The rise in the demand for virtual care has come with the need for home-based patient-monitoring solutions. The next generation of wearable devices has risen to the occasion.
These wearable devices will play a crucial role in the expansion of telehealth, especially in the hospital-at-home (HaH) setting. They can play a central role in disease management at various stages, including early screening, diagnosis and post-discharge care.
The continuous data monitoring offered by wearables provides real-time data collection, increasing accuracy and timely decision making. The data captured by wearables provides physicians valuable insights that go beyond the patient’s electronic health record (EHR).
Examples of wearables and what they monitor
Wearables help HaH patients stay connected to their care team. For example:
Oxygen Saturation
Pulse oximeters for patients with chronic obstructive pulmonary disease measure continuous oxygen saturation, or SpO2. The traditional version is usually clipped on the finger or earlobe. Next generation oximeters are based on flexible sensing via organic optoelectronics that can measure SpO2 at any place on the body such as the wrist, head, chest or other areas. This makes it easier to keep on continuously.
Respiratory Rate
Respiratory rate (RR) can be a strong predictor of cardiac arrest and unplanned intensive care admission. New wearable RR monitors include motion sensors, a clip-on device for monitoring breathing, and a patch that uses piezoelectric sensor array to detect deformations thoracic and abdominal surfaces. A wearable device with these sensors can be mounted into chest belts, applied to the skin, among other methods.
Lung Sounds
Diseases can cause abnormal levels of air and fluid in the lungs. A wearable digital stethoscope patch can monitor breathing continuously without placing sensors over different parts of the body
Heart Rate and Cardiovascular Disease (CVD)
Widespread use of fitness trackers has meant that heart rate, usually with chest bands or watches, is being tracked every day, worldwide on millions of users. Another common heart monitoring wearable is the adhesive electrocardiogram (ECG) patch. The patch is small and wireless with miniaturized electronics. Easy and comfortable to use, it can monitor the electrical impulses over many days to detect arrhythmia.
Blood Pressure
Traditional in-home blood pressure kits have transformed into cuffless, unobtrusive devices such as watches, glasses, a wrist/armband, shirt, sleeping cushion, chair, smartphone, camera and flexible patch. Patients can use multiple forms to fit their lifestyle, such as a wristwatch during the day and a sleeping cushion at night.
Hip Triaxial Accelerometer
Accelerometer-based measures captured during walking have shown promise in screening for fall risk. Use of a wearable device, placed at the hip, during walking tasks can record a person’s gait during the day. Accelerometers are becoming more affordable and available in consumer devices as ubiquitous as smartphones.
Biosensors
Biosensors, usually self-adhesive patches, allow patients to move around while collecting data on their movement, heart rate, respiratory rate, and temperature. Research from Augusta University Medical Center showed that biosensors can register an 89% reduction in patient deterioration.
Challenges for wearables
Wearable health technology has the potential to transform patient care. However, there are major challenges that wearables will have to overcome before widespread adoption in the regulated health sector:
- Data Quality: To go from consumer to medical grade standard, wearable device manufacturers will need to improve significantly. For example, due to the inconsistency seen in fitness trackers in past clinical studies, physicians are still hesitant to use them to make clinical decisions.
- Data Overload: Wearables generate large volumes of data that needs to be managed and maintained. The best telehealth platforms will be able to integrate this data into EHRs to personalize treatment. This is happening on a small scale. Numerous health institutions have started to integrate device data into patient portals. Several start-ups are developing technology to enable wearable-EHR integration for health systems. And a few insurance companies are encouraging the integration of wearables.
- Interoperability: Data residing on multiple mobile devices needs to be collected and analyzed seamlessly across different wireless technology standards and eventually synced to a patient’s EHR. To do this, telehealth platforms need to host an array of different devices and apps that can work together, sharing data that ultimately improves clinical decision making.
- User Appeal for User Adherence: To encourage patients to use medical-grade wearables, they must be simple to set up and use, small, lightweight, power efficient, silent, reconfigurable, durable, easy to download and aesthetically pleasing.
- Data security and privacy protection: According to a recent Pew Research Center 2019 study on digital privacy perceptions, 81% of Americans responded that the potential risks of data that companies collect about them outweigh the benefits. To build trust, manufacturers need to prioritize adherence to Health Insurance Portability and Accountability Act (HIPAA) and the European General Data Protection Regulation (GDPR).
A HaH program supplemented by wearable devices can empower patients to take better care of themselves on their health care journey. The extra data they provide can improve clinical decision making and clinical outcomes. With the Centers for Medicare and Medicaid Services (CMS) recently approving virtual care like HaH, it is only a matter of time before wearable manufacturers make an effort to improve their devices and EHR systems across the country integrate with this potentially useful data.
To learn more about telehealth-enabled hospital at home programs, please contact us.