What started with a limited number of health monitoring devices used in the home, has evolved into a new market sector for wearable healthcare technologies used to monitor a wide range of physiological indicators of health and wellbeing.

Wearable healthcare is expanding: According to Berg Insight by 2023, 239 million devices will have shipped. The personalized health devices typified by fitness trackers and smartwatches will be joined by new innovations such as satnavs to step-trackers that may be incorporated into robotic limbs, transforming prosthetics into multifunctional ‘IoT’ devices. This will enable amputees to incorporate their consumer tech into their replacement limbs while also providing a new source of data on everything from amputee patient posture to physical activity.

Berg Insight says: “Built-in sensors streaming live performance data will enable “remote clinicians” to evaluate rehabilitation outcomes, support physical therapy regimes and adjust prosthetics to suit changing needs. Digital connectivity will enable constant upgrading of technology. In the future, technicians might even be able to ‘remote in’ and re-calibrate a malfunctioning microprocessor in a robotic leg.

“Built-in sensors will also create more personalized health treatment plans. Doctors and health care providers will be able to accurately infer the future medical status of amputees by tracking exercise habits through fitness trackers built into artificial limbs. Ultimately, we could even see ‘self-adapting’ prosthetic limbs that use sensors and data to predict and change configuration or function to empower patients to self-heal by prompting them to exercise or improve their gait.”

The data that wearable technologies could collect about a patient is highly sensitive. Businesses building these devices will have to pay particular attention to the security implications.

As wearable devices will use some form of wireless connectivity, CTOs will need to have a clear strategy to ensure the transmission of data over these networks is secure. Here, technologies such as the Blockchain could deliver high levels of security that will be needed if wearable healthcare is to become familiar and mainstream.

Speaking to Silicon, Dr Vincent Grasso, Global Practice Lead, Healthcare and Life Sciences, IPsoft said: “There is significant concern over the privacy and security implications of patient private health information being captured and transmitted by an ever-growing number of vendors. As a result, for example, the US Congress introduced The Internet of Things Improvement Act which requires all IoT [https://www.silicon.co.uk/cloud/https-www-silicon-co-uk-iot-business-and-industry-301719] devices purchased by the US Government to meet minimum security standards.

“As the number of devices and vendors increases rapidly, governing agencies involved in maintaining standards are finding it difficult to keep up. Patients have very little insight, if any, into what is happening to their private health information that is being captured and transmitted by clinical apps within specific devices or within smartphone apps.”

Wearable healthcare

An excellent example of wearable healthcare technology that has a practical application is Current who have developed a wearable device that can remotely monitor patients after they are discharged from the hospital. Worn on the upper arm, the device uses AI to analyze patient data delivering actionable insights to clinicians. The Dartford and Gravesham NHS Trust Hospital report a 22% drop in home visits after deploying the technology.

“The value of Current was demonstrated in our very first patient – a chronically unwell patient who suffered a decline in oxygen saturation, which Current detected sooner than standard care would have caught it, letting us intervene earlier and in the patient’s home,” said Dartford and Gravesham, CIO, Neil Perry.

Perhaps the Apple Watch, is the most conspicuous use of a wearable device for healthcare monitoring. The current iteration of the Watch can monitor the wearer’s heart rate and alert them if there is a potential issue. And with cases of diabetes on the rise, devices such as the Dexcom CGM offer a convenient monitoring solution.

Other examples of wearable healthcare technologies include the Ava bracelet is a wearable sensory device paired with an app, which helps women to understand their bodies and cycles better. Enterprise VR training company Immerse developed a fully immersive virtual experience for GE Healthcare to help upskill radiographers in using CT scanners. By creating an environment that allows radiographers to practice without having to use relatively scarce equipment and in high demand, GE Healthcare can open up faster and more regular training to staff and reduce the need to train on the CT scanners so they can be operational for longer.

BT and the University Hospital Birmingham recently demonstrated the ‘connected ambulance’ consisting of a 5G-equipped ambulance crew equipped with a VR headset. The clinician can visualize precisely what the paramedic sees in the ambulance. Using a joystick, they are then able to remotely direct the paramedic in real-time to perform any necessary scans, as well as get close-up footage of the wounds and injuries of a patient.

