKit-enabled
cardio equipment, and was the first health
and fitness brand to include Apple Fitness+
as part of its memberships.
“As a working parent, I juggle
multiple projects at a time so
LumiHealth provides me with
helpful reminders to keep
my health in check. These
include breathing exercises
using the Breathe app to help
my mental health, curbing
sugar intake to keep my diet
in check, and switching up my
workouts so I don’t keep doing
the same thing. When you
have many things going on, an
app that helps you keep your
wellbeing in check is very much
welcomed.”
75
Faz Gaffa, writer and
marketing professional,
Singapore
For more information on how health organizations are promoting healthy lifestyles with Apple
Watch through various programs, please see the Extensions and Spotlights section 8.
Supporting the health ecosystem by collaborating with the medical community
Collaborating with health organizations to promote healthy lifestyles at large scale
41
The use of Exposure
Notifications System
During COVID-19, 76 regions
worldwide launched exposure
notifications.
In the UK, 56% of the eligible
population downloaded the
National Health Service (NHS)
Covid-19 app, which had been
downloaded more than 21 million
times as of February 2022.
76
Koronavilkku, the Finnish
national contact-tracing app,
had been downloaded 2.5 million
times as of October 2020.
77
In Switzerland, the SwissCovid
had been downloaded more
than 3.8 million times.
78
A study published in Nature
estimated in May 2021 that for
every percentage point increase
in uptake of the NHS Covid-19
app in England and Wales,
the number of cases could be
reduced by up to 2.3%. Analysis
suggests approximately
600,000 cases were prevented
by the app between September
2020 and February 2021.
79
In research looking at just 15%
participation based on three
Washington state counties in the
US, exposure notifications could
reduce infections and deaths by
about 8% and 6%, according to
an npj Digital Medicine article
from March 2021.
80
Especially during times of need, we strive to play a role in helping communities
emerge stronger. We are indebted to heroic first responders, medical profession-
als, and public health authorities (PHAs) who work to prevent disease transmission
and promote improved health. As we partner with clinicians and local governments,
we look for unique ways to support their work through manufacturing and donating
protective equipment, creating helpful apps and features, and working to dissem-
inate reliable information to our users, all of which are crucial to contain and better
manage public health crises.
Contributions and voluntary relief efforts
during health crises
Apple regularly donates to relief efforts following natural disasters such as hurri-
canes and floods, and contributes to organizations such as UNICEF, World Central
Kitchen, Feeding America, and other local, national, and international non-profits
that support public health.
For more than 15 years, we have partnered with (RED) to support their fight against
HIV/AIDS. A portion of proceeds from every PRODUCT(RED) purchase goes to the
Global Fund to fight AIDS with (RED). Apple-supported grants have provided life-
saving treatment to over 13.8 million people living with HIV.
81
And in 2020, Apple
was one of the first companies to shift resources to the Global Fund’s COVID-19
Response. By redirecting donations to the Global Fund’s COVID-19 Response at
the onset of the pandemic, Apple customers were able to help fund programs that
mitigated the impact of COVID-19 on existing HIV/AIDS programs.
SUPPORTING THE HEALTH ECOSYSTEM BY COLLABORATING
WITH THE MEDICAL COMMUNITY
Supporting public health and
government initiatives
Supporting the health ecosystem by collaborating with the medical community
Supporting public health and government initiatives
42
Apple’s company-wide response to the COVID-19 pandemic involved teams
across the businesses, including product design, engineering, operations, packag-
ing teams, suppliers, and more. At the beginning of the COVID-19 pandemic, when
personal protective equipment was in short supply, we sourced through our supply
chain and donated more than 30 million masks for healthcare workers worldwide.
And in a company-wide effort, we brought together product designers, engineering,
operations and packaging teams, and suppliers in the US and China to produce
and ship over 10 million face shields. These face shields were delivered to sites
around the world from NewYork-Presbyterian Hospital in the US to the Ministry of
Health in Zambia.
84
Additionally, Apple donated tens of millions of dollars toward the global COVID-19
response, and matched employee donations two-to-one to support COVID-19
response efforts worldwide. We awarded 10 million from our Advanced Manufac-
turing Fund to COPAN diagnostics, a market leader in sample collection kits, that
rapidly accelerated their ability to supply sample collection kits to hospitals in the
US for COVID-19 testing.
