Welcome to the age of the Quantified Self; an era of physical enlightenment, fueled by the onslaught of wearable health monitoring devices. These wristbands, watches and high-tech apparel track everything from footsteps and heart rates to sleep patterns and stress levels—creating biological “selfies,” delivered straight to smartphone on cue.
From out of nowhere, wearable fitness devices and exercise-related gadgets have moved from obscurity to bestsellers, quickly emerging as the revenue-producing darlings of companies worldwide. According to a recent study published by the Consumer Electronics Association (CEA), demand for these devices is expected to quadruple in 2014—well surpassing $1 billion in revenue. Most research agrees sales of devices and related services will continue to skyrocket for years to come.
While it’s clear this trend is giving a lot of app developers, software providers and device manufacturers healthier bottom lines, what about the rest of us? Will all of this newfound medical knowledge really make us all healthier? Or are these devices, and the data they extract, the latest fad in a world that’s becoming increasingly “all about me?”
“I think that wearable devices are an exciting new area in heath care. They offer potential to easily obtain valuable data for the patient and their health care provider that, in the past, required more expensive equipment and laborious efforts,” explained Peter Stack, MD, FACP. “For example, a device that accurately identifies changes in heart rate or rhythm could potentially reduce the need for expensive cardiac tests to detect heart rhythm problems.”
According to Dr. Stack, even the most rudimentary fitness trackers have value, if only to give their wearers a hefty dose of reality.
“I have patients say to me, ‘I’m exercising, I’m eating right, but I just can’t seem to lose weight.” More often than not, they’re seriously underestimating the number of calories they’re taking in and overestimating the number of calories they’re burning. The Weight Watchers’ goal of 10,000 steps-per-day is far more exercise that most people realize,” Dr. Stack said. “I’ve been encouraging patients to buy some sort of monitoring device to give them the sense that “every step I take is counted.” Hopefully that will give them a realistic sense of just how much exercise they’re getting, and encourage them to walk more.”
Wearables and Wellness Programs Could Be Risky Business
But, consumers aren’t the only ones with an appetite for these wearable accountability buddies.
In an effort to reduce insurance costs, many companies are launching employee wellness programs that incorporate fitness trackers. Program participants have the opportunity to earn rewards by making healthier choices, from ramping up physical activity to keeping calorie consumption off the astronomical chart. Employees get healthier, increase camaraderie with their peers; the company reduces the cost of a very fat budget line item. Everybody wins.
Although wellness programs can offer real benefits, they do come with some risk.
“Any time you track employee activity outside of the office or collect personal data, there are potential issues,” explained Tiffani McDonough, a labor and employment attorney at Obermayer Rebmann Maxwell & Hippel LLP in Philadelphia. “So, when companies offer wellness programs, I always recommend that they use a third-party administrator to track employee progress and collect the information, not their own HR department. This significantly reduces risk.”
Even seemingly innocuous program reward goals could land a company in hot water.
“Title VII of the Civil Rights Act states that organizations can’t have different standards for men and women. The problem is, we are physically different,” McDonough said. “By complying with Title VII, a company could put a group at a disadvantage for achieving program rewards. So, the reward tiers have to be carefully thought out, or you could alienate the very people you’re trying to motivate.”
According to McDonough, another big consideration is the Americans with Disabilities Act (ADA) compliance. That means every wellness program has to offer a reasonable alternative to individuals with disabilities. A program that rewards adding extra steps, for example, has to provide an alternative way to earn rewards to employees in wheelchairs. These programs could also uncover some employees with disabilities that the company didn’t previously know about.
“My best advice is, before you start a wellness program, get legal counsel from someone who understands both employment law and the laws governing your state,” McDonough said. “For example, New Jersey has a law protecting any employee’s Lawful Off Duty Conduct. So, if it’s a legal activity in the state, companies can’t penalize the employee for doing those activities on his or her own time. So, it would be difficult to run a company-sponsored smoking cessation program there.”
This is not to say that wellness programs are more trouble than they’re worth; nor to encourage you to step away from the concept more quickly than your wearable device can count steps. Just know all the risks and rewards upfront. Consult with legal counsel, make the program voluntary, outsource your data collection, and understand that a corporate wellness program is anything but a no-brainer. Do less, and the outcome could have you feeling a little sick yourself.
Innovations That Could Change Everything
Although we’ve given the ubiquitous fitness band the spotlight up until now, these devices are only the beginning. The emerging innovations are enough to make anyone’s heart race, whether you have a cardiac condition or not.
