How Apple Wins by Sensing and Responding

Apple no longer sits at the cool kids’ table. It runs the table. 

The company recently reported quarterly revenue of $91.8 billion, an increase of 9 percent from the year-ago quarter and an all-time record, and quarterly earnings per diluted share of $4.99, up 19 percent, also an all-time record. Apple continues to make fools of analysts who’ve questioned the company’s relevance, especially amid a slump in iPhone sales. Well, guess what: iPhone sales are doing just fine after all. And so is Apple’s stock price year over year:

Now consider this:

  • Siri, once the weak sister among smart voice assistants, has the world’s largest market share, even more than Amazon Alexa, Google Assistant, and Microsoft Cortana. Turns out the never-say-die iPhone and the release of AirPods Pro have helped propel Siri to a wider base of users.

What do all the above statistics tell you? Apple is defining its market as well as it always has, just in different ways that are perhaps not as earth shattering as the launch of the iPhone in 2007. (Let’s face it: the iPhone was like Van Gogh’s “Starry night over the Rhone” – a masterpiece and highwater mark that is seldom if ever matched again). For example:

  • Apple saw the rise of wellness care coming and positioned the Apple Watch not as a cool wearable but as a healthcare device. As CNBC reported, “Apple’s wearable category which includes the Apple Watch and AirPods wireless headphones, has been growing strongly. In the December quarter, that division brought in over $10 billion in net sales, a near 27% year-on-year increase.” In a newly published Hacker Noon article, I dig into the reasons why the Apple Watch has flourished in context of Apple’s strategy to be the data backbone of healthcare. 
  • Apple saw a growth opportunity in services (as opposed to hardware sales). Its Services division reported an all-time high in revenue growth for the most recent quarter, $12.7 billion versus $10.8 billion year over year. For its fiscal year 2019 (ended September 28, 2019), Apple reported $46.3 billion in Services, a 16 percent year-over-year increase. 
  • Apple got out in front of the rise of the voice-first world and introduced Siri in 2011, beating Amazon Alexa to the market by three years. (But Amazon completely outflanked everyone, including Apple, in the smart speaker market with the launch of the Amazon Echo in 2015.)

What’s next for Apple? Becoming a credible player in the streaming wars. Apple TV+, launched in November 2019, has a long, long way to go. Apple TV+ is being met with the same derision that Apple Music once faced. And whereas Apple Music could play catch-up by developing an formidable library of someone else’s music, Apple TV+ needs to develop original content to compete with Amazon, Prime Video, Disney+, and Netflix. 

But don’t ever underestimate Apple. The company has a huge reservoir of cash, and it’s willing to dip into it an example being the recent hiring of Former HBO CEO Richard Plepler to run Apple TV+. 

Do you really want to bet against Apple?

Apple TV+ Needs Cultural Relevance — and “Dickinson” Delivers It

Disney+ has The Mandalorian. Netflix has Stranger Things. What does Apple TV+ have to capture our imaginations and light the internet on fire?

Well, nothing approaching Stranger Things or The Mandalorian-level of widespread excitement. But the Apple TV+ show Dickinson is quickly building momentum and delivering what Apple TV+ needs: cultural relevance.   

Why Cultural Relevance Matters

Cultural relevance is essential for any entertainment company to succeed in the long run. Brands become culturally relevant when they connect with an audience through their attitudes, beliefs, and behaviors. Sometimes cultural relevance means shaping attitudes, beliefs, and behaviors, too. When brands achieve cultural relevance, they become so inextricably linked with our lives that we become lifelong members of their tribes.

Disney Masters Cultural Relevance

Disney is the master of cultural relevance. Mickey Mouse is more than a popular animated character. Mickey Mouse is an international symbol of childhood. Frozen is a pop culture phenomenon. The Lion King introduced the words “Hakuna Matata” to millions of people. The Little Mermaid inspired cosplayers for generations to come. And now, Disney+ is having a culturally relevant moment with The Mandalorian.

Almost immediately, The Mandalorian sparked passionate conversations on social media about Baby Yoda, Boba Fett, and Star Wars lore. I’ve not seen social media explode with such ferocity over a pop culture phenomenon since Pokémon GO hit. The Mandalorian did something else: it became the most in-demand original streaming TV show in the United States, unseating Netflix’s Stranger Things. Is it any surprise that Disney+ achieved more than 10 million subscribers on launch day? And all this excitement hit in time to unleash related merchandise for the holiday shopping season. 

Netflix Defines Cultural Relevance

Netflix, meanwhile, released Season 3 of The Crown on November 4. Here is a wildly popular show that connects with American audiences by tapping into Americans’ longstanding fascination with the Royal Family. The Crown inspired a wide range of commentary, some connecting the show to contemporary American politics, others offering insight into the importance of Welsh languageAnd the Royal Family itself commented on the opening episode

This is what culturally relevant shows do. They inspire conversation that transcends the show itself. Among the streaming companies, Netflix has created the gold standard for cultural relevance (although Disney may catch up and then some). Stranger Things has become a pop culture sensation by tapping into 1980s nostalgia (and arguably engineering that nostalgia). Tidying up with Marie Kondo connects with an American materialism (and its consequences) so profoundly that the show actually created a spike in donations to thrift stores. This is the entertainment company that changed how we watched TV and is responsible for vernacular such as “Netflix and chill.”