Building apps and features to support
public health authorities and disseminating
reliable health information during the
COVID-19 health crises
We are proud to have been able to support public health authorities in their efforts
to respond to health crises such as COVID-19 by adapting our technology and
empowering users with resources to keep themselves healthy. Apple has partnered
with governments, PHAs, and major technology companies to create innovative
technologies that leverage our products, and our efforts have had a noteworthy
impact worldwide.
Our partnerships to deliver innovative technologies have covered a wide array of
features and programs, including Exposure Notification APIs, the Exposure Notification
System, a COVID-19 Screening Tool, Mobility Trends Reports, University of
Nebraska Medical Center’s 1-Check COVID App, verifiable health records and
vaccination cards in Apple Wallet, and Apple Maps Airport Guidance.
In addition, we believe our users should have access to health information so they
can be better equipped to protect themselves and others during a public health
emergency. To do this, during the COVID-19 pandemic we tailored our services —
Apple Podcasts, Apple News, the App Store, Apple Maps (with vaccine and testing
locations), and Siri — to promote easy access to reliable information on the
outbreak, vaccination locations, and testing sites.
Supporting the health ecosystem by collaborating with the medical community
Supporting public health and government initiatives
43
Extensions and Spotlights
44
1. The science and clinical validation behind our heart health
features and our collaboration with medical experts
Apple collaborated with researchers at Stanford University School of Medicine to conduct the Apple
Heart Study on AFib detection to validate the irregular rhythm notification on Apple Watch.
85, 86
Apple sponsored clinical trials to rigorously test the ability of the ECG app on Apple Watch to detect
AFib and compare it with the results from ECGs conducted with FDA-cleared clinical devices. For
more information about the development of the ECG feature — Apple’s first regulated feature — see
Apple’s White Paper: “Using Apple Watch for Arrhythmia Detection.”
The VO
2
Max and Cardio Fitness features available on Apple Watch were rigorously tested in a study
with over 700 participants. Data collected during this study was used to design the algorithm that
calculates the VO
2
max measurement. For more information about the development of the Cardio
Fitness feature, see Apple’s White Paper” “Using Apple Watch to Estimate Cardio Fitness with VO
2
max.”
Independent research from Duke University has validated Apple Watch’s technology for measuring
heart rate against ECG readings and found that the heart rate readings from Apple Watch Series 4
were accurate relative to an ECG, both when measured at rest or during activity.
87
Spotlight: Apple Heart Study
• The unprecedented study enrolled more than 400,000 Apple Watch users from all 50 states in a
span of only eight months.
• As part of the study, if an irregular heart rhythm was identified, participants received a
notification on their Apple Watch and iPhone, a telehealth consultation with a doctor and an
electrocardiogram (ECG) patch for additional monitoring.
• Results published in the New England Journal of Medicine by Stanford Medicine found that
the probability of receiving an irregular pulse notification was low: 2161 participants (0.52%)
received notifications of irregular pulse. Among participants who received notification of an
irregular rhythm, 34% had atrial fibrillation on subsequent ECG patch readings. This resulted in
a positive predictive value for the irregular rhythm notification of 0.84 (95% CI, 0.76 to 0.92)
among participants who had received an irregular rhythm notification.
45
2. The science and clinical validation behind our mobility
features and our collaboration with medical experts
Fall detection was initially designed to detect the types of falls that adults over 55 are more likely to
experience as they age – slips, trips, or falls.
To develop this feature, we worked with assisted living facilities and movement disorder clinics to
observe real-word movement patterns and falls, following 2,500+ people over a total of 250,000
days.
88
We expanded the fall detection capabilities using the results of the Apple Heart and
Movement Study – a study in collaboration with Brigham and Women’s Hospital – for a wide range
of activities and user demographics.
To design and validate the Mobility metrics features – including measuring walking steadiness – we
gathered data through several in-lab studies. For more information on the development of this
feature, see Apple’s White Paper: “Measuring Walking Quality Through iPhone Mobility Metrics.”
Apple Watch also expands on the ability to measure changes in mobility patterns by estimating the
distance users are able to walk in six minutes, a measurement of overall mobility that was previously
only available in clinical settings. For more information on the development of this feature, see
Apple’s White Paper: “Using Apple Watch to Estimate Six-Minute Walk Distance.”