Fotis Karonis, CTIO and 5G executive lead for BT Enterprise, said:
“We’re delighted to be demonstrating this cutting-edge technology here in Birmingham, which was amongst the first places in the UK and Europe to get switched on to 5G.”

Karonis continued: “Not only is 5G capable of ultrafast speeds it has much lower latency meaning there is little to no delay when transmitting data over the network. This means things happen in ‘real-time.’ This is of significant interest to the NHS because of its potential for medical applications, such as diagnostics and preventative healthcare. This capability provides efficiency opportunities for both hospital and ambulance trusts by reducing the number of referrals into hospital and patient trips.”

Connected devices

Businesses developing wearable devices for the healthcare sector will see this market continue to expand. Says IPsoft’s Dr Vincent Grasso: “The next five years are going to witness profound changes within the healthcare delivery landscape concerning medical devices and technology in general. The expansion of the AI ecosystem assets such as conversational computing, Machine Learning, smartphone apps, and others will have a profound impact on the delivery of care.

“As hospital systems migrate from on-premises information system hosting to the cloud, the ability to integrate an ever-widening list of IoT devices, peripherals, expert systems, and other related will increase rapidly. Maintaining security and privacy around all of this churn will be difficult to manage. Data breaches will be ever more complex. The trade-off is better quality healthcare delivery and management within a decentralized network.”

With Antonios Oikonomou, the Graphene Flagship Business Developer for Wearables and Optoelectronics concluding: “Long term predictions foresee wearable technology to contribute to global cost savings on the order of $200 billion in the health care sector. This cost savings is partly due to the shift of using wearables for sporadically health care situations or scenarios to continuous patient care. A reduction of hospital costs by as much as 16% in the next five years could be achieved through such shift. The digitalization of the sector, together with the development of low-power, highly integrable, multifunctional solutions, are all key trends in the healthcare industry.”

Personalized medicine is accelerating, as digital services come online to support the wearable devices already in the marketplace. 5G and the burgeoning IoT sector will inevitably have a profound impact on the whole wearable healthcare market. CTOs have great opportunities, yet must innovate with the patient and regulatory environment always in mind.

Silicon in Focus

Nigel Whittle, Head of Healthcare and Medical at Plextek.

Nigel is Head of Healthcare & Medical at Plextek, working with clients to provide expertise in the development and commercialization of cutting-edge technology. With over 20 years of experience in the medical and pharmaceutical sector, Nigel has pioneered innovative medical technologies for companies such as MedImmune, Celltech, Cantab Pharmaceuticals and Genentech. During this time, Nigel has developed a strong reputation as a leading authority in wearable technology, biotechnology and regenerative medicine technology.

Can you identify any key trends in wearable technologies across the health industry?

Wearable technologies have significant roles to play in both monitoring wellness, and also in identification and diagnosis of disease. The rising prevalence of lifestyle diseases, such as obesity, has led to interest from consumers and doctors in using wearables to alleviate these conditions.

Wellness monitoring includes devices such as the FitBit, Jawbone, Garmin and Apple Watch and these devices are likely to see increasing take-up in the general population, driven by a growing awareness of health and fitness issues. These devices can now routinely measure heart rate, blood pressure, step count, sleep quality and temperature. The trend is likely to be for the addition of further sensors to monitor more (but straightforward) aspects of physiology, or indeed to add environmental monitoring such as air quality or ambient sound levels.

Perhaps more significantly, wearable sensors are starting to impact the practice of medicine by enabling health monitoring outside of clinic settings. There are already numerous devices in the current healthcare ecosystem that can monitor parameters of physiology and pathology, including metabolic, cardiovascular, neurology, sleep and a variety of disease conditions. This information can provide profound insights into physiology and disease states and assist doctors in making their diagnoses.

Which areas of healthcare should CTOs focus on new product development?

At the other extreme from the wellness market, is patients suffering from particular chronic conditions, of which diseases like diabetes or COPD are particularly relevant. Non-invasive blood glucose monitoring is a holy grail of wearable device developers but is beset with many problems. But the ability, for example, of patients with respiratory disease to monitor their condition in combination with environmental monitoring, would be a great benefit.
Other disease areas of interest might include neurological diseases, such as epilepsy or Parkinson’s Disease.

