Healthcare: Managing the information flow from wearables and remote monitoring devices
Wearables devices are the source of an immense amount of health data and are experiencing growth in two health-related markets. One is the wellness category, which includes the use of devices such as activity trackers and smart watches by individual consumers and in corporate wellness programs. The other market is health monitoring for individuals with illnesses such as diabetes and high blood pressure. The data that flows from these devices is being analyzed to help patients maintain good health and to manage diagnosed conditions. In addition, AI and machine learning are being applied to provide feedback and suggestions to users in both categories, and predictive analytics is being used to help anticipate medical events.
Spending for health trackers and remote patient monitoring devices will reach $20 billion annually by 2023, according to Juniper Research. A separate market for service revenues, including collecting and selling the data that comes from the devices, is projected to be $855 million by 2023. As the quality of remote wearable monitoring devices continues to improve, they are likely to see increasing use in clinical settings and potentially support increased use of telemedicine. In pandemic situations, as with COVID-19, such monitoring could help leverage scarce provider resources and reduce the spread of disease.
Personal health data in the U.S. is subject to HIPAA, so corporate wellness programs cannot use information at the individual level unless the person gives permission. Instead, they aggregate it at the population level over a period of time to get statistics on the level of participation and how many steps are taken or calories burned at the collective level. Corporations are interested in the return on these programs. In a study conducted by the National Business Group on Health and Fidelity Investments, large companies were planning to spend an estimated average of $3.6 million on wellness programs in 2019.
Data from patient monitoring has a different workflow. “It is collected under the care of medical staff and is used to coach and guide an individual’s behavior as well as to detect out-of-range metrics,” said Alan Antin, research director at Gartner. “In some cases, AI is being used by the systems that look at the data coming off the devices, and, based on what the measures show, the system provides guidance to the patient.”
Because of the volume of data, in some settings the goal is to spot the outliers rather than calculate averages. “A typical health coach might manage 250 patients,” noted Antin, “so the software can be set up to determine who has not stayed in compliance with the target measures.” Data may be analyzed within the closed system in which it is collected, or uploaded to a host for analysis. In addition, some software programs are designed to integrate data from multiple sources to provide a more comprehensive view of an individual’s health.
Monitoring for improved outcomes
Diabetes is one of the most impactful chronic diseases, both financially and with respect to health. It accounts for an estimated one-quarter of all healthcare costs, with the average cost per patient per year exceeding $16,000, including lost productivity.
The Diabetes Group at Medtronic is focused on individuals with intensively managed diabetes; these individuals are at acute risk for both short- and long-term effects. Its Guardian Connect continuous glucose monitor (CGM) consists of a minimally invasive wearable sensor and a small transmitter that pairs with a smartphone. The CGM system can also be paired with a pump that delivers insulin as needed, if desired.
“With our Guardian Connect CGM, patients can see their glucose levels via an app on their phones,” explained Mike Hill, vice president and general manager of the multiple daily injection solutions team at Medtronic. “In addition, Guardian Connect presents a graph that visualizes the glucose levels, provides alarms and alerts, and is the gateway to other destinations, such as sending the data to the cloud. There, the data can be aggregated from many patients and analyzed for trends.” A lot of rich data comes through the phone into databases, so security and privacy are carefully maintained.
Based on the data collected, personalized responses are downloaded to the patient’s smartphone and a healthcare provider’s dashboard. The information can be targeted because users have the option to enter details such as the food they are consuming during each day. The system can infer the effect of various foods and provide responses that the individual can see immediately. “CGM connectivity to phones was developed about 2 years ago,” said Hill. “Many individuals with diabetes prefer the convenience of the smartphone as opposed to having to carry a separate display, and they like having a monitoring device that is not as publicly visible.”
Continuous glucose monitors have been around for several decades, but only in 2018 did Medicare begin providing reimbursement. The policy changed once clinical evidence was developed that showed the devices could improve outcomes by increasing the time an individual was in the normal range for glucose and reduce hospitalizations.