3. APIs available for third-party developers
Apple has made a number of APIs available to third-party developers so they can build innovative
health apps.
HealthKit HealthKit is an open-source API
designed to share health and fitness data while
maintaining the users’ privacy and control. The
framework constrains the types of data and
units to a predefined list — developers cannot
create custom data types or units — ensuring
that all apps understand what the data means
and how it can be used.
ResearchKit ResearchKit is an open-
source framework that was released to
help researchers create powerful apps
for medical research. Since launch,
researchers have been able to initiate
groundbreaking new studies through
apps that reach participants at scale and
produce breakthrough insights.
CareKit CareKit is an open-source
framework for developing apps that
support care for patients with medical
conditions. Care teams can continue
to remotely monitor patients with
apps that can deliver personalized
treatment, track daily progress, and
generate trends over time.
SensorKit For researchers who are looking for
more nuanced data types for study purposes, the
SensorKit framework makes additional data types
available with consent from users with iPhone and
Apple Watch. Access to these data types is limited
to research uses and requires an app to have a
private entitlement, which is reviewed separately
for each study.
46
Movement Disorder Doctors and researchers
can monitor the symptoms of movement
disorders continuously using Apple Watch.
The Movement Disorder API provides a power-
efficient approach to measuring and recording
tremors and dyskinetic symptoms for Parkinson’s
disease. It is Apple’s first API with scientifically
validated digital biomarkers. In a study published
in Science Translational Medicine, the tremor and
dyskinesia symptoms measured on Apple Watch
matched clinician expectation in 94% of cases.
89
Fall Detection Apple Watch Series 4
and later can detect when a user falls,
and contact emergency services if
necessary. The Fall Detection API is
particularly useful for apps that need
to respond to falls in a timely manner
so that the app can provide help to
the person who fell. With a user’s
authorization, an app can set up a
delegate to receive notifications about
these fall detection events.
4. Information on Research app Principal Investigators
Apple Heart and Movement Study
Dr. Calum A. MacRae is Vice Chair for Scientific Innovation in the Department of Medicine at
Brigham and Women’s Hospital, a Principal Faculty Member at the Harvard Stem Cell Institute,
an Associate Member of the Broad Institute of Harvard and MIT, and a Professor of Medicine at
Harvard Medical School, He received his medical degree from University of Edinburgh Medical
School and his PhD from the University of London. He is a cardiologist and a geneticist whose
interests include investigating new ways to measure health and disease, developing new ways to
treat or prevent disease and accelerating the translation of research findings into broad public use.
He holds numerous patents for his work, and has authored over 300 peer reviewed publications
on a range of medical and scientific topics. He is particularly focused on the role of the individual in
understanding and managing their own health and wellness.
47
Michelle A. Williams, SM ’88, ScD ’91, is Dean
of the Faculty, Harvard T.H. Chan School of
Public Health, and Angelopoulos Professor in
Public Health and International Development, a
joint faculty appointment at the Harvard Chan
School and Harvard Kennedy School. She is
an internationally renowned epidemiologist
and public health scientist, an award-winning
educator, and a widely recognized academic
leader. Prior to becoming Dean, she was
Professor and Chair of the Department of
Epidemiology at the Harvard Chan School
and Program Leader of the Population Health
and Health Disparities Research Programs
at Harvard’s Clinical and Translational
Sciences Center. Dean Williams previously
had a distinguished career at the University
of Washington School of Public Health. Her
scientific work places special emphasis in the
areas of reproductive, perinatal, pediatric,
and molecular epidemiology. Dean Williams
has published more than 500 scientific
articles and was elected to the National
Academy of Medicine in 2016. In 2020, she
was awarded the Ellis Island Medal of Honor
and recognized by PR Week as one of the top
50 health influencers of the year. The Dean
has an undergraduate degree in biology and
genetics from Princeton University, a master’s
in civil engineering from Tufts University, and
master’s and doctoral degrees in epidemiology
from the Harvard Chan School.
Shruthi Mahalingaiah, MD, MS, FACOG, is
an assistant professor of environmental,
reproductive, and women’s health in the
Department of Environmental Health at
the Harvard T.H. Chan School of Public
Health. She serves clinically as a physician
specializing in ovulation disorders,
reproductive endocrinology and infertility at
the Massachusetts General Hospital in the
Department of Obstetrics and Gynecology.
