Can the Apple Watch Plus HealthKit Tie All Your Health Tracking Needs Together?

Now that Apple Watch OS 2 is out and the product has been in the market several months, what’s the verdict on the watch as a health tracker? Note the emphasis on health, not fitness.

In a rare PR move for Apple, there was an interview with Jay Blahnik, Apple’s director of fitness for health technologies, in Outdoor magazine in August. The interview was revealing as to Apple’s intentions in the area of health and their overall approach. Jay laid out the strategy behind the creation of the Activity and Workout apps and said it all boiled down to — sit less, move more, and get some exercise.

So, how does the Apple Watch succeed against these goals? What’s missing?

There have been many reviews of the watch as a fitness device, most saying it’s solid for recreational athletes but perhaps lacking for fitness fanatics. If you haven’t seen it in action, tracking exercise on the watch uses the Workout app. When you work out, you can either set a calorie goal, a time goal, or an open ended goal. A heart rate monitor is built into the Watch and runs while you exercise. I’ve tested it against my Polar chest-strap based monitor and it was quite accurate — so now I’ve replaced the chest strap with the watch for my workouts. Since a decent heart rate monitor could easily run you $100, that can be factored against the price of the watch. At first I was pampering my Watch and wouldn’t have done worn it during a workout, but now the honeymoon’s over. The sport watch band is well suited for workouts and changing bands is so easy you can swap them for a daily workout in less than a minute. The Watch doesn’t track time in heart rate zones, but it does what I need and it’s probably sufficient for most people — if they are willing to measure workouts the Apple way. However, If you’re a dedicated runner or cyclist, you may want an exercise-specific app instead of the Workout app, or specialty device like a running watch.

The Activity app is Apple’s gamification dashboard for overall health. As described in the Outside article, Apple wants you to make healthy choices. It’s not enough to exercise — being sedentary is evil. By most accounts the hourly watch prompts to stand and hit your move goal are motivating. So, most would agree the Apple Watch does a solid job against those goals of: sit less, move more, and get some exercise.

However, overall health is a broader concern than simply exercise and movement. Nutrition (weight too) and sleep are missing from Apple’s tracking.

Apple has wisely left nutrition tracking to several already existing and excellent apps. Let’s use MyFitnessPal as an example. It’s a highly polished app that lets you either enter your meals or zap the UPC codes of items you eat to track your calorie intake. If you plan to lose some weight, you identify your goal and the app will track you to a daily calorie limit. If you set alerts to enter your meals in MyFitnessPal, you’ll get a reminder to do them on your Apple Watch, which is motivating. Calories show up in the Apple Watch companion app.

When you look at the integration of MyFitnessPal nutrition data with Apple’s exercise and activity tracking it gets interesting. Apple has an underlying health data interchange platform called HealthKit. HealthKit exchanges selected data between apps, including data from devices such as the Apple Watch, wifi scales, etc. and integrates it all in one place. It can also connect to Electronic Health Record systems such as Epic, meaning you can share what you want with your doctor.

HealthKit is Apple’s operating system for health information but it’s a work in progress.

Pulling all this data together isn’t as simple as the advertisement shows. I used to enter workouts into the MyFitnessPal app where they would then show a calorie offset against the day, e.g. 220 calories from exercise on an elliptical meant 220 more calories I could eat that day. I setup MyFitnessPal as a source in the Health app (which is the dashboard app for HealthKit). Calories transferred seamlessly, but not workouts. This is where you start banging your head on the table. When you set up MyFitnessPal as a source in Healthkit, you’ll see that it MyFitnessPal can read workout data from Health but not write to it.

That’s ok, you can enter a workout directly into the Health app. So, I entered a bike ride into the Health app as a data point. The workout showed up in Health, but would not transfer into MyFitnessPal (even though Health is set up as a source). It also did not show up in the Activity app against the 30 minute exercise goal. Crap.

So Health/HealthKit is something of an island at this point and you have to be a good data analyst and willing to tinker with the apps you use to get everything working for you. I wrote about HealthKit a year ago and many of the same issues are still there.

