wearables

Over the past year, health has become the focal point in our lives in a way that few of us could have predicted, nor ignored.

Just like consumer culture transformed our societies two centuries ago, health and health-related issues now shape our identity, our lifestyle, our perspectives and our aspirations for the future. To understand the implications of such a profound transformation, it is worth revisiting how consumerism came to be so prevalent in our society and how it influenced what we eventually came to call ‘design and innovation’.

Technically speaking, consumerism encouraged us to consistently improve and enhance our lifestyles through the acquisition of new goods. As consumer societies flourished, our urge to have and do better increased the value of innovation and creativity – in their attempt to set themselves apart from the competition, companies aspired to understand dynamic consumer behaviours and invested in the design and development of the most attractive products or services. In that context, appealing to our desires and aspirations – what things looked like, smelt like, felt like, sounded like or tasted like – became ever more important, and ultimately shaped our understanding and expectation of consumer products, services and experiences.

In healthcare innovation however, things were fundamentally different. Rather than sensorial appeal, innovation developed through science advances and an urgency to address immediate needs. It thrived on effectiveness, accuracy and reliability, all in the context of a highly-regulated environment.

Today, the divide between consumer and healthcare products is becoming less clear, and more challenging. With access to information online, modern-day patients are no longer just the recipients of medical therapy, but the drivers of it, with clear demands and expectations about the treatment they need and the care they receive. To respond to that shift, healthcare providers, pharmaceutical companies and medical device manufacturers are increasingly looking to develop products and services that not only improve someone’s health but offer a compelling, engaging experience for all.

But how can organisations that have, until now, focused solely on science and regulation embrace this new opportunity? And what, if anything, can they learn from those who embarked on a similar journey over two centuries ago?

Understanding the healthcare consumer

At PDD, our teams are constantly exploring the similarities and crucial differences between consumer and healthcare innovation. With solid expertise in both sectors, over the years we have uncovered countless opportunities to cross-pollinate and create better solutions.

In our experience, when addressing the needs of the healthcare consumer, a good place to start is to include the intended user in the process of developing the medical device or service, right from the beginning. By reflecting the values and desires of the users, products and services can be tailored to the patient, increasing their willingness to use them over a period of time. Increasing the ‘desire to use’ also increases an individual’s adherence to certain devices or systems, leading to better patient engagement in therapy, higher quality of care and better chances of treatment success.

What’s more, our research shows that when patients directly engage with their own health, they also tend to focus on preventive means to improve their conditions, eventually reducing healthcare costs and the time it takes to recover. For example, patients with a cardiovascular condition may voluntarily buy and engage with a ‘step-counting’ device to increase their daily activity, or adopt other lifestyle changes- such as healthy eating- in order to improve their condition.

A consumer-led approach in the medical device sector not only benefits the intended user but acts as a catalyst for medical device innovation. When there were fewer options available, individuals were inclined to accept what they were given. Now, with increased competition, manufacturers need to pay attention to the user experience and aspects such as comfort, aesthetics and portability in order to differentiate themselves.

Active early interaction and collaboration between users and medical device manufacturers at the beginning of the development process leads to better quality, functionality, usability, design and effectiveness. It also helps to identify pain-points, reducing the risk of costly later-stage development changes and driving the overall success of the device as patients are more willing to comply with the treatment. This is especially important of self-administering devices, such as infusion pumps or dialysis machines for at-home use.

But engaging with the active healthcare consumer also present us with some challenges. Technology advances mean that people are now used to instant solutions. The currency of convenience within our culture also means that patients are less willing to make lifestyle changes to suit a new medical treatment, and expect instead for the treatment to suit their lifestyle choices. They may be willing to adapt to an extent but the majority can now research alternatives to their prescription and find a more flexible alternative that fits better into their daily life. In this context, aligning new treatments and devices with the user expectations around convenience is, therefore, crucial. And never more so than now.

Home is where your health is

Last year, our desire for convenience took an unexpected turn with the pandemic, and the mandatory move to use our homes to work, exercise, educate, and as the place for all our day-to-day activities.