Shruthi has a BA from Middlebury College,
where she dual majored in chemistry/Spanish
and dual minored in physics/dance. Supported
by a Thomas J. Watson III Fellowship, she lived
with indigenous shamans in the Ecuadorian
Amazon Basin, Andes mountains, and Bali
studying the role of ritual in the healing
process before matriculating to medical
school. She attended Harvard Medical School
and an OB/GYN residency and fellowship in
reproductive endocrinology and infertility at
Mass General Brigham. She joined the faculty
at Boston University School of Medicine/
Boston Medical Center in 2011 with K level
funding from the Building Interdisciplinary
Research Careers in Women’s Health (BIRCWH
2011–2014) and the Reproductive Scientist
Development Program (RSDP 2014–2017) to
study environmental exposures and incidence
of benign gynecologic conditions. She received
a Master of Science in epidemiology at Boston
University School of Public Health in 2015.
She was awarded the 2016 Endocrine Society
Early Investigator award, an Ellison Family
Foundation award, and an RSDP seed grant
in 2017–2018 to create a pilot online study of
ovulation and menstruation health.
Russ Hauser MD, MPH, ScD, is chair of
the Department of Environmental Health,
Frederick Lee Hisaw Professor of Reproductive
Physiology, and professor of environmental
and occupational epidemiology at the Harvard
T.H. Chan School of Public Health. He also
holds an appointment at Harvard Medical
School, where he is professor of obstetrics,
gynecology, and reproductive biology. Dr.
Hauser’s research focuses on the effects of
environmental chemicals on reproductive
health, perinatal outcomes, and children’s
health. He has served on several NRC and
IOM committees, including the Committee
to Review EPA’s State of the Science Paper
on Non-Monotonic Dose Response, the
Committee on the Health Risks of Phthalates,
and the Committee on Endocrine-Related
Low Dose Toxicity. Dr. Hauser was a member
of two U.S. EPA Science Advisory Boards
and served on the U.S. Consumer Product
Safety Commission’s Chronic Hazard Advisory
Panel examining the effects of phthalates on
children’s health. He received his MD from the
Albert Einstein College of Medicine and his
MPH and ScD from the Harvard Chan School,
where he also completed a residency in
occupational medicine. He is board certified in
occupational medicine.
Brent Coull, PhD, is professor of Biostatistics
in the Departments of Biostatistics and
Environmental Health and associate chair
of the Department of Biostatistics at the
Apple Women’s Health Study
48
Harvard T.H. Chan School of Public Health. He
received his PhD in statistics from the University
of Florida and has over 25 years of experience
in a wide range of biostatistical applications
to environmental health and health disparities
research. His primary research interests
focus on the development and application of
integrative modeling of exposure and health
data collected at multiple spatial and temporal
scales, measurement error issues associated
with the use of outputs from such models in risk
assessments, and methods for analyzing the
health effects of high-dimensional environmental
mixtures in complex epidemiological study
designs. Professor Coull directs a NIH T32
training program in environmental statistics, is
Associate Director of the Air, Climate and Energy
(ACE) Research Center at Harvard University,
and is principal investigator of the Environmental
Statistics and Bioinformatics Core of the Harvard
NIEHS Center. Professor Coull has served as
an external advisor for multiple U.S. EPA and
NIH research centers and as an associate editor
for the Journal of the American Statistical
Association and Biometrics.
Apple Hearing Study
Rick Neitzel, PhD, CIH, FAIHA,is a
Professor of Environmental Health
Sciences and Global Public Health
at the University of Michigan (UM)
School of Public Health. His work,
and the work of his team in the UM
Exposure Research Lab, focuses
primarily on noise exposures,
noise-related health outcomes,
and injury risks, and takes place in
workplace and community settings
both domestically andabroad.
He is particularly interested in
incorporating new methodologies
and exposure sensing technologies
into research, and also has a strong
interest in translating his research
findings into occupationaland
public health practice. Dr. Neitzel
is Chair of the ACGIH® Threshold
Limit Values for Physical Agents
(TLV®-PA) Committee. He is also
a Fellow of the American Industrial
Hygiene Association and has been
a Certified Industrial Hygienist since
2003. He directs the UM Global
Public Health Certificate program,
and is also Director of the UM Center
for Occupational Healthand Safety
Engineering.
