by Nicholas Chapple
The added value of wearable devices
At the forefront of Apple’s pitch for its new watch is the device’s ability to monitor its wearer’s health and fitness. Two apps developed by Apple, Activity and Workout, collect data from an in-built heart rate monitor and accelerometer, allowing users to track how much they exercise throughout a day. However, most wearables on the market already measure these and other parameters relating to the wearer’s health. Consumers are no longer content with just this information; they want to know what it means and what actions to take to improve their well-being. This is where the Apple Watch stands out; it uses these data to send encouraging prompts, such as reminders to move around if users have been sitting down for too long. This can help consumers to improve their health by motivating them to change their behaviour positively.
HealthKit, a platform developed by Apple, serves as a bank for these patient-generated data. Apps available through HealthKit can track users’ health and allow doctors and patients to remotely monitor chronic diseases, such as diabetes and asthma. For example, the Apple Watch can be used by patients with diabetes to show blood glucose levels as a graph on the watch’s display. The glucose information is collected by a monitor placed under the skin that transmits the data to an iPhone app, which sends the graph images to the smartwatch. Another app aims to help people with asthma track their medical adherence and lung function. Data generated by an inhaler strap and mobile spirometer is synced with and collated by an iPhone app and relayed to the patient’s healthcare provider. GPS is also used to track weather, pollen count, air quality and other personal triggers to notify the patient when conditions that might initiate an asthma attack arise. Other available apps aim to improve users’ medication adherence; the user inputs their medication schedule and is reminded when it is time to take the medication.
The availability of these continuous aggregated data is a valuable addition to episodic data from hospital visits, providing physicians with a better sense of how patients are doing on a day-to-day basis. This could allow doctors to intervene before a medical problem becomes acute and may drastically reduce healthcare costs. The availability of these data could also allow treatment to be tailored to the patient’s DNA, geography, and bodily responses, pushing healthcare to become personalized. Health insurers would also have access to more information on customers’ health, potentially leading to a fall in premiums.
Apps for healthcare professionals, which aim to make patient data more accessible and daily routine care more convenient, have also been developed. These provide the ability to respond to calls and messages from team members, and to call up patient medical records.
ResearchKit, another platform developed by Apple, brings benefit to another sector of the healthcare industry, by allowing researchers to write iPhone apps for medical studies. These allow scientists to collect data using wearable devices. ResearchKit amplifies the potential size and scope of these studies, allowing researchers to enrol many participants quickly thereby generating big data.
What needs to change?
Wearable devices undoubtedly have the potential to offer great value to patients, physicians and researchers. However there are a number of barriers that stand in the way of their uptake, not least because the smartphone has become such a ubiquitous part of everyday life, for a smartwatch to take off it will need to present a distinct value proposition that a smartphone alone cannot deliver.
Apple has been keen to allay fears of data privacy, stressing that they do not collect data and that data is encrypted, meeting all industry standards. Despite assurances, concerns persist around the issue of data privacy. Much of the value in health data lies in it being shared, but some patients may not be open to handing over personal information, while authorities maintain a tight grip on data.
The value of information collected by these apps to health services and the integrity of this data raises other important questions. The generation of large amounts of data has potential, but it may place a burden on healthcare systems, as the ‘worried well’ head to physicians with data they think indicates a condition in need of immediate care. Many ResearchKit apps also have no way of confirming that a patient qualifies for participation in a study. Healthcare providers and researchers must decide whether the effort of sorting through a mass of patient-generated data of varying quality is worth the investment.
Marketing the Apple Watch as a luxury item also means that data from patients who cannot afford, or do not use, an iPhone, will not be available and raises the issue of selection bias. While Google and other companies offer alternatives, there are compatibility issues as information is not integrated between platforms. In addition, there may be problems with unfamiliarity with modern technology in some patients.
Issues surrounding the risk and reward of mass screening must also be addressed. The potential for the collection of these data to be perceived as mass screening is clear, and consumers and healthcare systems must be careful to use the data wisely. Most mass screening programmes prove to be ineffectual or even harmful.
Although wearable devices have wide-ranging potential, there is concern that they will elicit an over-reliance of healthcare systems on technology. It is essential that physicians remain the main care-providers, and there is a danger that a habit of self-diagnosis may proliferate with increased accessibility of healthcare data.
What value can wearable devices currently add to the field of healthcare?
The Apple Watch and its various platforms and apps solve a number of healthcare and clinical research challenges. They allow physicians and researchers to reach a large number of people and collect continuous, real-world data and give users immediate feedback. As a result, wearable technology has the potential to play an integral role in helping to identify disease trends, predict treatment outcomes and improve future diagnoses, and consequently bring down healthcare costs. These devices may also encourage less reliance on the NHS by helping patients to take more responsibility for their own health, which is becoming increasingly important with mounting cuts to healthcare budgets. However, no matter the support given by technology, patients must still motivate themselves to commit to medication adherence or keep fit to improve their well-being.