Healthcare systems also saw a surge in demand for home-based medical treatments instead of patients receiving all their care in hospital. For example, cancer patients may now opt to receive therapy in the comfort of their home through ambulatory infusion pumps worn over twenty-four-hour periods rather than having to go through multiple hospital visits.

At-home care means that patients can reduce the number of people they come into contact with, alleviating the load on hospitals by reducing the number of in-patients. It also means that patients can spend less time in hospital settings, and alleviate the impact that multiple hospital visits might have on their everyday life and mental wellbeing. Another prominent driver for at-home care is the aging population as we see an increase in chronic illnesses such as incontinence and diabetes.

Enabled by advances in medical technology, treatment and care go hand in hand and makes it possible for patients to receive treatment outside of a clinical environment with the required level of control. Predictive analytics allow for the identification of patients that could most likely benefit from such home-care schemes. With precision monitoring and connected devices, patients are also empowered not to rely so heavily on healthcare professionals being physically present.

While there is a drive for more at-home treatment, it is also worth noting that there are some patients who still want to have full contact with a doctor and to be treated in a clinical environment. In the same way that other consumer-led industries tailor their products and services to people’s needs and desires, healthcare providers and medical device manufacturers should be adaptable and adjust their approach when designing new products or services too – there is no ‘one size fits all’. In that context, listening to the targeted users of new devices, adapting to their evolving needs, and considering a choice of therapies or systems that might suit their aspirations is essential to succeed.

Conclusion

Ultimately, using consumer knowledge and understanding user behaviours during the design process of medical devices and systems adds enormous value for all stakeholders. Having such knowledge at the forefront of the process improves later adherence and empowers individuals leading to a more successful result.

With technological advances, healthcare professionals can ensure appropriate use, driving adherence remotely and opening up opportunities for a collaborative approach and win-win situations when it comes to the patients’ health and wellbeing.

If there is anything we learnt last year, it is how quickly our values and priorities can shift. With this in mind, medical device manufacturers and healthcare provides must continue to adapt to the needs of patients.

This is inarguably the direction the medical industry is heading. Healthcare innovators must consistently gain feedback and insight directly from their target audience and avoid holding onto assumptions. Only then we can stay ahead of patient attitudes that continue to evolve – as they inevitably will.

In recent years, wearables have started to play a pivotal role in the lives of patients. From the management of chronic conditions to making sure that we drink enough water, wearable and mobile devices are revolutionising the way that healthcare occurs.

Wearables can improve the lives of patients and caregivers and, crucially, in the context of the current pandemic, reduce the burden on healthcare systems at a time when they are most stretched.

From smart textiles to electronic tattoos, the increased use of wearables in healthcare has been driven partly by remarkable developments in technology. These range from leading-edge advances, like augmented reality and body-powered devices to traditional products like watches or GPS devices, adapted and repurposed to provide new capabilities.

But the change has also been underpinned by the fact that people are increasingly willing to share their health data, and take an active role when it comes to staying healthy. Tools like GPS tracking, and activity and heart rate/oxygen saturation level monitoring increase people’s ability to self-manage conditions, and can support disease prevention. Such tools can also be used for remote diagnosis and collect data in a way that was hitherto not possible.

In this article, we will look at the current and new wearable technologies that are emerging in the context of COVID-19, and what they might mean for the future of healthcare and the prevention and management of chronic conditions. Lastly, we will tackle one of the biggest challenges ahead – how to test and validate the use of wearable devices successfully in the context of clinical healthcare settings.

Wearables and digital healthcare in the context of COVID-19

Earlier this year, a piece of research conducted by the International Data Corporation in light of the new coronavirus predicted a 30% increase in sales of health wearables in 2020, due to consumers’ increased interest in their own health. At the same time, opportunities for new product development are opening up with a range of technologies that lend themselves to varying forms of infection control.

One example is Immutouch – a smart band that vibrates when users touch their face, potentially preventing them from catching diseases. After downloading the Immutouch app, the band can be calibrated by bringing the hand closer to the face, which will cause the device to vibrate, thanks to a gravimeter placed inside that uses a personalised algorithm.

This type of solution may be helpful for those working in a front-line role. It can also provide potential benefit to those working in customer-facing industries like retail, manufacturing and public transport.

