One particular thought about the Apple keynote

by Volker Weber


Let's forget about the iPhone for a second. Apple Watch Series 4 is huge. No, not the larger screen, not the smaller bezels, nor even the faster processor. The really big thing is how Apple doubles down on health.

Health might not be a concern, if you are younger. But if you are my age, you are increasingly faced with health issues. Your parents become frail or they die. You will even have friends your own age or younger die. So health is a big thing. You often take it for granted when you are younger. But as you get older, you suddenly know your vitals. Your blood pressure, your cholesterol levels, your blood sugar.

And your heart.

When I was in a critical condition last year, my Apple Watch data showed me very clearly that I was in trouble. It did not alert me, but I could see that my heart wasn't working as it should.

With Apple Watch 4, this will evolve in a fundamental way. Watch will watch over you. It will alert you, when your heart rate is too low or too high. It will alert you, when your heart rhythm isn't as it should be. And it will let you take an ECG (EKG in German), exactly when you think something is off. Not when you are at the doctor, but right here and there, when it happens. And you will be able to share that ECG with your doctor, exactly the same way it would come out of a ECG machine.

Caveat emptor: ECG and arrythmia detection aren't here yet, and it will only get to American customers this year. Watch will be a medical device and it needs to be certified, which isn't working worldwide. I hope it spreads faster than Apple Pay.

Beyond the heart monitoring, which will save a lot of lives, there is another important feature. Watch will detect when you fall. And it will call help, even completely autonomously, when you pass out. You cannot imagine how important that is if you want to monitor an old person. If they are willing and able to wear an Apple Watch and charge it daily, you are watching over the biggest immediate risk.

This is a huge move for wearables. It puts Apple Watch way above the competition.


Surprisingly, we call it an EKG here in the US, too. Go figure.

Richard Schwartz, 2018-09-13

Apple is really going serious about the Watch being a device to help with your health. To me, who suffers from issues with the heart rythm (which sometimes isn‘t rythmic), this was the biggest announcement yesterday. I want that - the sooner the better. I don‘t know how lomg it usually takes in Germany to get a medical device approved. Hopefully not too long.

Oliver Stör, 2018-09-13

I wonder how Apple will turn off the EKG functionality outside the US and how "difficult" it will be to turn it back on. I guess approval in DE (or would it need EU approval?) could take years ...

Matthew Langham, 2018-09-13

It's an app. You will only see this app if you are supposed to see it. There are two ways to do it:

1. Region setting
2. Apple ID

Region setting is the weaker one and it is used by Wallet. That turns on and off the ability to add credit cards to Apple pay. An Apple ID registered in the US is the stronger one. If I had a serious heart condition (knocks on wood), either one would not stop me.

Volker Weber, 2018-09-13

Does the german version include the ekg-thing?

Karl Heindel, 2018-09-13

Hardwarewise, yes. But it's not yet enabled. And we don't know when and if it ever will be.

Volker Weber, 2018-09-13

Actually I am really wondering, how they are going to make a full EKG just by measuring the heart rate? AFAIK an EKG looks at all the electrical signals running through your heart (hence all that cables) to detect anomalies. I'd really be surprised if Apple Watch could achieve this by just looking (literally because it is an optical sensor, isnt't it?) at the pulse?

Mike Hartmann, 2018-09-13

I agree that this watch is a great tool to monitor your health and could be saving lives. However, I think only our generation is ready to use it as such. My parents’, let alone my late grandparents’ generation is not prepared (or able) to spend 1000 Euro for a watch and a phone nor to dive into this new world of complex tech gadgets. So only with our generation this will really take off. Not that we are too young ...

Jochen Kattoll , 2018-09-13

It's not. It has contacts on the back of the Watch and another one on the digital crown. You start the process and then touch the crown with your other hand. That creates a closed circuit. The process takes just 30 seconds.

Volker Weber, 2018-09-13

Jochen, this will trickle down. People like to say, Apple is no longer innovating, which is a sign of ignorance. Apple is beating a new path and others will follow. However, this isn't as easy to copy as a notch.

Volker Weber, 2018-09-13

Actually we witnessed some game-changing innovation yesterday. I believe that apple finally found the market for the watch. And health & fitness packaged in a consumer-friendly device will help to make our lives better.

Dirk Bartkowiak, 2018-09-13

A few comments:

Dirk, I absolutely agree - health will be the main selling point and there will be more capabilities with each iteration.

Matthew, I don’t think it will be years, but they have to get it licensed under the German “Medizinproduktegesetz” (love my language!😉), which is pretty strict - a good thing in my opinion. A EU license alone wouldn’t cut it.

I think Volker is right - the fall detection is a gem. And it’s not only for frail people; think sports: running, biking, skiing etc.

