Guthrie

Phillip Snider

If you want to trace back to the original wearable technology, you’d have to go back to the 1200s when eyeglasses were first invented. Next was the pocket watch, abacus ring and about 40 years ago, calculator watches. The 1990s ushered in pedometers and I remember wearing my Casio EXW-50 pedometer watch that let me count the number of steps on a run.

Fast forward 15 years and companies like Nike, Apple and Fitbit were introducing the first activity trackers that would sync with a computer. Just a short time later Garmin introduced a GPS enabled watch and in 2009 I was vacationing in Rome, Italy and was able to upload a run around the coliseum and view it on Google Earth.

Today we’ve seen the wearable market explode with devices and companies that have come and gone. Familiar names such as Apple, Fitbit, Garmin and Polar have been joined by Sony and Samsung.

As these companies have grown, so has what their devices can do. In just 25 years, we’ve gone from stopwatches and step counters to wrist based devices that can detect an impending heart attack or seizure and alert your doctor that your COPD is worsening. Both Fitbit and Apple have been credited with alerting users to seek medical help when dangerous heart abnormalities were detected before anything bad happened. This technology has progressed so rapidly that the FDA's Center for Devices and Radiological Health released a Digital Health Innovation Action Planto develop a fast track approval program. Over 200 companies applied to participate in but only nine were selected including Apple, Fitbit and Samsung.

In addition to its ECG app, Apple has its Health app which allows users to upload the data collected by the Apple Watch in addition to all the information from your electronic health record. For Android devices, Google has and app called Google Fit.

Fitbit was acquired by Google for $2.1 billion and has collected data on 27 million users in 10 years. According their CEO and co-founder James Park, they have amassed 228 billion hours of heart rate data, 202 trillion steps, 10.5 billion nights of sleep and 517 billion minutes of exercise. With all this data being generated and stored, companies are having to ensure they are complying with privacy and security laws and allowing user’s data to be shared with unauthorized persons or stolen.

Giving Apple stiff competition, they have launched a subscription coaching service (Fitbit Care) that’s $10 a month or $80 a year. They have partnered with over 100 health plans to provide information about behaviors of plan participants and now utilize Google's Cloud Healthcare API tool to connect smart watch users' data with their electronic health records (EHR).

Spire is a company that has focused on measuring breathing. It’s device attaches to a bra strap or underwear waistband. It can detect how often you breathe and how your inhale compares with your exhale. Preliminary studies show that they can predict worsening of CHF or COPD by up to three days.

In addition to worn devices, companies such as Withings have devices that can connect to software platforms. Bluetooth scales, blood pressure, blood sugar monitors, blood oxygen sensors and thermometers allow a much broader set of data to be collected.

Some companies are tracking their employee’s sleep habits. Preliminary cost savings data have ranged from no benefit to saving up to 1.2 million a year in health care costs at one company.

Healthcare organizations are also using data gathered from wearables. Population health management and avoiding hospital readmissions are the current focus and diseases such as CHF, COPD or sleep apnea are prime targets for this approach. Care coordinators reach out when a patient gains weight, moves less or has a change in their oxygen levels.

Other areas of healthcare are benefiting such as medication adherence, notification of caregivers if a patient has had a seizure or early signs of developmental delay in children.

A major hurdle of incorporating this information is getting insurance companies to pay doctors and hospitals for the time involved in monitoring and using this data for patient care. So far, the experience has been mixed but payers are already collecting their own data. Humana unveiled its Go365 program over 5 years ago and United Health has a similar program. They’ve noted improved diet, exercise and cholesterol levels of their members. Medicare and Medicare Advantage plans have set goals to better engage patients through virtual technology and even some life insurance companies are offering discounts if policy holders have wearable devices.

Although it’s not yet clear whether bringing in step counts and sleep logs are useful at routine doctor visits, as devices start to automatically integrate data in the EHR, it will get easier and may even become expected.