Most of us think we’re pretty familiar with the concept of ‘wearable health’ as we sync our activity trackers with our smartphones. But from a clinical perspective, few devices are yet capable of the accuracy, durability, specificity and flexibility needed to truly enable continuous physiologic monitoring.
By enabling doctors to collect real-world evidence about their patients both inside the hospital and while they go about their daily lives, wearable technologies have the potential to revolutionize health care—but to reap the benefits devices need to be more accurate, doctors need to be more receptive to using the data, and systems need to be deeply integrated.
“There’s a natural trend within the connected devices space in which wearables are the starting point for first improving efficiency, and then improving patient care and outcomes,” says Kenneth Loparo, Nord Professor of Engineering at Case Western Reserve University. “Rather than bringing patients into clinics time after time to perform inefficient tests, why not use in-home devices instead?”
Continuous monitoring —or the remote observation of patients’ vital signs beyond the walls of the healthcare environment—is only made possible through high-quality, accurate data, and lots of it. Consumer-grade wearables barely succeed at reliably measuring your heart rate, much less guaranteeing the precision needed to support clinical research. Their consumer-driven design and the limits of their size and positioning on the body make them poor substitutes for the monitoring devices found in even the most bare-bones ICU.
“There are all kinds of consumer products on the market today that claim to be collecting and processing data that’s physiologically accurate,” Loparo says. “The data generated is very sparse with limited clinical utility.”
The ideal continuous monitoring wearable device isn’t just compact, non-invasive, accurate, precise, and reliable. “It’s also integrated,” Loparo says. “Ideally, a clinician or researcher would be able to work with a range of sensor types and then integrate the data they produce over time in order to be able to make diagnostic and/or treatment decisions.”
Clinicians don’t need raw data — they need information that tells a story. The data needs to be fused together and visualized in such a way that it can be used by doctors to obtain real-time feedback to drive medical understanding and decision-making.
Cardiopulmonary stress testing, for example, is often used to see if a patient is responding to a treatment compared to an earlier test. During such a test, various physiologic signals are recorded while the patient is exercising on a treadmill to assess their heart’s ability to handle a workload. This set of signals is easy to replicate or extend using wearables. For instance, a chest patch can record the electrocardiogram and respiratory parameters. Another sensor can track oxygen saturation and blood-related parameters. Together, the insights would generate a comprehensive picture of the patient’s cardiopulmonary health.
To achieve the maximum impact through the use of devices, the pull for technology needs to come from the healthcare side. If not, you end up with a set of reluctant potential customers and adopters, and the potential for new technologies to be integrated into meaningful solutions are slim.
Most clinicians, however, start out skeptical that any wearable device can collect accurate data. On the other hand, technology developers may have some general awareness of medical challenges, but the process is more likely to yield benefits to patients when there is close collaboration between the two groups.
“I’ve seen research groups collect data as part of a clinical trial and meet with a data analytics company to see what can be made of it. The data experts analyze the data, but they have no idea what the insights mean or what the limitations of the analysis are,” says Frank Jacono, Associate Professor of Medicine at Case Western Reserve University. “To avoid this, there has to be excellent communication between the engineering side and the purely clinical side.”
When clinics, hospitals, and doctors become responsible for the quality of their care, good things quickly follow. Competition re-enters the healthcare market, effectiveness — not compliance — becomes a key driver, fossilized administrative processes are eliminated, costs are reduced and we all live healthier lives.
“People will demand this shift,” Loparo says. “The economics are already demanding it. Clinicians are starting to demand it, too. As you move further out from the patient, efficiency is value-driven.”
Hans Danneels is co-founder and CEO of Byteflies, a Belgian-American wearable health company.