Another example is VivaLNK’s Continuous Temperature Sensor patch, designed for remote, 24-hour monitoring of axillary body temperature. This type of solution has a broad purpose – it could provide a monitoring tool for those who are undergoing immunosuppressive treatments and could also support the conduct of clinical trials. The product range employs an eSkinTM Technology which is a breathable film substrate with integrated sensors and circuits. This illustrates one of the big advances in this field – the shrinking of sensing technology means that it can be worn for increasing amounts of time, enabling new applications.

Digital tools can also help when the goal is to provide public health information or to respond to requests for information. For instance, the Japanese chatbot Bebot supports crisis workers by giving members of the public instant information about COVID-19. The chatbot doesn’t require an app and pops up offering clear information in multiple languages to people visiting Japan, as soon as they connect to a public Wi-Fi.

Both within and beyond the current crisis, wearable technologies have the potential to profoundly impact our lives and support decision-making. In a way, it is about relaying information back to the user as well as recording information from them.

For example, Mojo provides smart contact lenses with built-in displays. Created by optometrists, medical experts, and technologists, Mojo lenses can help users access important notes without the distraction of a mobile device.

The lenses also display health-related information, such as heart rate, and navigation and sight-enhancement features. Within the current crisis, the benefit of this type of technology is that it can support communication without the need to touch an interface or mobile device.

Wearables in the context of chronic conditions

Whilst our immediate focus may be on COVID-19, there is a bigger picture in terms of managing and reducing the occurrence of long-term and chronic conditions. This type of condition accounts for the majority of healthcare spend and can be a significant risk factor in COVID-19-related hospitalisation.

Wearable technologies can prevent, reduce or delay the exacerbation of chronic conditions through real-time monitoring. The use of wearable devices means that symptoms can be picked up earlier, and that patients can monitor their own health and capture data to aid physicians in their treatment and prevention plans.

Good examples are wearable technologies that monitor someone’s activity, with monitors and smart watches becoming increasingly popular.

Being active plays a major role in the reduction of risk for many chronic conditions, and the use of wearable devices have been shown to reduce sedentary behaviour and improve overall wellness. In both the UK and the US, schemes have been rolled out that provide incentives to encourage patients to hit their daily step count and activity levels; factors which contribute significantly to chronic disease prevention such as obesity and diabetes. Such incentives can be in the form of vouchers or discounts, or funding towards health insurance. This incentive model can encourage people to remain active and reduce the risk of those susceptible to certain chronic conditions.

Monitoring through wearables also facilitates shared decision-making between patients and healthcare professionals, and is a valuable tool to promote adherence and compliance.

Enabling patients to monitor and potentially improve a chronic condition through tools such as wearables gives them a greater sense of control and empowerment.

Continuous glucose monitors are a perfect example of how a wearable can reduce the burden and increase the level of monitoring. With the device constantly tracking glucose levels throughout the day and night, an app can notify the patient of highs and lows. Patients are therefore provided with a clear image of their blood sugar levels without them needing to carry out regular finger-prick testing.

As the device allows continuous monitoring throughout the night, they are provided with a higher volume of data and therefore more consistent monitoring of their blood sugars in a way that would not have been previously possible.

Benefits are not limited to glucose monitoring – for some conditions such as Alzheimer’s and Dementia, simple wearables with real-time mapping, voice systems and the ability to activate an emergency call can greatly increase a patient’s independence and reduce the burden on their caregiver.

By being able to track a patient during their walk and communicate with them if necessary, their risks are reduced and the patient is provided with freedom for an extended period of time (i.e. they can be alone if they want to).

Some chronic conditions may be less obvious – for example, those that are at risk of heart disease can benefit from something as simple as a step counter.

As technology moves on, there is potential to integrate multiple sensors and leverage existing platforms, such as phones to develop a rich picture of, for example, the link between cardiac health and lifestyle. With this understanding, appropriate interventions can be targeted accordingly.

It is becoming increasingly clear that there is a lot of potential in wearables in terms of pre-empting and proactively managing chronic conditions, as well as managing and mitigating the impact of COVID-19.