Mike: you have a metal sensor on the back of the watch and by putting your finger on the metal crown, you close the circuit.

Regarding the EKG: as excellent and important as this function and its implementation is, it’s NOT a full EKG, regardless of what you can read in many blogs. And APPLE never claimed that yesterday, they chose their words carefully. The Apple Watch is a so called 1-canal-EKG. Whith it, you can detect arrhythmia pretty well, which is very important. But it’s not a diagnostic tool. This means: if the AW tells you it detected a problem, then you have a problem and should have checked it as soon as possible. But a normal 1-canal-EKG doesn’t mean your heart is ok - not by far.

I’m really excited with what’s to come in the Apple Watch health sector and the series 4 will be my first AW.


Alex Martin, 2018-09-13

Alex, thank you for the explanation. Very welcome.

Volker Weber, 2018-09-13

Mal was anderes: weiß jmd. Ob es sich lohnt auf die Nike Version der Series 4 zu warten?

(Ist wohl erst später verfügbar laut

Matthias Welling , 2018-09-13

Ist die „arrythmia“ etwas anderes als die Frequenzvariabilität. Die Daten sind ja in der Series 3 schon da. Ich verstehe nicht ganz, warum es da eine Series 4 benötigt, um darüber alarmiert zu werden. Ebenso beim niedrigen Herzschlag.

Oliver Regelmann, 2018-09-13

Die Frequenzvariabilität schaut auf den Rhythmus der Herzschläge. EKG schaut in die einzelnen Herzschläge hinein. Das Herz hat vier Kammern, von denen jeweils zwei zusammenarbeiten. Erst kontrahiert die Vorkammer, dann die Hauptkammer. Das nimmst Du als EINEN Herzschlag war. Wenn im Ablauf der Kontraktionen ein Fehler ist, dann kann man das auf dem EKG sehen.

Volker Weber, 2018-09-13

OK. Ich hatte das so verstanden, dass diese Warnung auch im normalen Betrieb kommt und nicht erst, wenn der Träger ein EKG durchführt.
Und deinen Beitrag mit der niedrigen Herzfrequenz im nächsten OS habe ich inzwischen auch gesehen ;-)

Oliver Regelmann, 2018-09-13

Volker and Alex, thanks for the explanation.

Mike Hartmann, 2018-09-14

This article explains it quite well, it's a health tracking device, but far from a medical device:

Armin Grewe, 2018-09-14

Bullshit meter off the scale. It's a class II medical device. Class III devices have to be life-sustaining like implantable pacemakers for instance. It needs certification, which Withings/Nokia has learned the hard way with their cardio scales. And it has received such certification for the US market.

The author tries to downplay the significance of a device that can detect AFib, which is really hard to diagnose, because it may not be present when you are at the doctor's. For those who don't know what AFib is, we call it Vorkammerflimmern.

Some AFib can be cured with heart surgery which one of my friends has submitted himself to. But first he had to wear a longterm EKG, which does what the Apple Watch 4 will be able to. Having this available for everybody is a HUGE innovation.

Volker Weber, 2018-09-15


"The ECG app is intended for over-the-counter (OTC) use. The ECG data displayed by the ECG app is intended for informational use only. The user is not intended to interpret or take clinical action based on the device output without consultation of a qualified healthcare professional. The ECG waveform is meant to supplement rhythm classification for the purposes of discriminating AFib from normal sinus rhythm and not intended to replace traditional methods of diagnosis or treatment."

informational use, supplement, not intended to replace traditional methods of diagnosis or treatment.

Yes, it can help. It can alert you that there might be something wrong. But I wouldn't rely on it. And if you are suspected to have it even with an Apple Watch I'm pretty sure they're going to give you a proper 24h monitor with several leads, not just one.

Oh, and I know very well what AFiB is. And how it is detected, analysed and treated. With a treatment that might or might not work.

Armin Grewe, 2018-09-15

Yes, really.

When this thing goes off, it will scare people to go see a doctor who will take it from there. The doctor will not take is as gospel, but he will know the patient isn't just making something up that he read on WebMD.

And that is going to save some lives.

Volker Weber, 2018-09-15

What will also helps is the fact that you can document your Vorhofflimmern as it happens. In my case all the Afibs I had in my life disappered on their own. Sometimes it took 10 minutes, sometimes a couple of hours. However only two times a proper ECG could be done during an Afib. So to document this thing while it happens would be a great plus in my case - even if it is just a 1-channel ECG instead of a proper 6-channel.

Oliver Stör, 2018-09-15

Late to the discussion, but check this out:

Apple Watch 6, anybody?

Erik Brooks, 2018-09-25

Old archive pages

I explain difficult concepts in simple ways. For free, and for money. Clue procurement and bullshit detection.


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