Along Comes Apple TV+

Now, what about Apple TV+, which launched on November 4? Well, the results are mixed, and Apple TV+ has been outflanked by The Mandalorian. The much hyped The Morning Show has failed to catch fire. Apple has delayed the release of theatrical film The Banker amid allegations of misconduct against one of the movie’s producers. But on the other hand, a lesser known series, Dickinson, has been steadily building a fan base.

On the surface, Dickinson focuses on the life of poet Emily Dickinson. But what makes Dickinson culturally relevant is that it’s more than the story of a poet. It’s a perfectly timed statement about female and LGBTQ+ empowerment. In addition, the casting is smart. For instance, Hailee Steinfeld, who portrays Emily Dickinson, connects effectively with Gen Z and the LGBTQ+ community. Wiz Khalifa, who portrays a personification of death, is highly relevant to music, fashion, and weed culture. And the show’s soundtrack, featuring artists ranging from A$AP Rocky to Billie Eilish, is a Millennial’s dream. As such, Dickinson is rapidly creating a fan base who call themselves “Dickheads,” and the show has inspired the term “Sexy Dickinson.” Now this is what cultural relevance looks like:

Dickinson has already been renewed for another season. 

Keep an Eye on Apple TV+

Creating cultural relevance requires an insight into consumer behavior, the agility to rapidly create content that taps into this behavior, and a platform to share that content at scale. Apple has the platform for Apple TV+ through Apple TV (and a new Apple TV app). As a media brand, Apple is getting better at tapping into consumer behavior and creating the right content. We all remember how Apple stumbled badly with its ill-fated forced download of U2’s Songs of Innocence album in 2014 – a miscalculation of consumer behavior (streaming was overtaking downloading, and people resented being forced to download music they did not ask for) and taste (U2 was out of fashion). But since then, Apple has adapted by launching a streaming service that now dominates the industry along with Spotify

Apple played catch-up and then became a leader in music streaming by becoming more culturally relevant with content that connects to millennial tastes, such as the Up Next program for developing artists and first-look album drops by artists such as Chance the Rapper and Drake. Original content alone was not the answer to the rise of Apple Music – culturally relevant content that connects emotionally was.

Apple TV+ has a long way to go before it attains cultural relevance. But Dickinson is a clear win. In addition, Apple has plenty of cash – and a lot of patience. You can be sure Apple is figuring out how to create its next Dickinson

Why Netflix Isn’t Afraid of Disney

Will Disney’s U.S. subscribers outnumber Netflix by 2024? That’s the question Danny Vena of The Motley Fool asked in an article after a Morgan Stanley analyst predicted that the combined subscribership of Disney’s streaming services could surpass Netflix’s own subscriber base within five years. Now here’s another question: how much do these numbers matter? After all, we don’t even know what kind of business Netflix will be in five years.

Netflix Is an Entertainment Company

As recently as 2012, Netflix was a streaming service. Today Netflix is an entertainment company, creating television programs and movies that have won Academy Awards, Grammys, and Golden Globes. Netflix has become a thriving haven for New Hollywood artists, such as Russian Doll’s co-creator Natasha Lyonne, or Roma’s director, writer, and co-producer Alfonso Cuarón, who seek to make unconventional and daring art that requires Netflix to take risks. And whereas vanguard rivals such as HBO changed the course of television, Netflix has changed how we watch TV by ushering in innovations such as on-demand binge watching.

Netflix Is Diving into Gaming

The increasingly popular narrative about Netflix is that the company that disrupted the entertainment world now risks being disrupted by new entrants such as Apple TV+ and Disney+, two streaming companies launching in 2019. Disney+ in particular will offer a formidable line-up of original programming, tapping into its extensive catalog of Marvel titles.

But while Apple and Disney leap into streaming, Netflix is already adapting its business model, an example being its expansion into gaming. Netflix recently announced that by 2020 it will offer a mobile game based on the hugely popular Netflix show Stranger Things. The company also said that a game, “The Dark Crystal: Age of Resistance Tactics,” will be launched as an adaptation of the Netflix movie The Dark Crystal: Age of Resistance (a prequel to Jim Henson’s 1982 movie, which should appeal to the coveted Millennial audience).

A push into gaming makes perfect sense for Netflix. The gaming market is expected to reach $180 billion by 2021, fueled by the growth of formats such as mobile gaming (which will grow to $106 billion by 2021). Netflix can offer well-known entertainment titles that lend themselves to games and an audience that is receptive to gaming. According to Karol Severin, lead gaming analyst for MIDiA Research, 46 percent of Netflix’s weekly active users play games on mobile devices and 33 percent play on consoles, “which over-indexes significantly compared to the consumer average.” In addition, gaming keeps Netflix’s audience locked into its own platform. After you’re done watching Stranger Things, you can play the Stranger Things game without leaving the Netflix universe. In addition, gaming creates the potential for revenue through features such as in-app purchases, a model that Fortnite has mastered. And Netflix needs more revenue.

