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

Discussion

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.

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.

Apple Takes a Step Back From Healthcare

According to a new report from Business Insider, Apple is scaling back its internal HealthHabit app that let employees track their fitness, talk to clinicians, and manage hypertension. 

HealthHabit was one of Apple’s largest projects resulting from a partnership with AC Wellness, a primary care provider for employers and families. Unnamed sources at Apple stated that HealthHabit was intended for a consumer launch if successful internally, which… it apparently wasn’t.

Although the project was the focus of more than 50 employees, it struggled with user engagement, a problem all too familiar to those working on digital health products.

  • The Strategy – Apple’s healthcare ambitions are apparent in its products, with the company incorporating a medical-grade EKG in the Apple Watch and data-sharing for clinical trials through the iPhone Health app. HealthHabit’s roadmap likely resembled that of Amazon Care, which began as an employee-only primary care app before expanding nationwide earlier this year.
  • The Trend – Apple’s news follows just days after Alphabet reported that it was dismantling Google Health and reorganizing its healthcare projects to be closer to their team-specific specialties (e.g. Health-AI moves within AI group). Sometimes taking a step back is the best way to move forward, and Apple’s recent moves are far from the end of its healthcare strategy. 

The healthcare history books are filled with would-be disruptors who seemed to have everything they needed (excellent teams, funding, strong industry connections), but few if any have had the bottomless warchest of capital and talent commanded by Apple.

While the moat around healthcare is incredibly wide (entrenched tech/vendors, complex datasets, demanding users), the same could be said about the smartphone market circa 2008.

Despite this step back, if any industry needs a disruptor, it’s healthcare – and if any consumer brand is going to pull it off, it’s Apple.

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-- The Digital Health Wire team