How Wearable Devices Are Changing Patient Care


How Wearable Devices Are Changing Patient Care

Wearables caught on fast and their potential for clinical use is unlimited

By Sue Montgomery, RN, BSN, CPHN
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Unless you were working the graveyard shift, you were probably fast asleep at 3:20 a.m. on August 24, 2014, when the Napa Valley earthquake hit. If you had a Jawbone UP fitness tracker on your wrist, the company knew if and when you awoke—as well as if and when you fell back to sleep. They were even able to correlate that data with your distance from the epicenter. Welcome to the future!

Wearable Mania

Wearable devices — most of them fitness-tracker wristbands — have become the rage for consumers over the past few years. Though many manufacturers tout the health benefits these devices can provide, there’s also criticism that wearables don’t really help those who need them most — like patients with chronic disease. 

In this article, we’ll take a look at the current state of wearables, their potential for clinical use and how they may impact your practice.

Wearables caught on fast and continue to grow at a blistering pace. A 2014 report by Juniper Research predicts that the global smart wearables market will hit $53 billion by 2019, up from $4.5 billion last year. With improvements in technology, success stories abound. In June, tourist Ken Robson used his Apple Watch data to self-diagnose sick sinus syndrome while on vacation in San Diego — and came home with a pacemaker to prove it. 

Digital health pioneer Eric Topol, M.D., director of the Scripps Translational Science Institute in La Jolla, was the one who originally broke the Robson story. Topol had previously related how he used an AliveCor device (a small mobile ECG controlled with an iPhone app) to diagnose another passenger’s heart attack while on an airline flight. 

What’s a Wearable?

The miniaturization and addition of biosensors to wearables take things to a whole new level, which is where medical applications will abound. To be clear, let’s define a few terms with the help of Rock Health:

• Wearables are on- or in-body accessories that enhance the user experience. 

• Biosensors are devices that convert a biological recognition element into a signal output.

• Biosensing wearables allow continuous physiological monitoring in a wide range of form factors. 

 Biosensing wearables include activity trackers, smartwatches, smart clothing, smart patches and tattoos, and even ingestible devices and smart implants. As companies continue to integrate sensing/tracking technology in search of greater convenience for consumers, we’ll see more of the “invisible” variety of biosensing wearables. 

Clinical limitations

Although wearables have great potential to make a big impact on  patient care, they haven’t done so just yet. There’s a mountain of data being created, but there are several reasons why most of that data isn’t being used in the clinical setting:

◗  Accuracy: Most physicians aren’t convinced that the data generated by wearables is reliable enough to act upon. 

◗  Volume: If you really think physicians want the hassles and legal responsibility of accepting  six months worth of minute-to-minute readings of someone’s blood pressure, think again. 

◗  Format: It’s difficult enough to get various EHR systems to talk to each other, let alone all of the devices that could potentially be involved. 

◗  Regulations: It’s much easier for innovators to stretch their creative muscles in the “anything that works, goes” atmosphere of Silicon Valley than in the paternalistic glare of HIPAA and the FDA in D.C.

Clinical Potential

Mobile technology is definitely racing toward new horizons in healthcare, and wearables will eventually be part of the pack. Here are some areas where clinical development will likely take hold:

Chronic Disease Management: The California HealthCare Foundation’s 2013 report, “Making Sense of Sensors: How New Technologies Can Change Patient Care,” provides a comprehensive overview of the potential for wearable sensors in medication adherence and the management of chronic diseases, including mental health, asthma, Alzheimer’s, sleep disorders and diabetes. 

Hospitals are taking notice. So far, three major health systems — Louisiana’s Ochsner Health System, King’s College Hospital in London and Nebraska Medicine — have signed up to use the Apple Watch for chronic disease management and clinical trials.

