Why Physicians Should Care About Wearables

Hansa Bhargava, MD, and Keith L. Martin

December 20, 2019

We are at the point of the "digital revolution" in healthcare and it is growing at a fast pace. With all of these new innovations, one issue is clear: The physician needs to be in the know, so we can continue to guide this new era.

Having a doctor at the table for all these new types of disruptive technology will help healthcare, help us be a part of the conversation, and ultimately will ensure that the patient gets optimal care.

One such example is wearable devices, creating a new form of data generated by the patient for interpretation by physicians.

The wearable medical device marketplace is expected to reach $14.1 billion by 2022 (from $6 billion in 2017). This growth is attributed to factors including new technology, greater use of smartphones, and growing preference for wireless connectivity among healthcare providers and patients. In a recent survey administered by Accenture in over 2000 patients, 75% stated that technology and digital health was somewhat or very important to them.

Interestingly, the traditional hurdles that exist between consumer rollout and applicable uses in a clinical setting may be changing. As a medical "device," wearables have been subject to Food and Drug Administration (FDA) approval if it seeks to help with treatment or diagnosis.

But now, there is a pilot program being tested by the FDA that may allow "skipping" of the line and process. This FDA precertification process would allow certain "trusted" companies to go through a fast track of getting devices approved. And this means more patients will be using these devices and bringing them to you in the near future.

And reimbursement for us as physicians and healthcare providers may be changing as well. Current Procedural Terminology (CPT) codes to begin in 2020 include billing for evaluation and management for digital information via a secured platform. This could include information from some wearables, as well as apps and texting platforms.

There are several disease states where wearables are assisting physicians diagnose and treat patients.

Preventing Asthma Attacks Before They Start

One of the biggest challenges for patients with asthma is knowing what symptoms could lead to an attack. Often, the start of an attack is the first indicator.

However, new wearables (none yet approved by the FDA) introduced in the last few years — such as self-adhesive patches — track biometrics (including heart and respiratory rates) to detect abnormalities and provide medication reminders. The devices also perform other functions, such as suggesting a patient stop exercising or head indoors to help prevent an attack before it occurs. Additional devices are still in the test phases at several US universities

Currently, the most promising technologies for those with asthma lie in smart inhalers and apps that patients can download to their smartphones. Many of the new inhalers utilize Bluetooth technology to detect when the device has been used, provide reminders, gather data, and provide notifications for users via phone.

While this segment of the market grows, some see further applications for tracking airborne threats to health and possibly diagnosing respiratory disease states.

Tech for Fertility and Pregnancy

There are numerous fertility/pregnancy/women's health apps on the market and the wearable options are also increasing. Multiple firms have unveiled  a host of devices, including sensor-packed bracelets to detect high fertility days; hands-free breast pumps that connect to a smartphone to track milk volume, pumping time, and set schedules; pelvic floor exercisers integrated into undergarments; and smart bras that tracks exercise data via smartphone.

As physicians, we can expect more questions about this in the near future from our patients, especially as millennials look to egg freezing more and more.

For pregnant women, devices ranging from wearable contraction monitors to noninvasive baby heartbeat recorders are also available. There is interest in freezing eggs as well, and there have been some startups in Silicon Valley to enter this area, tying wearables that track fertility into a tool for determining if and when women should freeze their eggs. As physicians, we can expect more questions about this in the near future from our patients, especially as millennials look to egg freezing more and more.

Keeping Tabs on Infant Care

Once a baby has returned home from the hospital, there are numerous wearables that can track, record, and report vitals for parents. From smart buttons worn on clothing and smart socks to monitor breathing and stomach sleeping, to onesies equipped with biometric-tracking technology, new parents are finding some peace of mind vs constantly hovering over a crib.

Although the data is sometimes lacking, and the devices at times are less than fully accurate, parents are relying on them much more. This can sometimes result in a dependence on these devices. Being aware of these devices can help us as doctors engage in meaningful conversation and guidance for our patients.

Pacifier-based thermometers, wristbands to monitor heart rates, and other devices are abundant. But the FDA warns against any device claiming to prevent or reduce the risk of sudden infant death syndrome (SIDS). The agency notes that, to date, it has not cleared or approved any product, despite the claim of some vendors.

Preventing Skin Cancer

With more attention on overexposure from the sun in recent years, the wearable marketplace has unveiled a number of smart ultraviolet (UV) monitors. From wearable patches that interact with a smartphone to devices less than 2 millimeters thick, individuals can monitor their UV exposure and take appropriate steps. There are also bracelets for adults and children that work without smartphones, but rather use LED lights to alert users that they have reached their limit of safe UV exposure.

Although these devices seem like the "magic" solution, we must continue to guide our patients to protect themselves from sunlight with protective gear and with sunscreen as guidelines recommend.

Although these devices seem like the "magic" solution, we must continue to guide our patients to protect themselves from sunlight with protective gear and with sunscreen as guidelines recommend.

Early Detection of Breast Cancer

Breast cancer remains a top concern for women, and rates have increased over the years. With mammograms happening only once a year or less, detection methods seem archaic to many.

In the last few years, wearables aimed at detecting breast cancer have been introduced to the marketplace. The most popular form is a "smart bra" or patch attached to the breast that communicates with a mobile device. The manufacturers say that the patch is able to monitor circadian metabolic changes in heat that correlate to the onset of cancer.

To date, there has been no scientific evidence to back up these claims and the "smart bra" is not FDA approved. Developers of the technology say the devices represent one way to help early detection, whether or not patients accurately follow mammogram recommendations by their physician.

There have also been clinical trials, including one at Cedars-Sinai Medical Center in Los Angeles, where patients with cancer have received wearable technology like a Fitbit to track patients' quality of life and whether they are healthy enough for chemotherapy. Researchers found that activity monitoring in patients with cancer is "feasible" and may be used to predict clinical outcomes, but further study is required.

Detecting, Monitoring Alzheimer's Disease and Dementia

Wearables are making inroads in assisting with patients who have Alzheimer's disease or other forms of dementia.

Shoe insoles and smartwatches containing GPS tracking devices can help to provide location to caregivers. There are also fitness bands to detect sleep patterns that could be a precursor to memory loss, and possibly nighttime wandering by patients. To date, there is no research on the use of wearables related to sleep patterns or to predict early detection of the disease.

A pilot study at Newcastle University in the United Kingdom is also exploring how low-cost wearables to assess gait can potentially detect Alzheimer's disease early and monitor its progression.

Wearables Are No "Fad"

While some physicians may see wearables as a fad, the fact is they are here to stay.

Google's $2.1 billion acquisition of Fitbit wasn't just a move to keep up with the Apple Watch, it was to get access to the growing information created by patient-generated data. Clearly, for Google, more data means more ways to market to wearable-enabled consumers, but it is also an investment in more than a fad.

Healthcare data generated by wearables means not only that consumers are taking a more active role in their wellness, but it could also mean more visits to doctors and other healthcare professionals to interpret that data — for better or worse.

So, fellow physicians, we would be wise to grasp this "digital revolution" now and be at the forefront. Not for our own self-interest, but to better guide our patients to healthy care decisions.  

Editor's note: Medscape does not endorse any of the products mentioned below and neither author has a conflict of interest to report.

Hansa Bhargava, MD, is a medical editor at WebMD, a member of the Advisory Board of Medscape Pediatrics, and board certified in pediatrics.

Keith L. Martin is the editorial director of Medscape Business of Medicine.

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