Do you fasten your Fitbit, smartwatch or other wearable device onto your wrist every morning and diligently track the number of steps taken or miles biked throughout the day? Perhaps you use an app on your smartphone to analyze your sleep patterns or as a reminder to take a vitamin or a medication. If you’re not using technology to track these activities, chances are you know someone who is.
According to eMarketer’s latest projection, over 50 million Americans are wearing some type of device that captures health information at least once a month. That represents almost one out of every five people in the U.S.¹ Sales of wearable technology are expected to reach $150 billion by 2027².
The growing adoption of wearable technology and the increased presence of digital health apps on smart devices holds great promise for personalizing care. This direct, individualized feedback can be an important step for the healthcare industry, which continues to pursue patient-reported data to help prevent and cure disease. But the growing use of technology in healthcare also poses several questions.
New tech from Apple moves the ball forward
Apple is upping the ante in how wearables might be used in the future. In early September, they unveiled the Apple Watch Series 4 that includes an FDA approved ECG monitor among other capabilities. The ECG feature, along with an atrial fibrillation algorithm, is able to screen the wearer’s heart rhythm and send a notification if it detects an irregular rhythm that appears to be atrial fibrillation. Apple says it won’t catch every instance of a-fib, but will report enough of them to inform people who were unaware they had an issue.
How can we be sure it works? A recent article describes how an Apple Watch detected a heart rhythm problem for a senior editor at ZDNet and instructed him to contact a heart study doctor. Further use of an ePatch showed he was experiencing atrial fibrillation 28 percent of the time. He underwent a series of tests that showed a mild enlargement of his left atrium that eventually led to a surgical procedure and is on the road to recovery. But his doctor told him if the watch hadn’t detected the arrhythmia, his chance of stroke would have increased as his condition worsened³.
In addition to the a-fib capabilities, the Series 4 also alerts wearers to abnormally low and high heart rates. Wearers can also press the digital crown of the device to run an electrocardiogram (ECG) that can be shared with a healthcare provider.
The Apple ECG also includes a “fall detection” feature that works by analyzing arm motions, wrist trajectory and impact acceleration to determine when a fall occurs. It then issues an alert to the wearer’s emergency contacts. This feature holds a lot of potential – falls are often the start of a downward health spiral for the elderly and a leading cause of accidental death in those 75 or older. It is estimated that one third to a half of people aged 65 and over experience falls on a yearly basis and half of these fall repeatedly. The data created from the Apple watch could be an important step forward in detecting falls4.
Challenging the status quo with technology
The growth of wearables and digital health technology seems to be a natural extension of wellness programs managed by employers’ health plans and insurers. Today’s wellness programs offer a continuum of care, including preventive services such as immunizations and screenings, treatment of acute medical problems and, in some cases, chronic care, travel medicine, and physical therapy services.
Health plans typically partner with employers to help administer these programs with the goal of improved employee productivity and retention, better employee health and morale, and lower health-related costs. These programs can be made even more effective with the feedback that wearables provide.
John Hancock is taking the use of wearables data a step further by incorporating their use into life insurance models. In mid-September, the company announced that all of its life insurance policies will now come with a behavior change platform called Vitality that leverages wearable technology. The new feature rewards customers for the daily activities that contribute to healthier lives.
The company says the move shifts their emphasis from providing financial protection to survivors after death, to helping improve the quality of life for policy holders while they are alive. A component of the new policy includes requiring policyholders to share the data from their wearable devices in exchange for insurance discounts. The company can use the data to adjust premiums based on actual behaviors rather than using population-based actuarial data based on historical averages.
Patient-generated data leads to personalized medicine
The increased use of and reliance on wearable devices and digital health apps is another important step on the road to personalized medicine. Rather than relying on generalized statistics, health plans and providers can now obtain specific, detailed data on individuals to help establish more customized care plans and optimize treatments when needed.
An individual’s willingness to share his or her information from wearables also helps meet another important component of value-based care – the absorption of more responsibility for healthcare by the individual. As more people engage in their own care, the chances increase that they will be more focused on altering their behavior towards a healthier lifestyle. This helps accomplish the goal of preventing disease before it occurs rather than treating it afterwards.
The continued adoption of wearables can also have a “peer pressure” effect and encourage people who may not initially be inclined to embrace the technology to get on board. Wider adoption of wearable technology can encourage a more active, healthy lifestyle – an important step for improving overall health.
Questions and challenges
The adoption and use of wearable technology poses a number of questions. If only one in five people are using them, what about the other four who aren’t? How do we continue to motivate more people towards a healthier lifestyle? At what point do wearable mandates make sense? Who owns patient generated data and how do we keep it safe?
Wearable devices and digital health apps present a huge opportunity to advance personalized medicine. Developers and users of these technologies should approach the questions above thoughtfully and work together to discuss options and solutions. But these concerns should not stand in the way of the continued development and use of these technologies. At the end of the day, the more we know about our own health, our risk of disease, even our own biology – the better we can take care of ourselves and live healthier lives. Data is crucial to this equation – whether in the form of wearables, genetic, personal health history or other. Our understanding is growing by leaps and bounds daily, and let’s face it – knowledge is power.
 Wearables Still Far from Mass Adoption, by eMarketer Editors, eMarketer, December 21, 2017.
 Wearable Tech is Here to Stay with a Robust Presence in the Future Healthcare Industry, by Stefanie Crucius, Wearable Technologies website
 How Apple Watch saved my life, by Jason Perlow, ZDNet, September 10, 2018.
 Fall Detection and Prevention for the Elderly: A Review of Trends and Challenges, by Nashwa El-Bendary, Qing Tan, Frederique C. Pivot, and Anthony Lam, International Journal on Smart Senssing and Intelligent Systems, June, 2013.