Netflix is already showing us another way the company is incorporating gaming — by embedding a gaming experience into the content itself, as we’ve seen with choose-your-own-scenario interactive film Bandersnatch that Netflix aired in 2018, and the choose-your-own adventure experience Minecraft: Story Mode. These are not games, per se, but interactive content in which the viewer participates in the storylines. Watch for Netflix to create more sophisticated social experiences that merge plots with games, perhaps with augmented reality and virtual reality.

Three Ways Ways Netflix Is Evolving

Netflix is changing in other ways, too, such as:

  • Becoming a licensing and merchandising companySpeculation abounds that Netflix will offset mounting operational costs by incorporating ads. In fact, Netflix is already monetizing its shows. Stranger Things alone has created a strong base upon which to build a licensing and merchandising business. For example, Netflix and bike maker Mongoose have agreed to offer a limited edition Mongoose based on a fictional bicycle used in Stranger ThingsAs reported in License Global, “The collaboration includes an in-episode promotion that will see Maxine ‘Max’ Mayfield from the series riding the bike in the upcoming season of the show. Starting later this month fans of the series will also be able to get their hands on a replica of the bike used in the promotion.” And Mongoose is hardly the only company co-branding with Netflix — as evidenced by co-brands launched in 2019 between Stranger Things and Burger KingCoca-ColaH&M, and Nike. These relationships — hybrid in-show product placements plus real-world merchandising — offers a glimpse of how Netflix will monetize its titles more broadly. In fact, Netflix has merchandised Stranger Things so extensively that Fast Company recently noted with derision that the show is turning into Sponsored Things.
  • Becoming a center for music exploration. Netflix is rapidly becoming a music brand. Homecoming: A Film by Beyoncé recently demonstrated how powerful and relevant Netflix can be as a platform for music distribution. Miley Cyrus understands this reality, as witnessed by her using Netflix as to drop new music linked to her appearance on Netflix’s Black Mirror. Meanwhile, the new Netflix movie Beats has gained street cred for its use of hip-hop, and Thom Yorke of Radiohead and Director P.T. Anderson recently made a music video for Netflix. Netflix is especially ideal for artists such as Beyoncé who are savvy about using multi-media to extend their audiences. Stay tuned.

I could also see Netflix monetizing customer data. Netflix is sitting on a trove of data about its customers’ viewing habits and demographics. It’s possible that Netflix will build a revenue stream from that data, as Amazon does. In addition to providing customer demographic data to third parties, Amazon also offers advertising services both on the platform and across the digital world by using data it has amassed on customers’ purchasing habits. Netflix has denied it will offer advertising on the platform itself. But Netflix could conceivably sell customer analytics services and even develop advertising products beyond Netflix.

Netflix Succeeds with Cultural Relevance

Meanwhile, Netflix continues to play to one of its strengths as a content creator: tapping into cultural trends, a case in point being the launch of Tidying up with Marie Kondo. The show not only mirrored culture but shaped it by prompting viewers to return their used clothing to vintage stores in droves. Shows such as Tidying up with Marie Kondo and Stranger Things remain important: they attract and keep audiences. But creating great content alone is not the future of Netflix.

Netflix Embraces Risk

Netflix’s ability to adapt is a reason why Netflix Vice President of Original Content Cindy Holland recently said of Disney and Hulu, “I don’t think there’s any one that stands out as the competitor. We’ve anticipated that all of these traditional players would enter into our space. The more successful we were at building an on-demand subscriber base with content, the more likely they were going to stop licensing to us. It’s actually one of the reasons why we started original content in the first place. We believed this shift would happen. It’s just taken many years longer than we thought. So we welcome it.”

Netflix succeeds by doing the things you don’t see coming. Doing so means taking risks. And perhaps the ability to take risks is really Netflix’s greatest asset. As Holland said, “We are not afraid to try a bunch of different things, some of which may work, some of which may not. It’s part of our culture to embrace mistakes and failure and learn something from it.”

Why Amazon and Google Are Fighting to Lead the Voice-First Economy

To no one’s surprise, the story of CES 2019 was the battle between Amazon and Google to lead the emerging voice-first world.

CES was awash with announcements about products such as alarm clocks and thermostats powered by Amazon’s Alexa virtual assistant and Google Assistant, prompting coverage such as CNET’s “Who Won CES 2019: Amazon or Google?” and USA Today’s “CES 2019: Google vs. Amazon, Who Won?

In the aftermath of CES, though, one question looms: What exactly do Amazon and Google get out of winning this battle?

Numbers Galore

Both Amazon and Google used CES to state the case for their leadership of voice (Apple, Microsoft, and Samsung, while certainly players, are not the leaders in voice although Apple is a strong challenger). Google announced that Google Assistant is on one billion devices, up from 500 million in May 2018 (a figure boosted by the sale of Android phones that contain Google Assistant by default). Amazon disclosed that it has sold more than 100 million devices that rely on its Alexa virtual assistant. In addition, the number of people who use Alexa every day — and who own more than one Amazon Echo smart speaker — doubled in 2018. 

Meanwhile, during CES, more telling numbers were disclosed. According to research conducted by Edison Research and NPR, 53 million adults in the United States (or two out of 10 Americans) own at least one voice-activated smart speaker. The number of smart speakers in homes has increased 78 percent year over year. And on January 8, Accenture reported that half of online consumers globally use digital voice assistants, up from 42 percent one year ago.

