Telemedicine and connected devices are emerging as technologies to provide greater access and convenience to care for those who can defer treatment by way of an in-person consultation.
Health care is moving toward a more connected future and wearable devices are tools that pave the way to a more linked care system in the future. The extensive availability of smartphones has further promoted the popularity of smart devices and connectivity.
Consumerism is prevailing in the health care space and consumers demand a model that can deliver more convenient, more accessible, and higher quality care at an affordable cost. Wearable devices can complement that model by providing patient vitals and activity data in real-time to health care providers.
Telemedicine and connected devices are emerging as technologies to provide greater access and convenience to care for those who can defer treatment by way of an in-person consultation. Advancements in artificial intelligence are further fueling the significant growth of wearables.
Remote patient monitoring is the use of wireless technology by health care providers to track and manage medical and health-related information from their patients. Physicians can monitor and treat chronic illnesses resulting in improved clinical efficiency and lowering the cost of care.
One in 6 adults owns a smartwatch and sales continue to go strong year after year. Sales were up more than 60% in the United States last year and people aged 55 years and older are among a big growth segment.
The remote patient monitoring market is projected to be $31.3 billion industry by 2023. Wearable devices are now better equipped with health monitoring features that appeal to older consumers. Studies suggest that people would be willing to use a wearable device if they knew their physician was using that information and it directly affected their clinical care.
Sophisticated sensors in wearable devices allow for the collection, storage, and management of a repository of patient data. Those data can then be transmitted to the patient’s health care providers to optimize tracking of key data points for various medical conditions.
Medical wearables enable remote monitoring, as well as notify medical practitioners in case of an emergency. If health care providers can get the right data at the right time, the information gathered from these wearable devices may better regulate a patient’s treatment plan and has the potential for more personalized treatments, more accurate diagnoses, and improved clinical outcomes.
Wearable devices also offer new ways to lower the cost of care. Imagine if a patient is on suboptimal drug therapy, and through data collected in a wearable device, a health care provider could change therapy and help the patient avoid additional refills of suboptimal therapies.
Improving optimal medication adherence helps lead to improved utilization and fewer condition-related complications. Wearable devices also allow for a caregiver to have access to the patient’s data so they can monitor progression of the patient’s disease.
Wearable devices have proliferated both specialty and non-specialty conditions. Although advancements continue to be made every day in this space, I will discuss some of the current opportunities to leverage wearable devices for specialty conditions.
In specialty disease states, devices such as a watch provide access to a multitude of apps for conditions such as multiple sclerosis (MS). One app I have seen is easy to access on a Smartwatch and with a click, patients can use several features including the help, symptom tracker, or walk test features.
With the symptom screen, patients can select from commonly reported symptoms for MS. Patients can use this feature to track when or if they experience symptoms such as paralysis, coordination disorders, fatigue, muscle weakness, and visual or speech problems.
Their care team will see newly reported symptoms and reach out if the patient reports increased symptoms that may suggest a change in status or adverse effects from medication. This log of symptoms can also be shown to their neurologist during a regularly scheduled visit.
Pairing this with connectivity to an electronic health record allows for seamless delivery of the information to the patient medical record. The walk test feature incorporates information from a walk test, which is a validated measure that over a period of time, can show progress or status change in a patient with MS.
Although individual measurements are not valid on their own, over time the information provides insights to empower conversations between patients and their nurse. The help feature sends a text to a caregiver or trusted person. It’s not like calling 911, but it provides peace of mind.
A patient with MS might find useful a help function that signals an “I’ve fallen, and I can’t get up” alert. Through the use of an accelerometer and a gyroscope in the watch, the software is able to analyze a falling speed and the angle at which a patient tumbles.
The watch can determine whether the patient has taken a hard fall or whether they’ve just stumbled. If it senses that they’ve fallen, it displays an alert saying, “It looks like you’ve taken a hard fall.”
Then you have a choice: If you’re OK, you can cancel the alert. If you’re not OK, you can tap the face of the watch, initiating a call to an emergency number and family.
If your tumble was really bad and you’re unable to trigger the emergency signal yourself, the watch will do it automatically if you haven’t moved for 60 seconds. With this feature, caregivers are alerted to their location. What’s helpful is that you can have 1 or more caregivers, family members, or trusted persons who will simultaneously receive the same alerts.
Health care providers may find this technology valuable to assist with care plans related to the patient’s condition. For example, if a patient exhibits with MS symptoms such as urinary incontinence, numbness, or impaired coordination, these symptoms may be better tracked and reported using smart devices, providing important information about the condition worsening and offering an opportunity for caregivers and health care providers to support earlier interventions.
