Suppose that every time you ate a bacon double cheeseburger, a sensor attached to your wrist would ping and announce on a tiny screen, via sad-face heart emojis, how much damage the meal was doing to your arteries. Imagine if every vape hit or glass of wine was logged in your electronic health record and sent to your doctor.
Those are exaggerated examples of the sort of health monitoring currently possible with wearable biosensors, sometimes called smart health technologies or ehealth or mobile health devices. But experts in biotechnology already predict that smart health technology will someday influence preventive care and lifestyle choices, such as what we eat and drink and how much we exercise. In fact, they say it’s likely within 10 years.
Devices and apps that promise to streamline healthcare by helping patients self-monitor at home, thereby giving doctors’ reliable, real-time patient data, aren’t exactly new. Researchers have been studying wearables and remote health monitoring since the early 2000s. But over the last five or so years, they’ve ramped up efforts, testing products that measure electrical currents in the body via wireless sensors and analyze the chemical composition of sweat to detect dehydration or disease. Scientists are also developing artificial electronic skin (“eskin”), skin-like sensors for use in robotics and in home health monitoring.
Although smart health tech applications are in their infancy, many experts say they’ll have an enormous impact on how we “do” healthcare in the near future.
“We’re at critical mass now,” says John Rogers, a biomechanical engineer at Northwestern University. “We’re just beginning to see the cusps of these kind of devices trying to move things in that direction. Researchers are not just writing papers now, but establishing a base for technology’s applications in healthcare.”
The pros of smart health tech are obvious as well as numerous. No one likes battling traffic or taking time away from work and family to trek to routine doctors’ appointments. The smart health industry intersects with telemedicine, making it easier for patients who live in rural areas or have mobility challenges to stay connected with their healthcare providers. Some biotech researchers are exploring how smart health tech can help people recover from surgeries at home and shorten costly hospital stays. Home monitoring post-surgery also can reduce patients’ exposure to germs in hospitals, preventing infections that could hinder their recovery.
Smart-health management programs, such as those to manage high blood pressure, also combat the “white coat effect,” the idea that doctors’ appointments make some people nervous, jacking up their blood pressure to render abnormally high readings. Health data tracked by a device might also be more trustworthy than data sourced from patients themselves, as people tend to overreport good health behavior and underreport the bad.
What’s happening now
Home monitoring devices already help diabetics control their condition. The Tandem Diabetes system, for instance, consists of an insulin pump and a continuous glucose monitor, an FDA-approved device that tracks blood sugar levels all day (and night) long. The pump and CGM “talk” to each other via Bluetooth. Patients can share their data with doctors using software, which lets both patients and physicians review it on a computer.
“The data is slightly different for patients versus physicians in the way it’s laid out,” says Tandem Diabetes representative Steve Sabicer. “In general, patients want more everyday data, while physicians want to see trends and extreme events.”
“Diabetic Danica,” who asked that we not publish her last name or location, says she is a nurse in a diabetes clinic who has Type 1 diabetes herself. She has posted reviews of insulin pumps on YouTube.
“There’s only so much data you can get verbally over the phone,” she says, “so it’s great to have access to full reports — which include trends and averages — that allow us to see the full picture of what is going on with that patient’s diabetes management.”
Although most people would probably like to improve their health, they might not be open to digital finger-wagging every time they skip a workout.
People with hearing difficulties are also benefiting from smart health tech. Signia hearing aids use a virtual care management system called TeleCare that enables devices with Bluetooth. Doctors can program the devices remotely based on feedback from patients about how they’re hearing different sounds, such as rustling leaves. The data is stored with Microsoft Azure, cloud-based data storage used by the IRS and the FBI’s Criminal Justice Information Service. Patients can also schedule video chats with their doctors to follow up remotely.
Usually, patients wear new hearing aids for two weeks before seeing their audiologists for a follow-up, says Eric Branda, director of product management for Signia. “This is a blind spot for the healthcare provider, because if something isn’t going well with the fitting, they really don’t know until the follow-up,” Branda explains. “With access to daily ratings, healthcare providers can be better prepared for the follow-up or even intervene earlier to make adjustments or talk with the patient to keep the process more positive.”
Scientists are also exploring smart health tech as a means of improving medication adherence with “digital medicine.” Pills containing minerals that activate when swallowed and emit a signal to a smartphone can help people diagnosed with schizophrenia, hypertension and diabetes take their medication on schedule. Digital medicine is also being tested for use in cancer patients. A recent study found that digital medicine improved medication compliance by 80 percent.
What the future holds
The tech sector appears to be more than happy to lead healthcare into a high-tech future: The smart health market totaled $5 billion worldwide in 2016 and is expected to exceed $14 billion by 2022, according to an industry report. But the technology could be outpacing the science of smart health, potentially putting patients’ health at risk or, less drastically, just not doing anything to make them healthier — at least not yet.
“The catch-up is harder because the science behind the tech is more complicated,” says Matthew Martinez, a cardiologist and chair of the American College of Cardiology’s Sports and Exercise Cardiology Council in Lehigh Valley, Pennsylvania. “The next step is for doctors to determine the clinical utility and the accuracy of the advances. And it’s in the tech industry’s best interest to know that too.”