These figures don’t mean that people are actually using their voices to buy things from businesses. In fact, most people use voice assistants to perform everyday tasks such as listening to music and getting weather information. But the usage data is important nevertheless. It shows that even if we’re not exactly living in a voice-first world, we’re getting there – and doing so quickly considering that the Amazon Echo didn’t exist until 2014, and Google Home just two years later. In addition, by 2016, 20 percent of all Google mobile queries were voice searches.  

The rise of voice also helps explains why so many companies continue to launch products fueled by voice at CES, and 2019 was no exception.

Gadgets and Software Integrations

CES unleashed a dizzying array of products powered by voice, usually through Google Assistant or Amazon Alexa. These products typically focus on making it easier for people to use their voices to live in their homes and navigate their cars. For instance:

In the Home

Lenovo announced an alarm clock powered by Google Assistant. KitchenAid and GE rolled out smart displays that rely on Google Assistant to help you get recipes, watch videos, and do anything else to keep you occupied and entertained in the kitchen. Currant’s new smart wall outlet, which can be controlled by Alexa and Google Assistant, monitors energy usage and suggests which products to automatically turn off to conserve power. The Dalkin smart thermostat works with Alexa and Google Assistant to control the climate in your home.

You can learn more about major product announcements here and here. (For those of you keeping score, in November 2018, Recode reported that Google Assistant works with 10,000 smart home devices versus 20,000 for Alexa.)  But the most intriguing products, such as the Currant smart wall outlet, use artificial intelligence to not only act on your voice commands but also give you information and manage your home without your intervention.

On the Go

Both Amazon and Google showed that Alexa and Google Assistant are powering our lives on the go, too. Google formally integrated Google Maps with Google Assistant, which is important because of Google Maps’s popularity for mobile wayfinding. As Mashable noted, “Google envisions users asking it for directions home, or to nearby restaurants and saved locations. You can ask the assistant to search for places along your route (like gas stations) or add a stop — all things that used to require some button pushing.”

Amazon announced a stronger push into voice-powered automobiles. CES was barely under way when Amazon and Telenav, a provider of connected car and location-based services, announced a relationship that makes it possible for drivers to use the Telenav Alexa-powered navigation system to do the same kinds of functional tasks that they can do with Google Maps. And then Amazon formally launched Amazon Echo smart speaker for the car. Google announced a similar product through a relationship with Anker’s Roav automotive accessory, which is essentially a Google Home for the car.

These announcements continued a battle for on-the-go voice experiences that has been going on for some with Google, Apple, and Amazon all rapidly launching products and software designed to be the de facto infotainment systems for different car manufacturers. The irony is that major auto makers have been announcing dips in sales for 2018. But overall, automotive has been a strong industry over the past several years. And now cars are getting smarter.

What Do They Want?

No wonder so many “Google versus Amazon” stories have proliferated throughout January. But the more important question than who “won” CES is what do Amazon and Google get out of all these voice-powered products? The answer is simple:

  The company that owns the ecosystem monetizes the voice-first world.

Owning the ecosystem yields practical benefits, such as revenue gained from the sale of smart speakers. Amazon commands a strong leadership of smart speakers, but Google is catching up. As of 2019, Amazon is capturing 63.3 percent of the smart speaker market, with Google Home accounting for 31 percent. The numbers matter for another reason besides revenue: smart speakers connect people with other smart devices, thus acting as a gateway for product integrations. As Accenture noted in its survey of global smart assistant users, “[n]inety-three percent of consumers globally expect their home device purchases, such as smart TVs or computers, to be based on ease of integration with their standalone smart speaker.”

Google’s Motivation

For Google, being the backbone of voice protects the company’s online advertising business, which accounts for more than 70 percent of Google’s revenue.  Google needs to keep giving people reasons to keep using products such as the Google search engine, Google Maps, and the Google Chrome web browser. As people stay on Google, Google can continue to deliver audiences to advertisers and learn from audience behavior. As people use voice, Google can keep them on Google by incorporating voice into its products, launching new products such as Google Home, and making Google Assistant part of other companies’ products, which is the alarm clocks, thermostats, and cars using Google Assistant come into play. 

But it’s not all about advertising for Google. Google also wants intelligent voice assistants to make Google software and hardware (such as Pixel phones) more useful and popular, a dramatic example being Google’s Duplex software, which can make convincing phone calls on behalf of human beings.  

What Amazon Wants

Amazon has its own motivations. Amazon is already a popular search engine for product searches, with half of online shoppers starting their searches on Amazon. Amazon also needs to incorporate voice to keep those shoppers using Amazon as they become more comfortable using voice – not just because Amazon wants them to buy things from Amazon with their voices, but also because Amazon is building an online advertising business that is already the third largest in the industry, behind Google and Facebook

As Amazon creates its own advertising business, it, too, needs to show potential advertisers that it can deliver an audience to them – in the home and on the go, whether they use their voices or text to get what they need. In 2018, it was reported that Amazon was in talks with advertising giants such as Procter & Gamble to permit them to advertise on Amazon Echo speakers. Amazon has denied that it’s going to permit advertising through Alexa. But even if Amazon does not offer ads, per se, it can use voice to mine valuable data about its customers that would be useful to its advertisers, such as Google can.