The team can see activity related to steps, movement, sleep, walk test, symptoms, and if the help button was ever pushed. Within MS specifically, we know gait, postural stability, and overall activity level is very important.
As a result, the data from the wearable device will be able to frame that out. This will be an important kind of data element that the team will be able to translate or look toward in terms of disease progression or potential adverse effects that the patient’s medication is causing because they have a decrease in that level of activity.
The other piece of this is sleep disturbances. Being able to track a patient's sleep and understand if they're waking up in the middle of the night could indicate something is going on. Maybe it's a bladder infection, which is common in MS. Maybe it's incontinence, which is a sign of disease progression.
Imagine being able to intervene quicker and potentially avoid faster or additional disease progression or maybe an emergency department visit due to bladder infection. Having these data enables the care team to proactively intervene and have a better view in real time of what's actually going on with the patient.
Other specialty condition wearable devices have sophisticated sensors that have the ability to measure UV exposure based on personalized and individual UV sensitivity. Imagine a patient at high risk for skin cancers, such as melanoma or non-melanoma (squamous and basal cell), being able to track their exposure to harmful UV radiation and create awareness on how to protect themselves from harmful UV exposure.
For patients with lupus, protection from sun exposure is a critical part of managing the condition. Lupus is an autoimmune disease in which the body’s own immune system attacks normal tissue.
People with lupus can experience photosensitivity or unusual sensitivity to sunlight. This can trigger symptoms such as itching, burning and skin rashes.
Excess sun exposure can also cause flares in lupus, causing symptoms such as fatigue, joint pain, weakness, and in some cases, internal organ damage. Wearable devices that incorporate a UV sensor paired with a smartphone can help measure and manage radiation exposure telling them when they had enough.
Cystic fibrosis is a genetic disorder that causes persistent lung infections and limits the ability to breathe over time. People with cystic fibrosis have a gene mutation causing a protein to become dysfunctional.
When the protein is not working correctly, it’s unable to help move chloride which is a component of salt, to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs like the lungs becomes thick and sticky.
According to the Cystic Fibrosis Foundation, a sweat test can measure the amount of chloride (a component of salt) in the sweat. By using sensors and microprocessors adherent to a patient's skin, the sweat glands can be stimulated.
The microprocessors and sensors then can detect the presence of different molecules and ions based on electric signals. With a wearable device, technology may now be able to analyze the chemical constituents of a patient’s sweat to accurately diagnose cystic fibrosis. And beyond diagnosing cystic fibrosis, each patient may have a different sweat profile, which could lead to more highly individualized care.
If a cystic fibrosis drug only works on only a fraction of patients, you can imagine a wearable device such as this is very valuable with people in clinical drug investigations allowing for better insight into how their chloride ions increase or decrease in response to a drug. A wearable sensor also presents an opportunity to increase patient access to care regardless of geographic proximity to a health care facility and, therefore, could have the potential for patient monitoring and management for a condition such as this.
Just this summer, the FDA approved a wearable device called IB-Stim to treat functional abdominal pain associated with irritable bowel syndrome (IBS) in patients ages 11-18 through nerve stimulation. A small battery-powered device, which is placed behind the ear, continuously emits mild electrical pulses that target certain branches and bundles of cranial nerves.
After 5 days, the device is replaced. IBS is one of the leading causes of abdominal pain in children. This stimulation targets brain areas involved in processing pain and aids in the reduction of functional abdominal pain associated with IBS. According to the FDA, patients can use the device for up to 3 consecutive weeks to help reduce functional abdominal pain associated with IBS, alongside other therapies for the syndrome.
The examples provided above for wearables specific to specialty conditions are just to name a few. Successful technologies should consider four foundational objectives:
1. Patients need to wear it.
2. The data will need to prove useful.
3. The technology will need to demonstrate meaningful and actionable interventions.
4. The information needs to be connected to the health care team.
Keeping this in mind, the possibilities are endless. The miniaturization of monitoring devices and power sources has created new opportunities for wearable technologies.
In the industry of health care, there is a great need for mass-personalization at an efficient and effective scale and scope. We have only begun to scratch the surface as the market of wearable devices will continue to grow and expand.
About the Author
Brandeis Seymore earned her Bachelor of Science Pharmacy degree from the Duquesne University School of Pharmacy and is currently enrolled in the Master of Pharmacy Business Administration (MPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. She has spent the past several years working as a senior clinical manager assisting employers with their pharmacy benefit management strategy. Prior to these experiences, she has held roles of increasing responsibility, most recently as a Strategic Account Executive to support client’s marketplace needs and demands.