Can heart rate variability data from the Apple Watch electrocardiogram quantify stress?

Chronic stress has become an epidemic with negative health risks including cardiovascular disease, hypertension, and diabetes. Traditional methods of stress measurement and monitoring typically relies on self-reporting. However, wearable smart technologies offer a novel strategy to continuously and non-invasively collect objective health data in the real-world. A novel electrocardiogram (ECG) feature has recently been introduced to the Apple Watch device. Interestingly, ECG data can be used to derive Heart Rate Variability (HRV) features commonly used in the identification of stress, suggesting that the Apple Watch ECG app could potentially be utilized as a simple, cost-effective, and minimally invasive tool to monitor individual stress levels. Here we collected ECG data using the Apple Watch from 36 health participants during their daily routines. Heart rate variability (HRV) features from the ECG were extracted and analyzed against self-reported stress questionnaires based on the DASS-21 questionnaire and a single-item LIKERT-type scale. Repeated measures ANOVA tests did not find any statistical significance. Spearman correlation found very weak correlations (p < 0.05) between several HRV features and each questionnaire. The results indicate that the Apple Watch ECG cannot be used for quantifying stress with traditional statistical methods, although future directions of research (e.g., use of additional parameters and Machine Learning) could potentially improve stress quantification with the device.

Cross Dataset Analysis for Generalizability of HRV-Based Stress Detection Models.

Stress is an increasingly prevalent mental health condition across the world. In Europe, for example, stress is considered one of the most common health problems, and over USD 300 billion are spent on stress treatments annually. Therefore, monitoring, identification and prevention of stress are of the utmost importance. While most stress monitoring is carried out through self-reporting, there are now several studies on stress detection from physiological signals using Artificial Intelligence algorithms. However, the generalizability of these models is only rarely discussed. The main goal of this work is to provide a monitoring proof-of-concept tool exploring the generalization capabilities of Heart Rate Variability-based machine learning models. To this end, two Machine Learning models are used, Logistic Regression and Random Forest to analyze and classify stress in two datasets differing in terms of protocol, stressors and recording devices. First, the models are evaluated using leave-one-subject-out cross-validation with train and test samples from the same dataset. Next, a cross-dataset validation of the models is performed, that is, leave-one-subject-out models trained on a Multi-modal Dataset for Real-time, Continuous Stress Detection from Physiological Signals dataset and validated using the University of Waterloo stress dataset. While both logistic regression and random forest models achieve good classification results in the independent dataset analysis, the random forest model demonstrates better generalization capabilities with a stable F1 score of 61%. This indicates that the random forest can be used to generalize HRV-based stress detection models, which can lead to better analyses in the mental health and medical research field through training and integrating different models.

Using apple watch ECG data for heart rate variability monitoring and stress prediction: A pilot study.

Stress is an increasingly prevalent mental health condition that can have serious effects on human health. The development of stress prediction tools would greatly benefit public health by allowing policy initiatives and early stress-reducing interventions. The advent of mobile health technologies including smartphones and smartwatches has made it possible to collect objective, real-time, and continuous health data. We sought to pilot the collection of heart rate variability data from the Apple Watch electrocardiograph (ECG) sensor and apply machine learning techniques to develop a stress prediction tool. Random Forest (RF) and Support Vector Machines (SVM) were used to model stress based on ECG measurements and stress questionnaire data collected from 33 study participants. Data were stratified into socio-demographic classes to further explore our prediction model. Overall, the RF model performed slightly better than SVM, with results having an accuracy within the low end of state-of-the-art. Our models showed specificity in their capacity to assess "no stress" states but were less successful at capturing "stress" states. Overall, the results presented here suggest that, with further development and refinement, Apple Watch ECG sensor data could be used to develop a stress prediction tool. A wearable device capable of continuous, real-time stress monitoring would enable individuals to respond early to changes in their mental health. Furthermore, large-scale data collection from such devices would inform public health initiatives and policies.

A conceptual IoT-based early-warning architecture for remote monitoring of COVID-19 patients in wards and at home.

Due to the COVID-19 pandemic, health services around the globe are struggling. An effective system for monitoring patients can improve healthcare delivery by avoiding in-person contacts, enabling early-detection of severe cases, and remotely assessing patients' status. Internet of Things (IoT) technologies have been used for monitoring patients' health with wireless wearable sensors in different scenarios and medical conditions, such as noncommunicable and infectious diseases. Combining IoT-related technologies with early-warning scores (EWS) commonly utilized in infirmaries has the potential to enhance health services delivery significantly. Specifically, the NEWS-2 has been showing remarkable results in detecting the health deterioration of COVID-19 patients. Although the literature presents several approaches for remote monitoring, none of these studies proposes a customized, complete, and integrated architecture that uses an effective early-detection mechanism for COVID-19 and that is flexible enough to be used in hospital wards and at home. Therefore, this article's objective is to present a comprehensive IoT-based conceptual architecture that addresses the key requirements of scalability, interoperability, network dynamics, context discovery, reliability, and privacy in the context of remote health monitoring of COVID-19 patients in hospitals and at home. Since remote monitoring of patients at home (essential during a pandemic) can engender trust issues regarding secure and ethical data collection, a consent management module was incorporated into our architecture to provide transparency and ensure data privacy. Further, the article details mechanisms for supporting a configurable and adaptable scoring system embedded in wearable devices to increase usefulness and flexibility for health care professions working with EWS.

Blockchain Applications in Health Care and Public Health: Increased Transparency.