Amazon is already working with businesses to monetize skills. Through premium content known as in-skill products that reside within Alexa skills, businesses can sell premium content such as in-game currency. For example, Stoked Skill offers free games such as Escape the Room and Escape the Airplane. The games are set up as Alexa skills. Players use Alexa skills to find clues that will help them escape spaces such as jell cells and cars. Customers can pay for optional “hint” packs (in in-skill product) that make it easier for them to escape. 

I could see Amazon also offering branded content and products to Prime customers who use Echo, such as discounts at local restaurants unlocked exclusively through Amazon Echo Auto. Doing so would monetize voice without more intrusive advertising that lack any useful offers.

Finally, Amazon has other plans to monetize voice in the enterprise, such as Alexa for Business to help enterprises use Alexa to improve workforce productivity. As these examples show, companies are using Alexa for Business to book conference rooms, manage the connection status of shared devices, and other workplace tasks. But Amazon has competition in the enterprise most notably from Apple and Microsoft.

What Business Should Do

Brands have a clear mandate: prepare for a voice-first world, and one where Amazon and Google call the shots for now. When consumers start really buying products and services via voice assistants, brands will need to play ball with the companies that control the voice ecosystem. Here is how Recode envisions one way that world will play out:

How it works now: If you ask Amazon’s Alexa or Google Assistant to buy, say, shampoo, they’ll surface what they think you’ll want. Alexa uses several criteria to suggest a purchase option: Your order history, whether a product is eligible for free Prime shipping and whether the product has the “Amazon’s Choice” seal of approval — “highly rated, well-priced products available to ship immediately.”

Google picks products from merchants thatare most relevant to the query. It also considers purchase history and information about user preferences, as well as an item’s availability and proximity.

Both companies say there is no favoring of specific retailers — or their own products.

Brands also can’t pay for visibility — yet. For now, Amazon and Google are trying to build trust among new — few — voice buyers by making their search results as relevant as possible. It doesn’t, however, take much imagination to see a future in which Amazon or Google merchants could pay to have their products suggested by their smart assistants — like sponsored ads that crowd their websites — as a way to generate more ad dollars.

Today, businesses are participating by creating sometimes clever and inventive voice-based brand building experiences, such as HBO’s voice-activated Westworld game, in which people use Alexa to explore the mythical Westworld. Other businesses have created their own branded Alexa skills. With Tide’s Stain Remover skill, you can get stain removal instructions shared with you through Alexa. Campbell’s offers recipes through Campbell’s Kitchen. Presumably, these businesses could offer in-skill products if they wanted to, an example being HBO offering a premium-tier Westworld game for purchase. And businesses are optimizing their content to be found through voice search. 

Amazon and Google are not the only companies doing the heavy lifting, but they are leading the way to a voice-first world. Smart companies are going with them. 

How Apple Is Changing Healthcare through Partnerships

Apple took a major step forward to influence the future of healthcare with the release of an ECG app and irregular heart rhythm notification. With the Apple Watch Series 4, users can take an ECG similar to a single-lead reading. And owners of Apple Watch Series 1 or later (with watch OS 5.1.2) can get notified if an irregular heart rhythm such as atrial fibrillation (AFib) is identified (per the American Heart Association, AFib is present in about one in five strokes.) The new functionality has already been credited with saving one man’s life. The release of the app also comes with a challenge: earning credibility with physicians, who have voiced concerns about people misreading the app’s data. But Apple is up for the challenge — and will succeed. That’s because for years, Apple has built partnerships across the healthcare ecosystem. Those partnerships have provided a proving ground for Apple’s healthcare apps and generated a reservoir of goodwill for one of the world’s most valuable brands.

A Healthcare Strategy

The ECG app, announced at Apple’s September 12 Special Event, support Apple’s strategy to improve healthcare by being the data backbone for patient care. That strategy has three key elements:

  • Software for patients and providers to monitor and share data, which is where apps come into play.
  • Hardware: the Apple Watch and iPhone to create an ever-present device platform.
  • Relationships with healthcare providers such as hospital networks to monitor and share wellness data.

Apple’s penetration of healthcare supports its growth in both wearables and services, two categories that, while small, are contributing more to Apple’s revenue growth based on its fourth-quarter earnings results announced November 1. But with healthcare, CEO Tim Cook has loftier aspirations than generating more revenue. As he told TIME recently, “Apple’s largest contribution to mankind will be in improving people’s health and well-being.”

His focus on wellness care in particular positions Apple well. The PwC’s Health Research Institute (HRI) cites wellness care as one of the top forces shaping the future of healthcare industry, with wellness accounting for $276 billion of the $5 trillion U.S. healthcare ecosystem.

