Wearables in Healthcare: Better All The Time

Companies continue to develop new features for wearables that blur the line between consumer products and medical devices, a trend that Deloitte predicts will be a dominant theme in 2022.

A new report from the consulting firm predicts that more healthcare improvements are on the horizon for wearables, which might increase their effectiveness in the clinical setting as early as next year.

  • Smartwatches that measure blood oxygen saturation (SpO2) will likely become more common, as low SpO2 is a potentially life-threatening symptom that’s hard to detect unassisted.
  • Continuous blood pressure monitoring could improve due to advances in photoplethysmography (PPG), Raman spectroscopy, and infrared spectrophotometers.
  • Over 10% of smartwatch owners are now using them to detect COVID-19 symptoms, with 15% of smartwatch owners purchasing them after the onset of the pandemic.

Although Deloitte projects total wearables shipments to climb from 320M units in 2022 to 440 units in 2024, it also notes several headwinds that could slow adoption.

  • Interoperability is cited as a top priority for provider adoption of new technologies, yet only 10% have integrated data from wearables into their EHR.
  • Data privacy remains a concern for 40% of smartwatch owners, a figure that rises to 60% among those who use smartwatches exclusively to track their health.
  • Increased regulatory scrutiny is anticipated as smartwatch outputs are integrated into EHRs, with most current devices avoiding HIPAA by collecting data for personal use.

Deloitte does not view these obstacles as insurmountable, and believes that simultaneous advances in sensors, semiconductors, and AI will lead to further innovation. Both big tech and the medical community see a bright future for wearables, and their continued investment could make it “a self-fulfilling prophecy.”

Can Wearables Help Measure Patient Outcomes?

Researchers from the University of Edinburgh published a systematic review in Nature that aimed to determine the current evidence base and reporting quality for mobile digital health interventions (DHI) in the postoperative period following surgery.

Methodology – After screening 6,969 articles for patients undergoing surgeries where postoperative outcomes were measured using DHIs (defined as mobile technologies to improve health system efficiency and health outcomes), 44 studies were included in the final review.

Results – The review indicated that several types of mobile phone- or wearables-generated data can improve the assessment of postoperative recovery:

  • patient-reported outcome data (from validated self-report tools)
  • continuous activity data (from wearables)
  • combining remote assessment with active clinical prompts or patient advice

DHI Shortcomings – Studies included in the analysis demonstrated that DHIs may facilitate patient recovery following major operations and reduce inappropriate service use, although they also revealed issues with the current evidence base that should be addressed:

  • patients are rarely engaged in the development of DHIs
  • only one study was designed to engage patients in reviewing their own data
  • high levels of exclusion exist for patients without relevant mobile technology


The increasing availability of high quality mobile technologies provides a new bridge between clinical services and patients’ homes, and while the authors of the study are optimistic about the technology, they stress the importance of improving reporting standards if its potential is to be fulfilled.

Going forward, the researchers suggest that studies of DHIs in postoperative settings seek to provide meaningful comparisons to non-DHI care in order to demonstrate clinical value, with particular attention paid to reporting quality so that equitable comparisons can be made to existing research.

Landmark Study Investigates Mobile Health Data

Medical researchers have typically relied on self-reported health data to establish patient metrics such as activity levels and heart rate, but a recent paper published in the Lancet by Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) aims to form a sturdier baseline for future digital health interventions.

The study is unique in its large sample size (n = 6,765) and the scale of collected information, capturing health data from underrepresented age groups, races, ethnicities, and underlying conditions.

While the preliminary results include only the first 90 days of the ongoing three-year observational study, the authors published the aggregated data to allow for comparison of groups (age, race, ethnicity, gender, body-mass index, beta-blocker use, medical conditions) to longitudinal patterns of activity, heart rate, and blood pressure data.

  • Methods – The study enrolled a diverse set of 6,765 US adults (54% women, 18% 65 or older, 17% Black, 17% Asian) of whom 10% have diabetes, 33% have hypertension, and 27% have depression. Participants were provided Apple Watches, Omron blood pressure cuffs, and a MyDataHelps smartphone app to record data on heart rate, blood pressure, step counts, and distance walked.
  • Results – A total of 200m heart rate measurements and 1.1m blood pressure readings were collected over the 90 day period. Participants 65 and older had significantly lower heart rates, while women had average resting heart rates 3 bpm higher than men. Heart rates and activity levels varied by race, ethnicity, and underlying conditions, underlining the importance of patient-specific context when interpreting data from wearables.
  • Discussion – Researchers noted that upon the study’s completion the participant data will span from before the pandemic to after its onset, enabling the evaluation of its impact on physiologic parameters due to illness and lifestyle changes.

Study Impact

Wearables have made longitudinal vitals monitoring a reality, allowing clinicians to paint a more complete picture of patient activity in daily life. As the study continues with its three-year monitoring phase, MIPACT intends to contextualize the patient data with information from EMRs and surveys, furthering its goal of creating better baselines for future digital health research. In the meantime, the authors hope that the easily navigable preliminary results will be used to improve study design and clinical recommendations.

Blood Pressure Tracking Is Coming to the Apple Watch… Eventually

The Apple Watch is arguably the most successful consumer health product of all time, allowing users to track a wide range of biometric data while shipping over 33m units in 2020 alone.

That’s why when the Wall Street Journal recently reported that Apple is planning to include an on-wrist blood pressure monitor in an upcoming version of the watch, both consumers and healthcare providers took notice.

  • How It Works – Citing internal company documents, the WSJ revealed that Apple’s tool tracks blood pressure changes using pulse arrival times, which measure how long it takes for blood to reach the wrist after a heart beat.
  • Limitations – This approach would show users how their blood pressure is trending (picture your wrist vibrating to tell you that your blood pressure is spiking during an argument), but would not provide a baseline measure of systolic and diastolic blood pressure.
  • Competition – Samsung is taking a different approach with the Galaxy Watch, which is already equipped with an optical sensor that can detect changes in blood pressure but requires a traditional cuff to calibrate and lacks FDA approval.
  • Launch Date – Although the Apple Watch Series 7 is set to debut later this month, blood pressure tracking isn’t expected before 2022, due in part to the engineering challenge of making the feature compact enough to fit in an already-crowded watch.

The Takeaway

Rumors of new Apple Watch features circulate every year before the product’s refresh, but the latest leaks provide more insight than most into Apple’s strategy for measuring blood pressure.

Pulse arrival time tracking highlights the Apple Watch’s potential and limitations in healthcare, but with hypertension afflicting ~100m Americans, the feature has the chance to make a significant impact in the lives of patients.

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