Could Better Health Be all in the Wrist?

Doctors aren’t necessarily clamoring for patients’ Fitbit data, but wearable technology may just be poised to transform medicine.

by / January 12, 2015

America is dangerously fat. The nation’s obese population puts itself at greater risk of coronary heart disease, diabetes, stroke and cancer, while contributing $190 billion in annual health-care costs to an increasingly unsustainable system. Starbucks buys more than 270 million pounds of coffee each year, yet still manages to spend more on health insurance — about $300 million annually. America’s health-care burden drives up prices — General Motors adds $1,400 onto the cost of each vehicle sold to cover its own health-care costs — and puts the nation at a competitive disadvantage, compromising the opportunities of future generations.

Today’s wearable technology won’t solve America’s health problems, but a single irresistible device could be enough to heighten health awareness and transform America’s image and culture, just as the iPhone kick-started a worldwide technology obsession less than a decade ago.

America wants to be healthy. Consultancy group PricewaterhouseCoopers projected that the personal health and wellness industry will grow to $452 billion by 2015, while others expect the sector to reach $1 trillion by 2017. The wearables industry alone is expected to reach $19 billion by 2018. As often seen in nascent industries, wearable tech is now waiting for a leader to emerge who can show the world what’s possible, and today there are thousands of researchers around the world applying their knowledge of technology to transform health care.

For personal health and health care, the potential impact of wearable tech is massive, said Michael Matly, principal at Montreux Equity Partners. Matly’s firm invests in late-stage companies in the health-care sector, but it hasn’t invested in wearables yet — it’s still waiting for the right product to come along. And new devices and apps seem to come along each week.

Sensor-laden clothing is produced by companies like Hexoskin, AiQ and Glofaster. There are dozens of wristband activity trackers, the most popular coming from Fitbit and Jawbone, with newer entries coming from Microsoft and Nintendo. Samsung and Apple are pushing smartwatches with marketing that is increasingly oriented around the wrist. Spire produces a respiratory monitor, and several groups are developing wearable glucose monitors. There are smart diapers (Pixie Scientific), smart glasses (Google), smart jewelry (Cuff, Logbar), two kinds of smart hand sanitizer dispensers (HyGreen, BioVigil), smart headphones (Bragi) and smart stickers (MC10). There’s even a smart wristband to shock the user into behaving correctly (Pavlok). The consumer wearable market is already so saturated that makers have begun catering to other species (FitBark, Whistle, Voyce).

“I think you’re starting to see trends where we are taking more ownership in our health and wellness,” Matly said. “So risk and cost are being transferred from employer to employee. Right now if you get sick, you’re pretty much responsible for financing a solution and you shop for physicians now the way you shop for phones. There is an increase in growth in the consumer-oriented health and wellness sector and I think that becomes apparent when you look at the wearable tech space.” Experts predict that 150 million wearable devices will be in use by 2020.

The wearable tech industry is exploding, but it has at least one big problem. The value of wearables is confusing. There was a point in recent history when it no longer made sense not to own an Android, BlackBerry or iPhone. Engineers kept adding functionality, the utility-to-cost ratio went off the charts, and almost everyone who didn’t already own a smartphone bought one. The same cannot yet be said of any wearable device. Today’s wearables are enticing to early adopters, they are novel, and in specific applications they can provide some narrowly defined value, but there is no wearable device that can change the lives of the general population in the expansive way that smartphones have.

One effect of the wearable industry’s ambiguous role in the consumer’s life is that device retention is relatively low. The winners in the wearable device industry will be determined by who can best harness the subtleties of human behavior, Matly said. “If you look at digital scales, the retention with those companies after a year is 80 or 90 percent,” he said. “Is it because the scale is giving better information than your wearable is? Probably not. I think it’s because you don’t have to do anything. You get out of your shower and step on your scale and you leave.”

Daniel Matte, leader of wearable tech research at Canalys, said attitudes toward wearable devices are in many ways similar to how people view gym memberships. “The perception is that that device may end up in the drawer after three months, after six months,” Matte said. “These activity trackers in particular, people buy them as part of a New Year’s resolution to lose weight or just to be more active, more healthy.”

The wearable market is small today with fewer than 10 million devices, but it’s growing fast and changing, said Matte. “We think smartwatches are the next big segment in consumer technology, the biggest since tablets,” he said. “We’re trending toward smartwatches because users only want to wear one device on their wrist, so there’s going to be a convergence of technologies. In time, smartwatches will come down in price to the point where it leaves very little room for the basic bands to compete. I think it will be very similar to smartphones encroaching on basic phones.”

Apple and Google must have noticed the fragmented and confusing space that wearable tech inhabits in the market, because they’ve both ramped up their investments in health sensor tech and launched mobile apps (Health and Fit, respectively) that act as central dashboards for wearable sensor data. If done correctly, apps like Health and Fit could impact health on a global level, especially since smartphones pass the passive-use test as most people keep their phone in their pocket or purse most of the time, making additional wearables viable but not essential components in the health data ecosystem.