Apple Women’s Health Study (continued)
49
5. Other studies that have been made possible
by ResearchKit
Exploring a genetic cause to PPD with
Mom Genes Fight Postpartum Depression
(UNC, US)
Our ResearchKit framework has been fundamental in
UNC School of Medicine’s research on postpartum
depression aiming at determining whether there
is a genetic cause to PPD. The app “Mom Genes
Fight PPD,” which relies on ResearchKit, allowed the
researchers to recruit, screen, and enable collection
of genetic samples from 4,000 women. Given the
large scale of the study, UNC researchers can better
understand the relationships between genes and
environment, thus potentially preventing risks of PPD.
Researchers also conducted a pilot study, tracking
daily symptoms of PPD in participants using Apple
Watch, and found that this data can be used to
enhance clinical care access.
90
Studying the psychological
effects of COVID-19 on
healthcare workers with the
Mount Sinai Warrior Watch
Study
91
(Mount Sinai,
New York, US)
In the Warrior Watch Study,
researchers from the Mount Sinai
Health System are studying the
psychological effects of COVID-
19 on healthcare workers and
the ability to predict COVID-19
infection before symptoms appear.
So far, the study has found that
self-reported metrics, health
records, and Apple Watch data
could help predict a positive
COVID-19 diagnosis up to a week
before PCR-based tests.
50
6. Technology to support care from anywhere
Connecting patients with their care teams remotely
for better recovery outcomes
Helping heart attack patients
navigate recovery and reduce
readmissions with Corrie Health
(MD, US)
This app is based on the collaboration
between Johns Hopkins physicians and
staff, nurses, engineers, and patients.
After a heart attack, patients are provided
with the Corrie iPhone and Apple Watch
app and blood pressure monitor in
the hospital and for an additional 30
days at home. The app uses CareKit
frameworks to offer evidence-based
education modules and a daily care plan,
track progress and provide reminders to
patients to complete daily tasks. The app
is integrated into clinical workflow and
the patient receives support from their
care team to optimize their recovery. In
the US, the all-cause 30-day readmission
rate following an acute myocardial
infraction is nearly 20%; a clinical study
showed that patients using the Corrie
Health platform had less than a 7%
chance of readmission.
92
Interactive Home Monitoring at UVA
Health (VA, US)
UVA Health serves a large cross-section
of patients with acute and chronic illnesses
including a number of patients from
underserved groups and rural communities.
Using a data plan-enabled iPad with the
Locus Health app and devices to monitor vital
signs such as blood pressure, weight, heart
rate, temperature, blood sugar levels, and
oxygen levels, patients can attend telehealth
visits with UVA care providers and share key
health information from home.
xii
The home
monitoring program supports a variety
of patients, including transplant patients,
premature infants, pregnant mothers at
high risk for delivery early, and patients with
chronic conditions such as heart failure.
During the COVID-19 pandemic, UVA Health
has leveraged the program to serve patients
recovering from the virus. The program has
improved patient outcomes, including lowering
the Emergency Department visits and hospital
readmissions as well as lowering blood-sugar
levels for patients with diabetes.
93
Leveraging iPad Pro and iPhone for mobile primary care with Heal
Heal delivers value-based primary care to patient homes to achieve better outcomes and lower
the cost of healthcare. Apple SDKs are used to build applications for patients, doctors, and care
coordinators. Doctors use iPad Pro to conduct patient visits and enter clinical notes. Patients use
the Heal app to make appointments, have telehealth calls, and utilize remote monitoring technology
to send their vitals readings directly to their doctor while in the comfort of their own home.
xii For more information on Interactive Home Monitoring at UVA Health, visit https://appletoolbox.com/how-uva-leverage-
apple-healthcare/.
51
Reducing cost and the length of NICU stays through remote monitoring
Odense University Hospital (Denmark)
The neonatal intensive care unit (NICU) of Odense
University Hospital relied on Apple technology and
products to shorten NICU stays and keep babies with
their families. By sending families home with an iPad
and an infant scale, NICU nurses trained parents of
premature babies to enter daily weight and other metrics
in the Odense My Hospital App. The data was directly
recorded into the patients’ medical records allowing
nurses to remotely monitor the babies and engage with
the families via video call. The program reduced the
length of stay in the NICU allowing babies to go home
sooner, with an average of 23 days of monitoring the
babies from home. The program was also more cost
effective than regular hospital care (15% less costly for
infants born under or at 32 weeks, and 5% less costly for
infants born after 32 weeks).