BACKGROUND: Although big data and smart technologies allow for the development of precision medicine and predictive models in health care, there are still several challenges that need to be addressed before the full potential of these data can be realized (eg, data sharing and interoperability issues, lack of massive genomic data sets, data ownership, and security and privacy of health data). Health companies are exploring the use of blockchain, a tamperproof and distributed digital ledger, to address some of these challenges. OBJECTIVE: In this viewpoint, we aim to obtain an overview of blockchain solutions that aim to solve challenges in health care from an industry perspective, focusing on solutions developed by health and technology companies. METHODS: We conducted a literature review following the protocol defined by Levac et al to analyze the findings in a systematic manner. In addition to traditional databases such as IEEE and PubMed, we included search and news outlets such as CoinDesk, CoinTelegraph, and Medium. RESULTS: Health care companies are using blockchain to improve challenges in five key areas. For electronic health records, blockchain can help to mitigate interoperability and data sharing in the industry by creating an overarching mechanism to link disparate personal records and can stimulate data sharing by connecting owners and buyers directly. For the drug (and food) supply chain, blockchain can provide an auditable log of a product's provenance and transportation (including information on the conditions in which the product was transported), increasing transparency and eliminating counterfeit products in the supply chain. For health insurance, blockchain can facilitate the claims management process and help users to calculate medical and pharmaceutical benefits. For genomics, by connecting data buyers and owners directly, blockchain can offer a secure and auditable way of sharing genomic data, increasing their availability. For consent management, as all participants in a blockchain network view an immutable version of the truth, blockchain can provide an immutable and timestamped log of consent, increasing transparency in the consent management process. CONCLUSIONS: Blockchain technology can improve several challenges faced by the health care industry. However, companies must evaluate how the features of blockchain can affect their systems (eg, the append-only nature of blockchain limits the deletion of data stored in the network, and distributed systems, although more secure, are less efficient). Although these trade-offs need to be considered when viewing blockchain solutions, the technology has the potential to optimize processes, minimize inefficiencies, and increase trust in all contexts covered in this viewpoint.

Convergence of Precision Medicine and Public Health Into Precision Public Health: Toward a Big Data Perspective.

The field of precision medicine explores disease treatments by looking at genetic, socio-environmental, and clinical factors, thus trying to provide a holistic view of a person's health. Public health, on the other hand, is focused on improving the health of populations through preventive strategies and timely interventions. With recent advances in technology, we are able to collect, analyze and store for the first-time large volumes of real-time, diverse and continuous health data. Typically, the field of precision medicine deals with a huge amount of data from few individuals; public health, on the other hand, deals with limited data from a population. With the coming of Big Data, the fields of precision medicine and public health are converging into precision public health, the study of biological and genetic factors supported by large amounts of population data. In this paper, we explore through a comprehensive review the data types and use cases found in precision medicine and public health. We also discuss how these data types and use cases can converge toward precision public health, as well as challenges and opportunities provided by research and analyses of health data.

A Blockchain-Based Consent Platform for Active Assisted Living: Modeling Study and Conceptual Framework.

BACKGROUND: Recent advancements in active assisted living (AAL) technologies allow older adults to age well in place. However, sensing technologies increase the complexity of data collection points, making it difficult for users to consent to data collection. One possible solution for improving transparency in the consent management process is the use of blockchain, an immutable and timestamped ledger. OBJECTIVE: This study aims to provide a conceptual framework based on technology aimed at mitigating trust issues in the consent management process. METHODS: The consent management process was modeled using established methodologies to obtain a mapping of trust issues. This mapping was then used to develop a conceptual framework based on previous monitoring and surveillance architectures for connected devices. RESULTS: In this paper, we present a model that maps trust issues in the informed consent process; a conceptual framework capable of providing all the necessary underlining technologies, components, and functionalities required to develop applications capable of managing the process of informed consent for AAL, powered by blockchain technology to ensure transparency; and a diagram showing an instantiation of the framework with entities comprising the participants in the blockchain network, suggesting possible technologies that can be used. CONCLUSIONS: Our conceptual framework provides all the components and technologies that are required to enhance the informed consent process. Blockchain technology can help overcome several privacy challenges and mitigate trust issues that are currently present in the consent management process of data collection involving AAL technologies.

Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.

BACKGROUND: There are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution. OBJECTIVE: This study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia's health care system. METHODS: We constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia's Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses. RESULTS: We found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities. CONCLUSIONS: Our analysis of British Columbia's health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

Disruptive Technologies for Environment and Health Research: An Overview of Artificial Intelligence, Blockchain, and Internet of Things.

The purpose of this descriptive research paper is to initiate discussions on the use of innovative technologies and their potential to support the research and development of pan-Canadian monitoring and surveillance activities associated with environmental impacts on health and within the health system. Its primary aim is to provide a review of disruptive technologies and their current uses in the environment and in healthcare. Drawing on extensive experience in population-level surveillance through the use of technology, knowledge from prior projects in the field, and conducting a review of the technologies, this paper is meant to serve as the initial steps toward a better understanding of the research area. In doing so, we hope to be able to better assess which technologies might best be leveraged to advance this unique intersection of health and environment. This paper first outlines the current use of technologies at the intersection of public health and the environment, in particular, Artificial Intelligence (AI), Blockchain, and the Internet of Things (IoT). The paper provides a description for each of these technologies, along with a summary of their current applications, and a description of the challenges one might face with adopting them. Thereafter, a high-level reference architecture, that addresses the challenges of the described technologies and could potentially be incorporated into the pan-Canadian surveillance system, is conceived and presented.