Reaction from Physicians

But to improve health and well-being, Apple needs to have physicians on board. Some have been publicly critical of the ECG app, while others have been supportive. The announcement of heart monitoring features during Apple’s September Special Event almost immediately triggered concerns from physicians who worried that patients would misdiagnose themselves. But the announcement also came with support from the medical community. For example, Christopher Worsham, a critical care physician at Massachusetts General Hospital, and Anupam B. Jena, an internist at Massachusetts General Hospital, wrote in Harvard Business Review, “ . . . doctors shouldn’t be too quick to dismiss the new feature, particularly as it appears amidst growing consumer enthusiasm for wearable devices that measure health behaviors. The Apple Watch has the potential to provide valuable data that benefits the entire health care community.”

Now that the ECG app is live, Apple has experienced both criticism and good PR. On the one hand, an Orange Country cardiologist, Dr. Brian Kolski, has complained about numerous patients contacting him because they thought their Apple Watches were reporting heart problems when in fact nothing was wrong. Dr. Kolski discussed a patient who contacted him in the middle of the night, panicking about a heart reading he’d seen on his Apple Watch.

“He texted me the strip, and it was completely normal,” Dr. Kolski told The Orange County Register. “This was a healthy 45-year-old man who was playing around on his watch and went into a major panic.”

On the other hand, the new features are generating positive news coverage for Apple. TechCrunch and ABC News have already reported the case of Ed Dentel, whose physician told him that the new app likely saved his life by notifying him of an abnormal heart rate. Dr. Sanjay Gupta, CNN’s chief medical correspondent, tested the ECG app and reported it to be “remarkably easy” although he cautioned users to use the app with care.

“The app may also increase visits to the doctor from newly concerned patients,” he wrote. “Still, there has been considerable enthusiasm from the medical community as a whole . . . There is no doubt Apple is counting on doctors to use the data collected by the Apple Watch. The company has made it easy to upload your ECG, along with a description of your symptoms, to your personal doctor directly from the app to facilitate that communication. It’s all part of their big bet on making an impact in health care.”

Strong Relationships in Place

The PR is important, and so is the data that Apple cranks out to substantiate the value and accuracy of the ECG app. But Apple already has something else going for it: a demonstrated ability to forge partnerships with the medical community. The launch of the ECG app is just the latest in a long list of Apple’s accomplishments on the road to become a healthcare player — and those successes have come through partnerships with physicians that I discussed in my recent white paper, Dr. Apple Will See You Now. For example:

  • In 2014 Apple, launched HealthKit to give Apple users a central repository to track health and fitness data on their Apple devices. In February 2015, Ochsner Health System in New Orleans launched its “Hypertension Digital Medicine Program,” which relies on HealthKit to help patients measure and share with the provider their own blood pressure and heart rates. Oschner adjusts (in real-time, if needed) patients’ medications and lifestyle counseling based on the findings.
  • In 2015, Apple released ResearchKit, an open source software framework designed for medical and health research, intended to help doctors and scientists gather data more frequently and more accurately from participants using iPhone apps. The University of Rochester has used ResearchKit to build an app for the largest Parkinson’s study in history. According to Apple, “the app helps researchers better understand Parkinson’s disease by using the gyroscope and other iPhone features to measure dexterity, balance, gait, and memory.”
  • In January 2018, Apple announced that its Health app will make it possible for users to see their medical records right on their iPhones, which would thus empower potentially 90 million Americans who own iPhones. When Apple launched the capability, the company came out of the gate with 39 hospital networks participating. (Apple keeps a running list of participating hospital networks on its website.)

Apple has published more examples of successful physician collaboration. For instance, at Johns Hopkins, physicians provide epilepsy patients with Apple Watches to track their seizures, possible triggers, medications, and side effects. Thanks to a special app developed by Johns Hopkins, the EpiWatch, patients have access to their personal information through a dashboard that also shares data with providers if the patient wants to do so. Patients can also send a message to family members and providers to let them know when the patient is tracking a seizure. Johns Hopkins is collecting this data to eventually understand how to predict seizures before they happen.

Hiring Physicians

Reportedly, Apple’s journey to healthcare prominence also means hiring approximately 50 physicians. CNBC cited the example of hiring hired an orthopedic surgeon, Sharat Kusuma, who leads a team working with medical device maker Zimmer Biomet “to study whether Apple technology can help patients recover from knee and hip replacement surgeries.” In a December 12 article, Christina Farr of CNBC wrote, “The hires could help Apple win over doctors — potentially its harshest critics — as it seeks to develop and integrate health technologies into the Apple Watch, iPad and iPhone.” She added,

Doctors can also help Apple guide the medical community on how to use Apple’s new health technologies  and to deflect criticism. As an example, when Apple announced its electrocardiogram sensor to track heart rhythm irregularities, the company  put up a website to help answer physicians’ questions. That’s important because there’s a very high bar to win approval among doctors who fear liability and are  already overburdened by technology

And here is where Apple’s established relationships with medical networks will pay off. Apple is not trying to build relationships and credibility from scratch. Apple already possesses goodwill by proving itself through efforts that precede the ECG app (such as those cited above). And Apple’s other ace in the hole is usage among physicians: 75 percent of doctors in the United States own some form of Apple device, according to a study by Manhattan Research.

We all know Steve Jobs was the super power who made Apple synonymous with changing the world. But Tim Cook is building a legacy, too, around healthcare. That’s because Apple is improving healthcare through partnerships, not disruption.