96, 97
University of Virginia
Children’s Hospital
(VA, US)
The hospital’s remote
monitoring program Building
HOPE uses iPad configured for
individual patients to collect
data that is automatically
transferred to their electronic
health records and facilitate
remote consultations. The
program has enabled early
discharge for babies in the
neonatal intensive care unit
who can be safely monitored at
home, leading to a reduction in
the length of stay by 8 days.
98
Helping veterans more easily connect with their care teams with iPad
As part of their efforts to address the digital divide, the U.S. Department of Veterans Affairs (VA)
worked with Apple before and during the pandemic to facilitate more equitable access to care for
Veterans without the technology or internet services they needed to connect to VA virtual care,
using iPads. This VA loaned iPad program provides qualifying veterans with cellular-enabled
iPads and currently helps more than 100,000 veterans across the country connect to VA health
care services virtually. In a recent JAMA study of more than 470,000 veterans living in rural areas,
VA researchers found that this program increased the participation in mental health care visits
via video; increased psychotherapy visit participation via video, phone or in-person; and saw a
20% reduction in the likelihood of emergency Department (ED) visits, a 36% reduction in the
likelihood of suicide-related ED visits; and a 22% reduction in the likelihood of suicidal behavior.
94
In addition, veterans across the nation and surrounding territories who receive their care through
the Veterans Health Administration can also use the Health Records feature within the iPhone
Health app to see a fuller, more comprehensive picture of their health care, including information
from multiple health care providers.
95
52
Helping patients with chronic conditions
Improving health outcomes for patients with
hypertension and diabetes with Ochsner
Digital Medicine (New Orleans, US)
The medical team at Ochsner uses Apple’s
technology, Epic’s MyChart app that is integrated
with HealthKit, along with third-party medical devices,
such as blood pressure cuffs and glucose monitors,
to provide remote digital medicine programs for
patients with hypertension and diabetes. Patients can
monitor their blood pressure and blood sugar levels
from the comfort of their homes and based on their
results, their care teams of physicians, pharmacists,
and health coaches can make real-time adjustments
to their care plan with data coming directly to the
patient’s Electronic Medical Record flowsheet. These
programs have led to patients showing significant
improvements: after 90 days, 79% of high-blood
pressure patients had controlled their blood pressure
under the program compared to only 31% of patients
not participating in the program
99
; after 1 year,
patients with type 2 diabetes enrolled in Ochsner’s
digital diabetes program saw a 57% reduction
in hyperglycemic events and a 74% reduction in
hypoglycemic episodes; patients not enrolled in
these programs had no significant changes in either
hyperglycemia or hypoglycemia.
100
NHS Sunderland helps
seniors with chronic
conditions live independently
(Sunderland, UK)
This hospital provides iPad to
senior patients and their nurses,
which enables them to share
health data with the Luscii app
and stay connected with the
care team, allowing them to live
independently at home. Patients
can record their vitals from their
own homes and share this data
with their care team. They can
connect with their care team
through video conferences and
nurses can visit them at home.
This program has reduced
accident and emergency visits by
70%, re-admissions by 26%, and
hospital costs by 51%.
101, 102
The
qualitative feedback for patients
participating in the COPD program
was universally positive, with
100% of patients seeing benefits
using Luscii app on iPad.
53
7. Augmenting patient experience in hospitals and
using hospital resources more efficiently
Better communication and care coordination among nurses with iPhone
Improved clinical
communications and improved
patient care at Parkview
Medical Center (CO, US)
Parkview has provided each of its
nurses with an iPhone so that they
can rely on certain features and
iOS-based apps to help deliver
better care to patients and to help
the staff stay coordinated and in
sync. As a result, Parkview saved
60 minutes per nurse, per shift, on
documentation and coordination
tasks, allowing them more time to
spend with patients.
