wearable tech
Did you close your rings today?
by Greg Shulas

First perceived as mere hype, the ‘wearable revolution’ is now being embraced by consumers and health care professionals alike across all demographics. Close to 20% of individuals aged 65 years or older have used wearables to track their physical fitness or monitor vital signs, an Accenture survey found. Amid this trend, home health care providers are becoming increasingly mindful of the role wearables can play in generating more effective patient outcomes—and helping patients remain independent at home longer. Juniper Research forecasts that $20 billion will be spent on wearable devices in the health care sector by 2023, with the home health care sector comprising a healthy segment of that market.

Putting ‘Wearables’ to Use in Home Health

Technically, wearables date back to the birth of the watch in the 1500s. Today, they are defined as electronic devices that can be immersed into an individual’s lifestyle. The technology—which has evolved as part of the internet of things (IoT) movement—can either be implanted in the user’s body or attached to clothing as an accessory. And while in homecare wearables are often thought of as traditional medical alert pendants, they have broadened to include fitness trackers and digital watches—many of which have safety and other apps for seniors built in—as well as advanced solutions equipped to connect to health care providers’ records and monitoring systems. They can assist older adults in the home and as they go about their daily lives by tracking vital signs, noticing when a fall happens and collecting other health data. Home health providers view wearables as not just a way to monitor a patient’s progress at home, but as a means to diagnose conditions in an efficient digital manner. “I am very positive around the use of wearable sensors within the context of digital therapeutics,” said Roeen Roashan, a senior analyst in the Healthcare Technology research team at IHS Markit. “It shows a meaningful use-case of wearables, which has been long overdue.” Without question, digital therapeutics (DTx) are a prime example of the potential that wearables have in terms of advancing health care delivery. DTx applications use flexible software solutions to deliver evidence-based interventions that improve health care outcomes at significantly lower costs due to scalability and personalization potential, Roashan said. “DTx applications work independently, with hardware or alongside pharmaceutical drugs. This is where wearables come in. For instance, [providers can use] wearable motion sensors to perform gait analysis and assess whether a mental health patient has taken his or her anti-depressive medication. Another example is using invasive continuous glucose sensors to monitor a diabetes patient and optimize medication,” Roashan said. Along with supporting diagnostic efforts, wearables are being integrated into prevention programs, especially in cases when care is funded by commercial health plans, said James Moar, senior analyst at Juniper Research. Still, it remains early days for such usage of wearables, as providers remain cautious about when to use them. “The areas where wearables have moved fastest are areas that do not require specific medical certification or integration and (are) therefore best suited to treating chronic conditions and/or relaying alerts to others,” Moar noted.

Growth Will Continue

Whether for diagnosing or incentivizing healthy behavior, wearables are expected to become ubiquitous in society, just as smartphones have. In a 2017 report, the tech research firm International Data Corporation anticipated that the wearables market will boast a “growth rate of more than 20% and is estimated to reach over 213 million units shipped worldwide by 2020,” as reported by TechDecisions. Further, Accenture found that 17% of individuals older than the age of 65 are using wearables, compared to 20% of those under 65—a finding that dispels the idea that this technology is mainly for millennials or Generation Z. “Devices are getting smaller and more powerful, software methodologies are maturing, and the population’s adoption of technology is ever increasing,” according to a report by De Montfort University. “It is now common to see people carry around several devices at once, all of which are more powerful than their predecessors of 20 years ago.” Overall, the strong growth rate in wearables will be tied to treating and monitoring lifestyle conditions such as diabetes and cardiovascular disease—a trend that will represent a growing opportunity for home health care clinicians, according to Moar. “As digital lifestyle treatments become more prevalent, wearables will gain more traction in measuring, monitoring and gamifying that treatment. The majority of these will be driven by the increasing need to lessen lifestyles that lead to developing and/or worsening chronic conditions,” Moar said.

Challenges Wearables Face

But while there’s consensus on the value of wearables, there are certain hurdles preventing the digital movement from making greater progress. In many cases, clinicians face system integration issues, as there are patient data feeds from digital devices that cannot be translated into medical language. Moreover, there is little medical guidance on best practices for using wearables, creating legal and compliance-related uncertainty that corporate home offices dread. As a case in point, 10,000 steps a day is a well-known way to gauge the effective use of pedometers, but it is highly debatable whether that is the right goal for each unique patient, especially given the different circumstances confronting each individual. The ambiguity on medical guidance “is even more true for homecare, where users are less likely to be medically trained and therefore reliant on the algorithms’ interpretations,” Moar said. “Until a true medical understanding of wearables’ longitudinal metrics can be reached, wearables’ use in the medical space will be limited to particular conditions.” Further, a challenge facing home health care providers in implementing wearables is having a proper metric program to benchmark a device’s effectiveness for an individual patient. Such issues can be operationally daunting given the challenges facing patients and the complexity of scaling such services in a cost-effective way, said Roashan. “The limits of a wearable device are obvious when… used to change behaviors,” Roashan said. “But overall, digital therapeutics remain a promising way in which variations of this technology can improve health care outcomes for patients.”