Apple Flexes Its Healthcare Muscle

At Apple’s September 12 Special Event, the company continued to show off its growing healthcare superpowers with the release of the Apple Watch Series 4. The latest iteration of the Apple Watch, available September 21, unleashes new features designed to help people manage wellness. Those features include:

  • Creation of an ECG similar to a single-lead electrocardiogram. Using a new ECG app, watch owners can take an ECG reading from their wrists and receive heart rhythm classifications. The Apple Watch can classify if the heart is beating in a normal pattern or whether there are signs of Atrial Fibrillation (AFib). In addition, the data is stored in Apple’s Health app in a PDF that can be shared with physicians. In Apple’s words, “It’s a momentous achievement for a wearable device that can provide critical real-time data for doctors and peace of mind for you.”
  • The ability to detect when a person falls and report a falling incident to a designated emergency contact. Analyzing wrist trajectory and impact acceleration, the Apple Watch sends the user an alert after a fall, which can be dismissed or used to initiate a call to emergency services. If the Apple Watch senses immobility for 60 seconds after the notification, it will automatically call emergency services and send a message along with location to emergency contacts.
  • More fitness features. The Apple Watch already gamifies healthcare by rewarding users with special badges for completing fitness tasks such as walking. Now the Apple Watch allows users to challenge other Apple Watch wearers to complete fitness tasks. In addition, the device provides other features such as prompting owners to start workouts and accurately tracking active calories burned for activities such as hiking and yoga.

With the Apple Watch Series 4, Apple extends its reach into healthcare, following a strategy that the company has been pursuing for years.

The Data Backbone for Patient Care Continue reading

Why GDPR Isn’t Coming to the United States

Will draconian privacy laws ever come to the United States as they have in Europe in recent days? The question is reasonable in light of ongoing news stories about Facebook’s cavalier treatment of user data. Now that the European Union has enacted General Data Protection Regulation (GDPR), we now have a template for stronger protection of consumer privacy, with businesses being held to more stringent privacy standards and facing steep fines for failing to uphold those standards.

The likelihood of GDPR-style regulation coming to the United States was one of several topics I discussed with a panel of journalists and industry practitioners recently. The panel, hosted by Chris Heine of the Bateman Group, focused on the many possible impacts of GDPR. Participants ranged from Gartner Analyst Andrew Frank to Kevin Scholl, director of digital marketing and partnerships at Red Roof Inn. My take: GDPR isn’t going to come to the United States anytime soon – especially during the Trump administration. Here’s why:

  • Data privacy is not a priority at the Federal level. We’ve already experienced the mother of all data breaches – and nothing happened. Remember Equifax, whose failure to protect user data affected millions of Americans? If ever there was a reason to usher in more serious privacy laws, Equifax handed it to the administration on a platter. But in fact the Consumer Financial Protection Bureau actually scaled back its investigation of Equifax. And Americans moved on. Meanwhile, influential businesses such as Alphabet and Apple have too much lobbying power for GDPR regulation to take hold widely. (Google alone spent more than $18 million on lobbying efforts in 2017.) The corporate-friendly Trump administration will likely place the adoption of widespread privacy measures low on the priority list.
  • The American won’t demand widespread regulation anytime soon. We may claim we care about privacy when we are asked– but our actions say otherwise. For example, the brutal Facebook/Cambridge Analytica scandal created a #DeleteFacebook spasm, which died away. It’s not that we want to give businesses unfettered access to our data. But we don’t have the time and energy to police them. Who really takes time to read the mind-boggling user agreements we are periodically asked to review when we update our Apple operating system or when LinkedIn or some other platform revises its practices? (Here’s LinkedIn’s privacy policy. I’m sure you’ve reviewed it carefully because you care about privacy, right?) In addition, and perhaps more importantly – big tech has the upper hand. We’re hooked to our devices and platforms. They fuel our lives. We’ve given them permission to manage us – which is a big reason why #DeleteFacebook died. We may be annoyed with Facebook the brand, but we want Facebook the community.

A more likely scenario: Facebook will take the fall. The company will become subject to more regulation and scrutiny, thus reframing a potentially more widespread issue as the problems of one company. Instead of inspiring Federal action to regulate privacy more broadly, Facebook’s failures will instead marginalize the issue. We’re already seeing Apple capitalize on Facebook’s problems by attempting to demonize the social media platform.

Tougher privacy laws may take hold at the state level, but don’t hold your breath waiting for a dramatic change to occur nationally.

For more insight into our panel, check out:

Adweek, “4 Big GDPR Concerns for Brands, Agencies, and Vendors,” Chris Heine, May 9, 2018.

Bateman Group, “Here Are 4 Big GDPR Concerns for Brands, Agencies and Vendors,” Chris Heine, May 23, 2018.

CNBC, “People will forget about data privacy issues soon — at least, that’s what ad experts expect,” by Michelle Castillo, April 12, 2018.

DMNews, “7 Ways GDPR Will Affect Your Marketing Efforts — According to Top Marketers,” Hillary Adler, May 28, 2018.

Voice Looms Large for Apple and Mary Meeker

Apple and Mary Meeker agree: we’re living in an increasingly voice-first world. But how well is Apple adapting?