103, 104
Barcode scanning to limit errors and patient
disruption at Rush University Medical Center
(IL, US)
Rush has deployed iPhone with the Epic Rover
app to all its nurses to streamline nursing care and
improve clinical communications. Nurses use iPhone
to send and receive text messages from care teams,
document vitals with dictation, and scan patients’
wristbands, medication, and blood products using
soft-scan that uses the native iPhone camera with
Rover, ensuring that each patient gets the proper
medication and reducing likelihood of transfusion
errors.
105
The scanning feature also limits patient
disruption by removing the need for a workstation on
wheels. Physicians, transport, radiology technicians
and many other groups of employees use iPhones to
help improve coordination among patient care teams.
Generating efficiencies and streamlining workflows
by using Apple technology
Reduced length of stay and wait times in the NYU Langone Health’s Emergency
Department (NY, US)
A study involving the emergency department (ED) found that the use of push notifications on
iPhone and Apple Watch alerting physicians about the availability of test results reduced the lag
between result availability and physician decision-making. Such efficiency gains decrease the
length of stay and wait times in the ED. The reduction in crowding in the ED is associated with
lower stress level among physicians and higher quality of care.
106
54
Virtual Onboarding and Training for Nurses
(Stanford, US)
Apple collaborated with clinicians and nurses at
Stanford Children’s Health on a project to explore
whether the use of mobile technology, modules and
software on iPad and iPhone, could be translated
to education within the health care setting. The
project results were published in the journal Nurse
Leader in 2019. Stanford’s virtual program saw
a cost savings of 1.3 million over 18 months by
reducing training costs compared to its traditional
“in-classroom” training programs. In addition,
the new programs allow nurses to use QR codes
strategically placed on medical equipment for
just-in-time training which has led to reducing
hospital-acquired infections and pressure injuries
with improved clinical outcomes and increasing
nurses’ competency.
107
NHS Ambulance Services
empowers first responders
with iPad devices
More than 30,000 iPads have
been issued to ambulance crews
across England so that patients
get the right care faster.
108
The
solution allows on-site paramedics
to document patient vitals as they
assess patients’ injuries and decide
whether they should be taken to
hospital or treated at the scene.
Detailed patient information can also
be sent directly to the emergency
department for patients that are
critically injured, this speeds up
patient handover and frees the
ambulance to attend to the next call.
Providing iPad to personalize the patient experience at hospitals
Helping patients connect with their
families during COVID-19 at NHS Greater
Glasgow and Clyde (Scotland)
During the COVID-19 pandemic, in-person
visits at NHS Greater Glasgow and Clyde were
suspended for most patients. The hospital created
“person centered virtual visiting” and used iPad
to help reunite patients with their families.
109
Using iPad reduce children’s
anxiety before surgeries among
children at Ann and Robert H.
Lurie Children’s Hospital of
Chicago (IL, US)
To reduce anxiety before surgeries
Lurie Children’s Hospital uses iPad
to distract, entertain, and calm
children, many of whom are facing
long stays and difficult treatments.
A study published by the Pediatric
Anesthesiology Department at Lurie
Children’s Hospital comparing the
use of iPad mini with the sedative
midazolam for pediatric patients
undergoing ambulatory surgery
showed that using iPad reduces
anxiety before surgery (perioperative
anxiety) and delirium after surgery
(emergence delirium), as well as
increases parental satisfaction. The
study also showed a 24-minute
reduction in median time-to-discharge
from the PACU (post-anesthesia care
unit) from using iPad mini.
112, 113
Integrating iPad for bedside connection
UCSD (CA, US)
UCSD has allowed patients to take control
of their hospital experience by adding iPad
to every hospital rooms. Patients can stay
connected with their loved ones, engage with
their care team, and control their room settings.
iPad apps such as Epic’s MyChart Bedside let
patients view their schedule, track progress and
lab results, which empower them to participate
in their own care.
110, 111
55
Leveraging technology during COVID-19
Reducing exposure to COVID-19
at Mass General Brigham Hospital
(MA, US)
During the COVID-19 pandemic, the health
system deployed iPad and iPhone to protect
staff, preserve protective equipment, and
help patients in isolation wards connect
with loved ones. Doctors and nurses used
Apple devices in rounds to provide virtual
care to patients. Through an app developed
by the health system, nurses could check
on and communicate with patients and
doctors. This enabled the hospital to reduce
its use of personal protective equipment
by 50%, helping the hospital cope with the
nationwide shortage of PPE, and reduced
virus exposure by the staff.