In the former case, the ability to predict the onset of a fit, or at least to provide an alert to a carer could be very valuable. In the latter case, the information submitted to the patient and the carer about the severity of the disease on an hour-by-hour basis, perhaps through gait analysis or by monitoring bodily tremors, could enable the patient to benefit from improved care.

Wearable devices are arguably most useful in monitoring highly prevalent chronic illnesses such as diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease. But, in principle, wearables can also be used in all conditions where outcomes can be measured in terms of improved vital signs and enhanced movement.

A key aspect of new product development might be to consider these devices as monitors rather than medical devices, thus avoiding some of the more arduous regulatory requirements. The key differentiating factor would be that the monitors would track the disease status as opposed to suggesting direct clinical intervention.

However, there will be an increasing demand for medical device wearables, particularly for monitoring clinical trials. A significant part of the cost of clinical trials is, of course, the regular monitoring of patients, and the more of this that can be done outside the clinical environment, in the ‘real world’ then the more relevant the data is likely to be, and the lower the cost of data collection. Perhaps unsurprisingly, there are now over 300 clinical studies involving the use of wearable devices for monitoring a range of medical conditions.

Wearables are likely to be useful, particularly in clinical studies where the patient needs to keep a diary, by simplifying the record-taking process, and by providing prompts and reminders to improve compliance with the treatment schedule.

How will the burgeoning IoT sector expand the capabilities of wearable healthcare devices?

Smart IoT depends on multiple sensor and information inputs combined with advanced rule-based algorithms and knowledge bases to sense the environmental context of the data, make sense of the information, and then make relevant decisions.

The ability of IoT to allow connectedness across a wide variety of systems is likely to bring in additional capabilities to wearable devices. For example, the ability to detect air quality across a large area could then be used to assist people living with asthma to avoid areas of significant pollution, or to alert them to stay indoors under particular circumstances.

A further example might be the use of wearable devices within a smart IoT environment to provide additional safeguards for older people, either indoors or outdoors. The combination of information about a person’s health as measured by mobility or posture, coupled with information about the environment (is it raining/ is there a busy road ahead?) would be very useful.

Is AI, machine learning and 5G, all essential components of next-generation wearable healthcare?

Wearable devices are capable of generating large sets of data relating to physiology and disease states. However, the value and significance of this data will require effective processing to make it useful for patients and clinicians.

The data generated by these devices can be processed and analyzed using machine learning and AI systems to not only inform on current conditions but also potentially to predict adverse health events. This capability is likely to have a huge impact on medical practice and revolutionize not only treatment but disease diagnosis.

A vital feature of these devices is often the incorporation of embedded technology which can facilitate the secure collection and transfer of large amounts of data wirelessly.

This allows health data from the subject to be collected effortlessly in the background, in the ‘real world’. As the amount of data being collected increases, then the ability to transfer data quickly and seamlessly for processing will become highly relevant. The capability of 5G for rapid transfer of data with low latency will become increasingly important.

As devices like Apple Watch and Fitbit become more capable, what does this mean for personal security and privacy?

As the industry develops, the value will increasingly come to reside in the data being generated by the wearable devices, rather than in the manufacture and sale of the devices themselves. Companies such as Apple increasingly see the value of medical and wellness data that can be harvested, and integrated with data collected from other sources, providing a rich and comprehensive picture of individuals’ characteristics and behaviours.

Unchecked, this is likely to lead to significant issues over privacy and personal security. Already there are substantial concerns about transfer and use of even anonymized medical data. These concerns can only increase as the comprehensiveness of the data increases.

With the prospect of developing richer and more complex patient health profiles, the primary benefit of wearable devices is access to the real-world, continuous measurement of a patient’s health through unobtrusive tracking during their daily routines. Other benefits include reduced costs for visits to clinical centres, access to a broader pool of geographically dispersed patients, and potentially decreased variability of data – allowing fewer patients to be recruited into the study to achieve the required statistical significance.

More speculatively, developments in predictive analytics offer the potential of alerting researchers to damaging side effects before they occur, based on data analyzed from individuals and patient groups. The continuous collection of data from wearables will undoubtedly provide valuable insights into a patient’s wellbeing, potentially by associating activity levels or spikes in blood pressure with drug dosing.

However, the real long-term significance is the opportunity to aggregate and integrate the data into a comprehensive and holistic model of patient wellbeing, generating new insights into a range of disease states, and suggesting new approaches to treatment.