However, if you go all-in on the Apple way and use the Workout app, things will work smoothly. The time you spend on the treadmill will count against the exercise circle goal in Activity. The workout will also show up in the Health dashboard, and the calories burned transfer from Workout -> Health -> MyFitnessPal. It’s pretty damn smooth.

The Workout app is simplistic and inflexible — it lists only a certain set of exercises and a few ways of tracking. Apple, we need some options here! People are waiting for this. If you’re doing martial arts or swimming you’re not going to want to wear your Apple Watch or any watch for that matter. If you want to track that exercise you should be able to enter it into Health or another app. The data should then transfer smoothly throughout this data ecosystem just like it does with Workout.

That’s not happening today. Activity does not appear to talk to any of the leading running or biking apps out there. Some specialty apps, like Runkeeper, will serve as a source for Health(Kit) and exchange data. But if you want to use Activity to stay healthy and do it the Apple way, your 1 hour run entered into Runkeeper isn’t going to make it back to Activity — you’ll still have your 30 minutes to go. Strava and Runtastic appear to be in the same boat and neither runs natively on the Watch, meaning you have to drag your iPhone around with you, which is a no-go with me. This lack of integration of Activity with third-party apps is a huge gap in Apple’s health tracking.

The Watch is a mass-market health and fitness tracker. It’s likely that Apple would prefer to satisfy running and other exercise enthusiasts by allowing great third-party apps to fill that gap (like they are). In the Outside article integrating Activity with leading apps was mentioned as part of the OS2 update, so hopefully it’ll happen soon.

The Health app itself, though charmless, has gotten interesting.

It’s a solid example of the integration at work. Take a look at these calorie charts (which are better in MyFitnessPal), and also charts for active and resting calories. There’s even a heart rate chart (by the way, when did I give Apple permission to monitor me all the time?) Weight also gets picked up from MyFitnessPal.

Sleep tracking is another area frequently identified as key for health. The Jawbone Ups were notable in this category as having excellent information display in the app and being pretty unintrusive on your wrist while you slept. I had two of them.

Sorry Jawbone, but now for free you can use Sleep++ on your Apple Watch. You simply wear your Watch when you sleep; you start the app when you go to bed and switch it off when you wake up. It shows the depth of your sleeping and sends the data over to Health. Overnight it uses about 10% of the charge on your watch and, critically, it’s a native watch app that runs independent of the phone — you can put your watch in airplane mode to save juice. Personally, I don’t want to wear the Watch when I sleep, but in my experience this app works smoothly.

The Apple Watch with the help of excellent partner apps and HealthKit covers all the bases and does a solid job of tying all your health tracking needs together. But, what’s next?

Activity, exercise, nutrition, and sleep are external drivers of health. How about blood pressure, cholesterol, and everything that goes on inside your body? This is where HealthKit is a slumbering giant. If you go into the Health app under “Health Data,” you’ll see all the current biometrics that HealthKit currently covers, and more are constantly being added. This image shows the categories available. HealthKit can be a living dashboard of your total health and help you tackle medical issues, going well beyond simple tracking.

I recently worked on an app that helps patients collect and manage crucial streams of health information for their anemia due to kidney disease or chemotherapy. The app integrates with HealthKit, using patient entered data as well as data captured from the phone. The combined data can be easily shared with your doctor. The app, Procrit’s Health View App, provides help beyond the prescribed drug to aid these patients — beyond the pill, as it’s known in the biz. It recently won the app category for PM360’s Trailblazer Awards (an industry trade magazine).

HealthKit eventually will be able to integrate app data, data from devices like a blood pressure cuffs, patient reported outcomes, and also environmental factors. Then you’ll be able to share this data with your doctor either via a patient portal, an electronic health record system, plain old email, or simply printing it out. At that point, you can work with your doctor to take a stronger role in your health, far beyond fitness. That’s the promise.

Mark Davis can be found online at www.IMetMark.com