Value-Based Care: Wearables’ potential to optimize care, reduce hospital readmissions and cut costs takes on new importance in the face of the Affordable Care Act’s move towards value-based payment models. With FY 2015 readmission penalties totaling $428 million — nearly double the 2014 figure — the need for improvement is growing more urgent.. 

Precision Medicine: When President Obama announced his Precision Medicine Initiative earlier this year, the digital health world went wild. The initiative’s main focus is genomics, but wearables are part of the picture too. In fact, the National Institutes of Health immediately started gathering input from a variety of stakeholders regarding the use of wearables to support the initiative. 

Clinical Trials: As device technology matures, there will be many applications for wearable tech in clinical trials. The pharmaceutical industry is taking interest in those possibilities, as evidenced by the recent deal between pharma giant Novartis and the digital tech firm Qualcomm Life. 

How Will They Impact Your Practice?

You’re probably not seeing many clinical applications for wearables in your setting just yet. As the devices become more fine-tuned and the regulatory fog clears, expect to see that change. However, wearables are already being put to good use in a few key areas from which nurses and nursing students can benefit:

• Hands-free video, allowing nursing instructors to be more focused.

• Maximizing clinical perspective,  providing front-row seats to clinical and surgical experiences.

• Preserving and extending knowledge by archiving footage to build the curriculum.

• Empowering nurses by honing interpersonal skills through direct observation and critique.

At this year’s Quantified Self conference in San Francisco, Martijn de Groot, Ph.D., M.Ed., M.Sc., a research director at Hanze University of Applied Sciences in the Netherlands, described his model for training the next generation of what he calls “Quantified Nurses.” De Groot says that those on the front lines of the care continuum need such training in order to make the most of the wearable data that patients provide. 

Staffing: You may not like the sound of this anymore than I did, but some hospitals are using wearable sensors (on a volunteer basis only) to track nurses’ activity and locations as a means of evaluating staffing levels. However, if the data is used responsibly, you won’t have to worry about anyone knowing where you took your break — rather, you might finally be able to count on getting one. 

Productivity: Nurses are some of the most efficient beings on Earth. Since things like smartwatches provide the potential for instant communication and the receipt of alerts and perhaps even patient information, I predict that nurses, especially the younger crowd, will be lining up in droves. The keys here will be HIPAA and organizational compliance, including data privacy and security.

Over the next few years, expect to see a big increase in the number of wearables in the clinical space. You’ll receive the most benefit from the coming wave if you’re informed and prepared to make the most of what they have to offer — both for your own benefit and for those entrusted to your care.   

Sue Montgomery, RN, BSN, CHPN, is a freelance healthcare writer, editor, analyst and consultant specializing in end-of-life issues, palliative care, bioethics and digital health.



by Aaron Severson

HIPAA is a fact of life for nurses, so you might assume when you strap on a new fitness tracker or download a healthcare app to your smartphone that the biometric information it gathers is protected by HIPAA, just like your patients’ info is. But is it really? The not-so-comforting answer is “maybe.”

HIPAA covers both privacy (with which all nurses are familiar) and security, which includes rules for the security of protected health information (PHI) that’s transmitted or stored electronically. However, HIPAA only applies to “covered entities,” meaning providers, health plans, healthcare clearinghouses and some business associates and subcontractors. If a hospital creates an app for patients to use that gathers or stores PHI, then the app and its data are subject to HIPAA. If the hospital hires an outside developer to build and manage the app, the developer is also subject to HIPAA.

However, if the app is created by a company that isn’t a covered entity or working on behalf of one, HIPAA does not apply, even if the information the app collects is health-related. Also, remember that personal information is only considered PHI if it’s associated with healthcare-related data. Your name, location and name, location and IP address, for example, are not PHI by themselves.

Can device or app makers trick you into authorizing the use of your information by burying the authorization in one of those user agreements nobody reads? If the device or app is made by or for a covered entity, probably not; federal law generally prohibits combining a HIPAA authorization with other agreements or documents. Otherwise, read the fine print before clicking okay! 


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