Contributed Commentary by George Lewis

March 5, 2015 | The U.S. spends more on healthcare than most other industrialized countries yet consistently ranks well below them in health outcomes. Nearly 85% of our health care dollars are spent on caring for chronic diseases, the most common, costly, and preventable of all health problems. These include diabetes, heart disease, and chronic pain from various causes; all of which require investments in monitoring, compliance, and behavioral change.  Could wearable technologies uniquely designed to help manage chronic disease provide a solution?

The role of technology in improving health outcomes 

Current wearables center primarily on fitness technology and data collection, a niche market that’s contracting. Even as adoption rates are increasing for niche audiences, consumers are abandoning their devices at “alarming rates.”(Endeavor Partners, July 2014). According to Yahoo finance, the market share will contract from 35% today, to 20% in 2019. Yet wearables have a unique value proposition for manufacturers, patients, and society as a whole in healthcare. In the future, wearables should not only collect data, but transmit that information to the patient and clinician in real-time to glean insights and provide actionable next steps, and ultimately treat certain conditions. 

Chronic disease and pain management require consistent day-to-day actions, rather than visits to the doctor to shape outcomes. It’s analogous to dentistry: having your teeth cleaned twice a year will probably keep them from falling out, but daily brushing and flossing is what’s really needed to maintain healthy teeth and gums. For patients with chronic diseases, wearables should remind, warn, encourage, and perhaps most importantly, supply the patient with innovative strategies to comply with treatment regimens (and in some cases, provide that treatment).

Lack of compliance isn’t just the patient’s fault, at least not initially. Some of the most egregious problems in healthcare happen even before the patient leaves the doctor’s office, clinic, or hospital. For example, fewer than 7% of people diagnosed with diabetes in 2011 and 2012 were given adequate self-management training, according to the CDC, despite the fact that self-management is key to a successful outcome.  

Technology can play a vital and personalized role in managing treatment, not only helping patients comply with instructions, but also making monitoring easier in a variety of ways.

Recently, professors at the University of Michigan and the NSF’s Innovation Corps collaborated to create a miniaturized, wearable sensor that detects airborne chemicals either exhaled or released through the skin. The sensor uses an innovative nanoeletronic graphene platform that’s fast and accurate, capable of detecting specific molecules in a ten parts per billion range.

The sensor is currently capable of monitoring multiple biomarkers, including those associated with diabetes, hypertension, and certain lung conditions. Using diabetes as an example, the sensor could detect even trace ketones, chemicals signaling low insulin, alerting the patient to take insulin. Theoretically, sensors could eliminate the need for invasive blood testing altogether.  

Potential benefits for technology in healthcare  

In addition to facilitating compliance and accurate monitoring, wearables could provide greater access to care for patients in remote and rural areas and reduce clinic and hospital visits.  Device monitoring would provide physicians with objective and consistent feedback, facilitating personalized treatment. Post-marketing studies to assess efficacy on a larger scale may spur refinements or new technologies.

Challenges for technology in health care 

Technological and miniaturization challenges can pose a barrier for the faint-of-heart.  Privacy and security concerns for wearables using electronic transmission of sensitive data must be parsed and overcome. HIPAA complexities must be embraced. For approval and reimbursement, accuracy of the device’s data collection must be validated–all very time consuming, frustrating, but essential tasks.

Treatment recommendation algorithms, such as modifying medication based on a multi-month record of data, must be developed in consultation and in collaboration with physicians and professional associations. Algorithms converting patient data in a simple summary form for physician records, accessible at a touch during a brief patient visit, will require technical expertise and collaboration with clinicians.

Medical device manufacture teams, once composed of representatives from research, engineering, quality, marketing, regulatory and manufacturing must be expanded even more to include a cross-functional team drawing from multiple disciplines.  Experts in data security, privacy, algorithm development, behavioral economics, behavioral psychology, content creation, visual messaging, and reimbursement will be required for execution. Technological integration, and integration into provider’s workflow are complex challenges entrepreneurs must address.

Patients will likely gain trust in wearables when they are recommended by their physicians, paid for by insurers, incentivized by employers with lower health insurance costs, and when manufacturers can assure efficacy, accuracy, privacy and security. Consumers want wearables that are attractive, unobtrusive and operate with an intuitive, human-centered design, tailored to their individual needs. 

But perhaps the greatest challenge of all is transforming the insights gleaned from data to ensure patient compliance.

Wearables can change health outcomes, in near equal parts due to technology advances, and compliance-boosting, something existing medicine has yet to successfully master. Industry, providers and payers need to work together, incorporating know-how, research, and creativity to determine which narratives, nudges and rewards will engage patients and get results. There’s compelling evidence demonstrating strategies adapted from economics (investment, loss and regret aversion), and the power of social norms can successfully generate voluntary compliance. 

For example, two Yale economics professors studied whether dieters would respond to economic forces as a motivational tool. An astonishing 80% of participants successfully lost weight, a rate that far exceeds any known diet plan.

It’s a wide open market, simple and complicated.  

If the technological challenges seem daunting, don’t despair.  Not all conditions require telemedicine or external feedback.  Some of the most effective wearables are those that operate with a single monitoring point and feedback mechanism. The Lumo monitors postural variation from a pre-established baseline, and vibrates when the user slumps, providing rudimentary yet immediate feedback, reminding the user to straighten up. Others act as a closed system treatment system. sam harnesses the power of long duration, low-impedence ultrasound to relieve pain and promote healing in a device the size of an iPod that can be worn anywhere.  The user feedback is the reduction or absence of pain, and that is the incentive to use the device. These are simple yet elegant solutions to problems that plague mankind.

Some wearables will be eagerly sought by self-motivated consumers, others will require adoption efforts by clinicians and manufacturers. But simple or complex, there’s room for everyone in this market, and a chance to transform a waning, to a winning, design.

George Lewis, PhD is the Chief Scientific Officer, Inventor, and co-Founder of ZetrOZ, and sam.