On May 30, Kleiner Perkins venture capitalist Mary Meeker, one of the most influential pundits in digital, released her annual Internet Trends report. The uptake of voice-based digital interfaces was a significant theme. She identified voice as one of nine areas where innovation and growth are occurring as U.S. internet usage continues to growth.

“With voice, we’ve hit technology liftoff with word accuracy and we’ve certainly hit product liftoff with Amazon Echo’s install base estimated to be around 30 million plus,” she said, as she presented her report at the 2018 Code Conference. And she presented slides to illustrate her point.

It’s worth noting that in her 2016 report, she quoted Andrew NG, chief scientist at Baidu, who said, “As speech recognition accuracy goes from say 95% to 99%, all of us in the room will go from barely using it today to using it all the time. Most people underestimate the difference between 95% and 99% accuracy – 99% is a game changer . . . “

According to Meeker’s 2018 report, we’ve now approaching that point where accuracy rates will trigger widespread adoption.

As Meeker noted, sales of the Amazon Echo have been phenomenal – an example of a technology company identifying a need that people did not know they had.  And the Echo is an important, but not the only, barometer of voice’s uptake. Businesses such as Amazon, Continue reading

Boom! Amazon Makes Voice a Whole Lot Bigger

Amazon just extended its influence on how everyday people live.

Today Amazon announced the launch of Alexa Blueprints, which makes it possible for anyone to create their own Alexa skills and responses with the popular voice assistant – and no coding is required.

In doing so, Amazon has found a way to build on its lead in the smart speaker category, where Amazon is crushing its competitors with a 70-percent market share through its Echo product powered by Alexa. But Alexa is more than the heart of the Echo. Alexa is helping to change the way people live through voice-based experiences.

Not long ago, the idea of using our voices to play music, organize recipes, manage our smart homes, and order pizzas seemed far-fetched in a world dominated by text-based searches and commands. But Amazon, Apple, Google, and Microsoft have been steadily developing assistants intended to get people to use our voices to manage machines. Now nearly half of Americans use voice assistants on their mobile phones alone. By 2022, 55 percent of Americans will have installed a voice-powered smart speaker in their homes.

Amazon is leading the way in the adoption of voice. Alexa is the most widely used voice assistant and enjoys higher rates of engagement than competitors such as Apple’s Siri. In fact, Alexa is the heart of a rapidly evolving network that relies on voice commands to manage our lives. Home base consists of the Alexa-powered Echo smart speaker, which reside principally in our homes. Since launching Echo in 2014, Amazon has sold an estimated 20 million Echo units on its way to achieving a commanding lead in the market for smart speakers.

But Jeff Bezos wants Alexa to go beyond our living room. It’s already well known that automobile manufacturers are incorporating Alexa into their vehicles, and Amazon recently launched an offering to extend Alexa into the workplace. At CES 2018, businesses showcased a number of products integrating Alexa – ranging from smart glasses to bathroom fixtures.

These applications of Alexa do something important: make people more comfortable with the voice interface. As Bezos told Billboard, “Alexa is primarily about identifying tasks in the household that would be improved by voice.”

But Amazon needs Alexa to perform more skills for the assistant to become the common fabric of our lives. According to Amazon, Alexa performs 25,000 skills including checking your bank account balance and cooking thanks to interfaces with  third parties. And with Blueprints, Amazon puts the tools of production into the hands of the owners. By empowering end users to create personalized Alexa skills and responses without needing how to code, Amazon has created a compelling way to accelerate the uptake of Alexa. Now anyone can create their own content and customize the product to do what we want. The Amazon website offers a number of suggestions such as helping the babysitter find things in your home, mastering subjects with your own voice-based flash cards, and creating stories.

Making tools more accessible is a common approach employed by technology companies such as Apple and Google. Apple, of course, made smartphone adoption explode by opening up the iPhone to third-party app developers. More recently, Apple released ARKit for developers to launch augmented reality products. Google has taken an even more democratic approach over the years by releasing tools that you don’t need to be a developer to use, such as Google Analytics. Google is now ambitiously trying to make virtual reality more popular by launching tools to create VR experiences.

Apple and Google face bigger challenges making AR and VR more mainstream although Apple less so because AR is easier and less costly to adopt. On the other hand, voice-based experiences are becoming more intelligent and accessible. Plus, it’s far less expensive for people to use voice assistants especially as they become more embedded in products we own already.

With Blueprints, Amazon is widening its lead in the marketplace for voice assistants by changing how we live. Amazon is now Amazon Everywhere.

 

Apple Wants to Liberate Your Medical Records

How easily can you obtain your medical records from your provider? Do you know what your precise cholesterol levels are? I’m willing to bet my new iPhone that your answers to these questions are “Impossible” and “No.”

But if Apple has its way, we’ll finally have always-available access to our own medical records – at least those of us who own iPhones will.

Announcing Health Records

On January 24, Apple announced that its Health app will make it possible for users to see their medical records right on their iPhones, which would thus empower potentially 90 million Americans who own iPhones. The capability became available for patients of 12 medical institutions January 25. Following a beta launch, Apple will expand the program for participating medical providers. Continue reading