The growing role of wearables in healthcare

In recent years, wearables have started to play a pivotal role in the lives of patients. From the management of chronic conditions to making sure that we drink enough water, wearable and mobile devices are revolutionising the way that healthcare occurs.

Wearables can improve the lives of patients and caregivers and, crucially, in the context of the current pandemic, reduce the burden on healthcare systems at a time when they are most stretched.

From smart textiles to electronic tattoos, the increased use of wearables in healthcare has been driven partly by remarkable developments in technology. These range from leading-edge advances, like augmented reality and body-powered devices to traditional products like watches or GPS devices, adapted and repurposed to provide new capabilities.

But the change has also been underpinned by the fact that people are increasingly willing to share their health data, and take an active role when it comes to staying healthy. Tools like GPS tracking, and activity and heart rate/oxygen saturation level monitoring increase people’s ability to self-manage conditions, and can support disease prevention. Such tools can also be used for remote diagnosis and collect data in a way that was hitherto not possible.

In this article, we will look at the current and new wearable technologies that are emerging in the context of COVID-19, and what they might mean for the future of healthcare and the prevention and management of chronic conditions. Lastly, we will tackle one of the biggest challenges ahead – how to test and validate the use of wearable devices successfully in the context of clinical healthcare settings.

Wearables and digital healthcare in the context of COVID-19

Earlier this year, a piece of research conducted by the International Data Corporation in light of the new coronavirus predicted a 30% increase in sales of health wearables in 2020, due to consumers’ increased interest in their own health. At the same time, opportunities for new product development are opening up with a range of technologies that lend themselves to varying forms of infection control.

One example is Immutouch – a smart band that vibrates when users touch their face, potentially preventing them from catching diseases. After downloading the Immutouch app, the band can be calibrated by bringing the hand closer to the face, which will cause the device to vibrate, thanks to a gravimeter placed inside that uses a personalised algorithm.

This type of solution may be helpful for those working in a front-line role. It can also provide potential benefit to those working in customer-facing industries like retail, manufacturing and public transport.

Another example is VivaLNK’s Continuous Temperature Sensor patch, designed for remote, 24-hour monitoring of axillary body temperature. This type of solution has a broad purpose – it could provide a monitoring tool for those who are undergoing immunosuppressive treatments and could also support the conduct of clinical trials. The product range employs an eSkinTM Technology which is a breathable film substrate with integrated sensors and circuits. This illustrates one of the big advances in this field – the shrinking of sensing technology means that it can be worn for increasing amounts of time, enabling new applications.

Digital tools can also help when the goal is to provide public health information or to respond to requests for information. For instance, the Japanese chatbot Bebot supports crisis workers by giving members of the public instant information about COVID-19. The chatbot doesn’t require an app and pops up offering clear information in multiple languages to people visiting Japan, as soon as they connect to a public Wi-Fi.

Both within and beyond the current crisis, wearable technologies have the potential to profoundly impact our lives and support decision-making. In a way, it is about relaying information back to the user as well as recording information from them.

For example, Mojo provides smart contact lenses with built-in displays. Created by optometrists, medical experts, and technologists, Mojo lenses can help users access important notes without the distraction of a mobile device.

The lenses also display health-related information, such as heart rate, and navigation and sight-enhancement features. Within the current crisis, the benefit of this type of technology is that it can support communication without the need to touch an interface or mobile device.

Wearables in the context of chronic conditions

Whilst our immediate focus may be on COVID-19, there is a bigger picture in terms of managing and reducing the occurrence of long-term and chronic conditions. This type of condition accounts for the majority of healthcare spend and can be a significant risk factor in COVID-19-related hospitalisation.

Wearable technologies can prevent, reduce or delay the exacerbation of chronic conditions through real-time monitoring. The use of wearable devices means that symptoms can be picked up earlier, and that patients can monitor their own health and capture data to aid physicians in their treatment and prevention plans.

Good examples are wearable technologies that monitor someone’s activity, with monitors and smart watches becoming increasingly popular.

Being active plays a major role in the reduction of risk for many chronic conditions, and the use of wearable devices have been shown to reduce sedentary behaviour and improve overall wellness. In both the UK and the US, schemes have been rolled out that provide incentives to encourage patients to hit their daily step count and activity levels; factors which contribute significantly to chronic disease prevention such as obesity and diabetes. Such incentives can be in the form of vouchers or discounts, or funding towards health insurance. This incentive model can encourage people to remain active and reduce the risk of those susceptible to certain chronic conditions.

Monitoring through wearables also facilitates shared decision-making between patients and healthcare professionals, and is a valuable tool to promote adherence and compliance.

Enabling patients to monitor and potentially improve a chronic condition through tools such as wearables gives them a greater sense of control and empowerment.

Continuous glucose monitors are a perfect example of how a wearable can reduce the burden and increase the level of monitoring. With the device constantly tracking glucose levels throughout the day and night, an app can notify the patient of highs and lows. Patients are therefore provided with a clear image of their blood sugar levels without them needing to carry out regular finger-prick testing.

As the device allows continuous monitoring throughout the night, they are provided with a higher volume of data and therefore more consistent monitoring of their blood sugars in a way that would not have been previously possible.

Benefits are not limited to glucose monitoring – for some conditions such as Alzheimer’s and Dementia, simple wearables with real-time mapping, voice systems and the ability to activate an emergency call can greatly increase a patient’s independence and reduce the burden on their caregiver.

By being able to track a patient during their walk and communicate with them if necessary, their risks are reduced and the patient is provided with freedom for an extended period of time (i.e. they can be alone if they want to).