Encouragement by employers further drives wearable adoption forward. In 2013, CVS Pharmacy infamously instated a policy that penalized its workers with a $600 annual fee if they failed either to quit smoking or to disclose their body weight. Though the policy was controversial, the company is far from being an outlier.

The Workplace Wellness Programs Study, published by the U.S. Department of Labor (DoL) in 2012, found that about half of U.S. employers with 50 or more employees offer workplace wellness programs that typically include things like clinical screenings, preventive intervention and health promotion benefits like onsite vaccinations. According to a Towers Watson survey, about 22 percent of companies with wellness programs use financial incentives structured as penalties, like CVS does. The DoL study concluded that employer wellness programs are both sustainable and clinically meaningful as a way to curb “the current epidemic of lifestyle-related diseases, the main driver of premature morbidity and mortality in the United States.”

Despite criticism that such programs are potentially discriminatory and privacy-invading, many are willing to accept such monitoring if they believe it can benefit them personally. For there’s no quicker way to abate man’s outrage than to hand him a check. A 2014 PricewaterhouseCoopers report called The Wearable Future found that price is the leading factor prohibiting wearable adoption, and offering wearables through employers boosted adoption rates greatly. About 70 percent of consumers said they would wear employer-provided wearables streaming anonymous data to a pool in exchange for a break on health insurance premiums.

The report also found that wearable makers have a great hurdle to overcome in changing the public’s ambivalence toward the technology. “If I head out the door in the morning and leave my fitness band at home, I’m not going to turn around to go back and get it. If I leave my phone at home, you bet I’m going to go get it,” said Jeff Malmad, survey respondent and Mindshare employee. “For wearable products to take off,” the report concluded, “they will need to carve out a distinct value proposition that a phone alone cannot deliver.”

That wearables have not yet carved out a distinct value proposition is largely because we are in the earliest days of the technology, said Lisa Suennen, managing partner of Venture Valkyrie Consulting. Wearables for health care are coming next.

“I don’t think there have been enough entries [to make an impact],” Suennen said. “Most of them have been heart rate monitors for arrhythmia, iRhythm is one instance — really good products, but they’re focused on one problem and there have not been a lot yet that focus on a broad range of medical conditions. But I think there will be.”

What’s Next for Wearables?

Described by creators as “mechanically invisible,” users of MC10 can jog, swim or shower while wearing it. The technology lets doctors monitor patient cardiac activity remotely, as well as muscle activity, eye movement, temperature and acceleration.

A group of Pennsylvania State University researchers called Atoptix is working on smartphone-based sensing technology to monitor blood and tissue.

Biovotion developed a wearable, smartphone-connected device designed to monitor patients with chronic conditions.

Researchers at GUES in London are developing a sensor that detects sleep apnea and hypopnea.

The Vitaliti health monitor is a cloud-based mobile platform with wearable devices for monitoring 10 health metrics, including heart rate, blood pressure and heart anomalies.

Suennen estimated that within the next five to 10 years, wearable devices will begin to prove their use in health care. But first, those products will need to demonstrate that they work effectively and reliably, they must go through clinical trials, and be placed in the hands of doctors, because most people won’t use medical-grade products without a doctor’s recommendation, Suennen said.

Most of today’s wearables are too whimsical to be taken seriously by the medical community. Doctors don’t care how many steps their healthy patients are taking, Suennen explained. They want an effective method for monitoring at-risk patients, so they can prevent readmission or catch a problem before it becomes a bigger problem.

In these early days of wearable research, there are many promising contenders vying to become the next big thing in health care. MC10 manufactures bendable, stretchable electronics that allow the user to affix multiple sensors to their body as they would a Band-Aid.

MC10 is unique because unlike other wearable electronics, the device integrates intimately with the human body and is “as soft as human skin,” said Yonggang Huang, an engineering professor at Northwestern University. Huang has spent the past eight years developing the technology behind MC10 along with John A. Rogers at the University of Illinois.

“It’s like a children’s tattoo printed on the skin and you don’t feel its existence and it doesn’t interfere with your daily activity in any way,” Huang explained. “You can even take it swimming, go jogging, play all kinds of contact sports. We call them mechanically invisible. That’s a big difference with wearable electronics.”

MC10 could allow physicians to monitor their patients remotely, wirelessly, 24 hours a day, Huang said. MC10 can monitor a patient’s EKG and send an alert to the hospital if something changes. It can also monitor muscle activity and eye movement, temperature and acceleration.

In October, Nokia announced 11 finalists to its Sensing XCHALLENGE, a contest in which the communications company would award $2.25 million to developers of breakthrough medical sensing technologies. A similar competition, called the $10M Qualcomm Tricorder XPRIZE, would reward research teams developing technologies that pull personal health technologies from the realm of science fiction and place them in the hands of patients.