114
Large scale vaccination in Toronto
(University Health Network, Canada)
10,000 iPad devices were deployed across
Ontario to support vaccination efforts during
the COVID-19 pandemic. In a joint effort
between the City of Toronto, Maple Leaf
Sports & Entertainment (MLSE), Scotiabank,
Michael Garron Hospital, and the University
Health Network, 385 iPad devices helped
enable large scale mass vaccination sites
in Toronto by transforming Scotiabank
Arena without the need for a single cable,
keyboard, barcode scanner, or monitor.
Vaccinations at Scotiabank Arena led to a
record setting, 26,771 people vaccinated in
one day.
117
Deploying Apple devices during
COVID-19 at University of Colorado
Health (UCHealth, CO, US)
UCHealth deployed over 3,000 Apple
devices – iPad, iPhone, and Apple TV – in
nursing stations, labs, translation service,
rehabilitation, remote doctor-patient
communication in high-risk environments,
accessing patient medical records, to
connect families to their loved ones, as
well as patient entertainment.
115
They
also partnered with Epic to use iPhone in
outdoor mass vaccination sites, where
paper documentation can be a major
hassle, to check in patients, document
responses and obtain patient consent. The
move from paper documentation to the use
of iPhone with 5G connections reduced
vaccination time from 3 minutes to 30
seconds per patient.
116
Scaling video visits during COVID-19
and NYU Langone (NY, US)
As with other hospitals during the COVID-
19 pandemic, NYU Langone had to quickly
change their patient-physician dynamic to
being by video rather than in person. The
ease of use of iPad and iPhone allowed
them to keep their patients connected
during the worst of the pandemic.
56
8. Health organizations promoting healthy lifestyles
with Apple Watch
Promoting healthy behaviors
with Apple Watch through the
LumiHealth program (Singapore)
LumiHealth is part of Singapore’s Smart
Nation initiative, a national effort to
leverage technology to deliver benefits
to its citizens and businesses. Created
in collaboration with physicians and
public health experts, LumiHealth
encourages users to achieve better
health over time using Apple Watch and
iPhone.
119
The program rewards users
for being more active, eating healthy,
improving sleep and mindfulness habits,
and going for health screenings and
immunizations. Since launch, the app
has been downloaded over 300,000
times, with more than 19 million health
and wellness challenges served. The
app has helped users increase their daily
exercise minutes, for example, users who
are a part of the ‘low activity’ group grew
their weekly exercise minutes by 88%
compared to the month before they start
using the program.
119
Rewarding activity with Apple Watch
and other rewards with Paceline (US)
With a program built in collaboration with
Apple, Paceline’s first-of-its-kind credit
card allows cardmembers to earn back the
purchase of Apple Watch by consistently
achieving a 150-minute exercise “streak”
each week. Paceline members connect their
Paceline app with Apple Watch to track
activity. When members hit their weekly
workout streak, they can also earn up to 5%
cash back on gym memberships, groceries,
fitness classes, and more, and up to 3% cash
back on everything else.
Encouraging active lifestyle and
positive behavior changes with Vitality
Active Rewards programs around the
world
Health and life insurance companies
around the world have adopted Vitality
Active Rewards – a behavioral program that
encourages physical activity. Through a global
collaboration with Apple, participants can
earn their Apple Watch or other rewards by
consistently meeting a weekly activity or other
goals over a period of time.
• An independent study by RAND
Corporation
120
of the Vitality Active Rewards
program in the US, UK, and South Africa
showed that the uptake of Apple Watch was
associated with a 34% average increase
of tracked activity days per month. This
increase in activity persisted after the end of
the program.
• AIA Vitality Active Benefits program
(Australia): The addition of Apple Watch
Benefit to the program led to a 35% increase
in physical activity year on year among
members who opted into the program.
121
Seamlessly integrating Apple
Watch into the Life Time member
experience (US and Canada)
With 160 athletic clubs across the
US and Canada, Life Time offers its
members the ability to use Apple Watch
for frictionless check-in, seamless
connectivity to GymKit-enabled cardio
equipment for optimal fitness tracking,
and pay with Apple Pay on Apple Watch
or iPhone at its in-club LifeCafe and
LifeSpa locations. In 2020, Life Time
was the first health and fitness brand
to include Apple Fitness+ as part of its
memberships.
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