Some chronic conditions may be less obvious – for example, those that are at risk of heart disease can benefit from something as simple as a step counter.

As technology moves on, there is potential to integrate multiple sensors and leverage existing platforms, such as phones to develop a rich picture of, for example, the link between cardiac health and lifestyle. With this understanding, appropriate interventions can be targeted accordingly.

It is becoming increasingly clear that there is a lot of potential in wearables in terms of pre-empting and proactively managing chronic conditions, as well as managing and mitigating the impact of COVID-19.

In a healthcare setting, there are additional advantages to the use of wearable technologies, including:

• Supporting condition management – i.e. wearable devices can contain sensors that allow for tailoring of support and treatment.
• Supporting the move to a pre-emptive model of healthcare – for example, by helping people to look after themselves and avoiding more significant interventions such as surgery. Wearables can also form part of a behaviour change approach that promotes a healthy lifestyle.
• Improving outcomes, by collecting data in a way that was not previously possible (e.g. home use body-worn ECG monitors).
• Engaging communities. One of the great things about wearables is that they allow for “maker” communities – working in hackspaces, with open source tools that share ideas in an interdisciplinary setting – to come together and approach a challenge from a fresh perspective.

Yet, with those advantages come some challenges, particularly when testing those devices in the context of traditional R&D models. In the last section of this article, we consider how such potential can be measured and demonstrated.

Testing wearables – what works best?

By definition, wearables are part of a broader system which means that collecting feedback is inherently contextual and distributed. What’s more, wearables typically involve attaching objects to people, a process that always requires careful consideration. For example, trials of systems that use an adhesive to attach wearable devices to the body reported instances of transient skin irritation in 2.7% of people. There is a large body of literature around MARSI (Medical Adhesive-Related Skin Injury) and a need to carefully consider the impact of extended wear periods.

Given the complexity of designing wearable systems, here are some suggestions as to how to get the best value out of them:

We need to adopt an interdisciplinary approach

Wearables combine different forms of technology. Take, for example, a body-worn sensor. In bringing a solution to market there would be considerations around the shape, size, method of attachment, etc. There would also be considerations around the internal components, the suitability of the sensing technology and a range of options around batteries and connectivity. The approach to testing will therefore need to take all of these factors into account and borrow learnings from other industries (sporting, military, etc.) – we need to think broadly.

We need to test in context

It goes without saying that when testing this technology, we need to take into account the complexities of everyday life, such as how technology is carried around and how it impacts on work life, social interactions, etc. This is hard to do in a simulated context, or in a market research facility because we don’t capture the full range of factors associated with real-world use. In these cases, a different type of approach is required where we use ethnography or contextual inquiry; or where, instead of a moderated study, data is collected through diaries or notes.

We need to collect feedback over extended periods of time

Something we want to avoid with wearable technology is people taking the device off. If that happens, the benefit of the technology has been lost. Although there are many ways of testing healthcare-related technologies, not that many of them consider extended periods of time, nor adopt a longitudinal approach or time-series data. This is particularly important as it is not uncommon for there to be an initial period of engagement to be followed by a fall-off in the use of a given technology. Therefore if the test window is short, we may miss important things. The longer a candidate technology is used, the more likely we are to find out what may impact on the acceptance of it. This requires the use of a new type of extended trial design.

We need to consider data analytics during the design and development process

Wearables often collect data. How this data is used is an important part of the process and there is benefit in terms of being clear about this at the outset.
There is a balance between too much and too little data, e.g. it can be helpful to know what you want to get out of a sensing technology and avoid throwing everything at a given problem.

We need to work within an underpinning framework

In the same way, there will be a need to fine tune some of the algorithms that will form the basis of the technology, there may also be a need to understand why a device does or does not provide the desired effect. Although this may be debatable – some might say that if something works, then who cares why – with wearable technologies, we need to adopt a theory-driven approach.

Whereas previously our interest would have been on whether someone can use a device – now we are also interested in aspects around continued use, co-evolution and effective adaption of intervention content to changes in technology.

PDD is exploring wirelessly-connected drug delivery systems alongside the use of digital apps and sensors to improve patient experience and condition management. We are also developing algorithms that can determine if people are compliant with this type of technology. For example, sensors that can be worn on the patient’s body detecting movements continuously on a 24/7 basis.

Although there are many off-the-shelf solutions which fulfil the need from a technical perspective, customised solutions can offer many benefits especially in light of comfort, compliance and long-term wear. We can therefore use sensors not only to determine aspects around lifestyle but also to understand the suitability of alternative solutions and the extent to which users are prepared to keep them attached for extended periods of time.

In recent months at PDD, we have developed our own innovations in terms of attachment, including adhesives and materials research to find a solution that can be as unobtrusive as possible. Our work included the research of current designs and off-the-shelf options, concept development, refinement and visualisation, early-stage modelling and two stages of user testing. The solution adds value in allowing for long term use and wear, improved compliance and rich data whilst being minimally apparent to the user.

With wearables becoming more popular within healthcare we need to remember that they will be used by a wide range of users from those who are digitally literate to those who are technology averse. Therefore, it is important to consider and research the varying user needs to ensure that what is developed fits a variety of user profiles.

At the same time, we need to consider aspects relating to data protection and privacy. Given the amount of data that is available through the use of wearables and the complexities relating to data storage, consent and management – there is a need to adopt a carefully designed process to research and development.

The road ahead might be complex, however, the opportunity for wearables to have a positive impact in our healthcare ecosystem in the long term is well worth the investment.