Atoptix, a research team at Pennsylvania State University, is developing smartphone-based blood and tissue sensing technology. Biovotion developed a wearable, smartphone-connected device designed to monitor patients with chronic conditions. Research team DMI of Cambridge, Mass., is developing a sensor that could run hundreds of clinical lab tests using a single drop of blood. London-based research team GUES is developing a sensor that detects sleep apnea and hypopnea (shallow breathing). The cloud-based Vitaliti health monitor provides a mobile platform and wearable devices for monitoring 10 health metrics. There are health monitoring projects under way by Danvantri, Aezon, Dynamical Biomarkers Group, Hemolix, Final Frontier Medical Devices, MESI Simplifying Diagnostics, Scanadu and dozens more research teams from around the world.

Many see wearable tech encroaching on health care within five to 10 years, but Arun Mathews says that day may come sooner. Mathews is the chief medical information officer at Medical Center Hospital in Odessa, Texas, where he assisted in the transition from paper to electronic medical records (EMR). Though wearable tech is still in the concept phase in his facility, the value in harnessing the quantified-self and quantified health care is hard to ignore, Mathews said.

“The part that really interests me as a clinician is the use of analytics to power advanced clinical decision support,” Mathews said. “We’re working with a third-party group to build some probabilistic computational logic to help identify patients that are high risk for readmission using our data and [scoring them] and once we identify those patients, adjusting our process while the patient is in the hospital to rapidly address things that they would need following discharge. And we’re tracking those outcomes to see if our analytics tool is in fact impacting our readmission rates as a result.”

Those who make conservative estimates about wearable adoption in health care may be (justifiably) looking at regulatory risk and institutional barriers in medicine as the main impediments to adoption, Mathews said. “The consumers are pushing it, and if all it takes is one or two very compelling applications of something like HealthKit, then health-care policymakers will start to sit up and take notice,” he said. “It’s not right around the corner, but I would say within the next five years we will see a compelling use of HealthKit data somewhere in the EMR.”

Wearable tech has the power to transform today’s sick-care model to one of high-quality preventive medicine and wellness maintenance, Mathews said. “The simple fact is, you give people the data in terms of how sedentary they are and behaviors start to change, and that’s pretty darn powerful. Then you can apply gamification principles into it and sustain some of these changed behaviors. In my view, even though I like the idea of using wearable tech to address acute problems and monitoring post-failure, I think pre-failure and keeping people healthy is where wearable tech has some real potential.”

Kevin Patrick: research shows The public is ready to share its health data, but the medical care system isn’t ready to use it.

Just how wearable sensor data can be integrated into health care is an area of budding research. Kevin Patrick, a professor at the Department of Family and Preventive Medicine at the University of California, San Diego, and principal investigator of the Health Data Exploration Project, is one of those investigating the degree to which companies, health-care institutions, and technology users are prepared to use their health sensor data to make the American population healthier.

Through interviews and surveys, the Health Data Exploration Project has in its earliest stages emboldened researchers by revealing a public that is ready to share and use personal health data, though not without qualification. There are prevalent concerns about data privacy, ownership and access. Those issues will be addressed in time, but the largest barrier to adoption may be a lack of institutional readiness.

“The last thing your doctor wants to see during an eight-minute visit is all your Fitbit data combined with a bunch of other things that you might have,” said Patrick. “The medical care system right now is not really set up to address or deal with this.” What’s promising, however, is that there is a lot of interest on all sides in making the most of the data that will inevitably be generated, Patrick said.

“There’s more to managing diabetes than measuring an HBA1C periodically and asking people whether or not they took their medication and whether or not they were physically active over the last few months,” Patrick explained. “It really is important to know how active they were, and — if they weren’t — what were the barriers, what were the problems, so health care can benefit from a lot of the insights that can come from a lot of these wearable devices. There’s just a lot of work right now to figure out how to make that happen.”

Getting a lot of people to monitor and share their data across populations is critical to making this whole thing work, and Patrick says it will happen one day. “We may consider it odd in the future if people aren’t using these kinds of devices,” he said. “There was a time when glasses were not very common or contact lenses didn’t exist and the first people who wore spectacles were probably considered oddballs, but now we just take them for granted. In all likelihood, I think that is going to be the direction we take as a culture in certain areas.”

Insurance companies have scared people to the point where they’re afraid to share data because they don’t want to be penalized, Patrick said. About 90 percent of those surveyed said they would want their health data to be shared anonymously. Whether data sharing is done anonymously or personally, collective data sharing holds the potential to unlock insights of untold prosperity.

“Every year, there are about 2.5 million deaths in the United States and we can explain about half of them as far as what the cause of death was,” Patrick said. “We can say somebody got cancer or had a heart attack or whatever, but heart attack and cancer were just the cause of the death — something caused the cancer, something caused the heart attack — smoking or obesity or whatever. We think opening up a bit more of these data and letting people look at them across demographic groups, by age groups or by location might actually help gain insights that save lives.”

Colin Wood former staff writer

Colin wrote for Government Technology from 2010 through most of 2016.

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