If you want to monitor a suspicious mole, there’s actually an app for that. Another company has created a mobile colposcope, which attaches to a smartphone to give aid organizations in developing countries a less expensive way to detect cervical cancer.
NTT DATA is focusing development efforts on the health arena as well, providing devices that support patient, medical community and health insurance providers alike.
“Consider the health and fitness market from a payor perspective. If I get a breathing test from my physician and have an issue, my health plan will probably send me educational information on asthma, based on my claim data,” explained Adam Nelson, vice president of Industry Solutions for NTT DATA. “What if that payor could put a wearable device in the hands of these people, monitored by Accountable Care Organizations (ACOs)? That changes everything.”
The problem is a number of aging Baby Boom (and pre-Baby Boom) patients with chronic conditions are not of the Internet Age. If a game of Angry Birds is a challenge, how in the heck will they manage mobile health monitoring?
“We wanted to put the technology in the hands of the patient, but do it in a way that was easy to understand,” Nelson said. “We wanted to create something that was unobtrusive, usable by the fitness community and also long-term care patients, supplementing the periodic visits from skilled nursing professionals and physicians on their rotations.”
The solution? The Hitoe shirt, providing a constant stream of ECG rhythms transmitted via Bluetooth to a smartphone or to the company’s data pattern and analytics framework for hospital systems.
Yes, I said “shirt.” The wearable wearable. It’s made of compression-controlled fabric to compensate for variation in body shape, and to fit well during movement. The Hitoe shirt monitors bio-electrical signals continuously using NTT DATA’s technique for fabricating electro-conductive polymer textile, collecting up to 24 hours of ECG rhythms and transmitting this out via Bluetooth. There’s nothing for the patient to learn, no buttons to push. If theory holds, this washable, no-nonsense T-shirt will soon have well-dressed cardiac patients literally wearing their hearts on their sleeves.
“Think about it this way: most heart patients get sent home with a 24- or 48-hour heart monitor that captures recordings and is dropped off at the cardiologist’s office. The device is bulky and inconvenient—you can’t get it wet, you have to keep it close while sleeping and the electrodes could fall off. Although it’s effective, 48 hours worth of readings just aren’t enough. Studies show that patients who were monitored for 30 days were more likely to have better outcomes, because it gives the clinicians a more complete view of cardiac activity,” Nelson explained. “Now, imagine sending the patient home with something that looks just like a regular T-shirt, with fabric-based electrode sensors and wire sewing techniques. The patient doesn’t have to learn how to use it, or have to carry around something that interferes with his or her own life. It’s also fully washable; the patient just snaps off the wireless transmitter and washes the shirt it with their other garments.”
As the technology increases in sophistication, it could redefine the entire doctor-patient relationship.
“Today, a physician prescribes a blood thinner, tells the patient to take it for two weeks, then, as one data point, report back on how he or she feels,” Nelson said. “With the shirt, the doctor has hard data; feedback on how that patient is reacting to the prescribed medication in real time.”
The Prognosis? We’ll Have to Wait and See
It’s clear that these devices have the potential to change the way doctors interact with patients, improve preventative care and could help manage chronic conditions. Is there any downside? Could this continual internal self-scrutiny increase stress levels or expand “white coat syndrome” beyond the confines of the doctor’s office walls?
“I think there is potential for people to misinterpret the data they get from a wearable. The people who tend to worry could have their anxiety fueled by what may be normal fluctuations,” Dr. Stack said. “Other people may get a false sense of security by selectively interpreting their results—dismissing abnormal readings as inaccurate and focusing on data that reinforces their mindset—for example, ‘my blood sugar only rises after I eat, so I’ll set my device to check only on the days I starve myself’.”
In other words, a worrier will worry and a fact twister will continue to do so, wearable device or no.
While no one is disputing the positive impact this new wave of wearables could have on overall wellness and that using these devices for monitoring is often less expensive than traditional tests, one big question remains. Will these devices and supporting analytics software significantly lower the overall cost of health care?
“I really doubt these wearables will reduce health care costs. If anything, they will feed the notion that we need more testing and measurement to prove that we are healthy. I can also imagine that health professionals could feel pressure to further investigate a potential problem if a patient presents with self-generating data that suggests a problem—”The device says that I’m not sleeping properly, so I must need a sleep specialist to get to the root of the problem,” Stack said. “I believe these devices could evolve to a point where they could be used in lieu of more expensive testing, which could reduce costs in that area. However, if they do their job, if these devices help more people live longer; if we prevent heart attacks and people age to longer lives, the cost of care will naturally increase because we’re caring for our patients longer.”
Maybe that’s a better goal after all.