What’s more, a 2018 research review paper published in Nature concluded that for now, there’s no evidence that remote monitoring of patients actually improves health outcomes. One study included in the review involved 40 patients with chronic obstructive pulmonary disease. Most reported increased positive engagement with their self-management plans, but the program didn’t appear to improve their condition any more than standard care did. The authors also evaluated studies on remote monitoring of physical therapy for scoliosis and arthritis patients. They concluded that remote monitoring rehab programs were most effective when healthcare practitioners had clearly defined guidelines for how to use the data to make adjustments in patients’ therapy plans.
The authors also noted that many patients don’t seem interested in sharing health data with their doctors. Although most people would probably like to improve their health, they might not be open to digital finger-wagging every time they indulge in dessert or skip a workout.
Experts express concerns about privacy issues as well. “How do we prevent what we now consider smart health, and a great potential for the future, from becoming surveillance technology?” asked Jonas Moll, CEO of Rehfeld Medical and former medical informatics researcher, during a 2018 conference. “How do we [protect] our ability to gather information about our health from misuse by corporations or insurance companies?”
The most promising programs — ones that transmit useful health information to doctors with the fewest headaches for all involved — lean on humans to process and steer patient data.
The potential for data overload is another often-cited issue with smart health tech. Health information needs to be stored safely and evaluated by someone skilled enough to put it to good use for patients. Some experts warn that we’re not there yet, and that physicians could become overburdened by useless data.
“This is just the first step,” says Martinez, the cardiologist, who has been using the ECG app (a screening tool that can detect irregular heartbeat) on the Apple Watch he got for Christmas.
“An ECG tracing doesn’t just spit out ‘normal or abnormal,’” he says. “I can look at a tracing and determine if it’s a concern, but patients will likely want to turn it in to have someone review it to make sure.”
Martinez notes that Apple Watch users choose whether to share readings with their doctors, and that the data isn’t automatically transmitted. That’s a plus in terms of protecting patient privacy, but perhaps not in expediting care. A reading indicating heart palpitations, for example, might cause a wearer anxiety and send them needlessly running to the doctor to alleviate that anxiety.
“It’s clear people want convenience, but we need to figure out if this next step is of value or whether it could make things worse,” Martinez says. “When health tech is directed toward consumers and they get a reading that seems abnormal, and I have to generate three tests to determine that the Apple Watch was wrong, that’s not helpful.”
What might be helpful, he says, is a mediating team to deal with remote patient data, just as nurses and medical support staff do with patient emails and phone calls. The need for knowledgeable evaluators in smart health is perhaps ironic: The most promising programs — ones that transmit useful health information to doctors with the fewest headaches for all involved — lean on humans to process and steer patient data.
One such program helped 81 percent of participating patients (around 130 people) get their blood pressure to a normal level within two months. Launched in 2016 at Brigham and Women’s Hospital in Boston, BWH Remote Cardiovascular Health gives patients a blood pressure cuff with Bluetooth technology that transmits readings to their electronic health records. The readings are then evaluated by non-medically trained patient navigators who act as a bridge between patients and doctors, answering their questions and altering their medications as needed.
Patients typically see primary care providers for around 20 minutes, which might not be enough time to answer all their questions about their blood pressure treatment plan, says Michael Kraft, a health psychologist and senior navigator with BWH Remote Cardiovascular Health. Patients might go home with a prescription, Google the medication, panic about possible side effects and refuse to take it. And even though patients have been able to check their blood pressure at home with a wrist cuff for years, for example, home blood pressure devices often aren’t as helpful without the feedback patient navigators can provide. A patient might take a reading and think it seems high, but dismiss it as the result of stress or caffeine. They might not check their blood pressure again for a while, or wait to follow up with their doctors, letting their blood pressure climb to unhealthy levels. Patient navigators help keep them on track.
Conversations with navigators can also help patients open up when they’d otherwise stay tight-lipped around doctors.
“Patients are at first hesitant about the program, because they don’t know who we are or why we’re calling,” Kraft says. “But once they trust us, they love it. And if someone isn’t taking a medication, we can work together to figure out why.”
Although remote health monitoring is already practiced in several areas, experts believe it will become more commonplace. Devices will become more comfortable and less intrusive, giving doctors a continuous stream of data.
“In the future,” says Rogers, the biomechanical engineer, “we’ll be moving clinical monitoring equipment out into the field, so it’s part of a natural daily routine.”
Not only will researchers have more data regarding patient health in the future, they’ll also have new types of data to analyze. Science is moving beyond physiological assessments, such as measuring heart rate and blood pressure, and toward biochemical ones, such as less invasive sweat analysis. The chemicals in sweat have a number of “interesting” biomarkers that have been relatively unexplored until now, says Rogers.
Deep data analytics will evolve too, giving doctors new insights into human physiology. We could discover new signs of disease, Rogers says, and improve our ability to catch health problems before they develop. If major kinks like device accuracy, privacy concerns and data analysis are responsibly ironed out, smart health could revolutionize not just how we treat conditions but also how we keep people healthy.