In a healthcare setting, there are additional advantages to the use of wearable technologies, including:

• Supporting condition management – i.e. wearable devices can contain sensors that allow for tailoring of support and treatment.
• Supporting the move to a pre-emptive model of healthcare – for example, by helping people to look after themselves and avoiding more significant interventions such as surgery. Wearables can also form part of a behaviour change approach that promotes a healthy lifestyle.
• Improving outcomes, by collecting data in a way that was not previously possible (e.g. home use body-worn ECG monitors).
• Engaging communities. One of the great things about wearables is that they allow for “maker” communities – working in hackspaces, with open source tools that share ideas in an interdisciplinary setting – to come together and approach a challenge from a fresh perspective.

Yet, with those advantages come some challenges, particularly when testing those devices in the context of traditional R&D models. In the last section of this article, we consider how such potential can be measured and demonstrated.

Testing wearables – what works best?

By definition, wearables are part of a broader system which means that collecting feedback is inherently contextual and distributed. What’s more, wearables typically involve attaching objects to people, a process that always requires careful consideration. For example, trials of systems that use an adhesive to attach wearable devices to the body reported instances of transient skin irritation in 2.7% of people. There is a large body of literature around MARSI (Medical Adhesive-Related Skin Injury) and a need to carefully consider the impact of extended wear periods.

Given the complexity of designing wearable systems, here are some suggestions as to how to get the best value out of them:

We need to adopt an interdisciplinary approach

Wearables combine different forms of technology. Take, for example, a body-worn sensor. In bringing a solution to market there would be considerations around the shape, size, method of attachment, etc. There would also be considerations around the internal components, the suitability of the sensing technology and a range of options around batteries and connectivity. The approach to testing will therefore need to take all of these factors into account and borrow learnings from other industries (sporting, military, etc.) – we need to think broadly.

We need to test in context

It goes without saying that when testing this technology, we need to take into account the complexities of everyday life, such as how technology is carried around and how it impacts on work life, social interactions, etc. This is hard to do in a simulated context, or in a market research facility because we don’t capture the full range of factors associated with real-world use. In these cases, a different type of approach is required where we use ethnography or contextual inquiry; or where, instead of a moderated study, data is collected through diaries or notes.

We need to collect feedback over extended periods of time

Something we want to avoid with wearable technology is people taking the device off. If that happens, the benefit of the technology has been lost. Although there are many ways of testing healthcare-related technologies, not that many of them consider extended periods of time, nor adopt a longitudinal approach or time-series data. This is particularly important as it is not uncommon for there to be an initial period of engagement to be followed by a fall-off in the use of a given technology. Therefore if the test window is short, we may miss important things. The longer a candidate technology is used, the more likely we are to find out what may impact on the acceptance of it. This requires the use of a new type of extended trial design.

We need to consider data analytics during the design and development process

Wearables often collect data. How this data is used is an important part of the process and there is benefit in terms of being clear about this at the outset.
There is a balance between too much and too little data, e.g. it can be helpful to know what you want to get out of a sensing technology and avoid throwing everything at a given problem.

We need to work within an underpinning framework

In the same way, there will be a need to fine tune some of the algorithms that will form the basis of the technology, there may also be a need to understand why a device does or does not provide the desired effect. Although this may be debatable – some might say that if something works, then who cares why – with wearable technologies, we need to adopt a theory-driven approach.

Whereas previously our interest would have been on whether someone can use a device – now we are also interested in aspects around continued use, co-evolution and effective adaption of intervention content to changes in technology.

PDD is exploring wirelessly-connected drug delivery systems alongside the use of digital apps and sensors to improve patient experience and condition management. We are also developing algorithms that can determine if people are compliant with this type of technology. For example, sensors that can be worn on the patient’s body detecting movements continuously on a 24/7 basis.

Although there are many off-the-shelf solutions which fulfil the need from a technical perspective, customised solutions can offer many benefits especially in light of comfort, compliance and long-term wear. We can therefore use sensors not only to determine aspects around lifestyle but also to understand the suitability of alternative solutions and the extent to which users are prepared to keep them attached for extended periods of time.

In recent months at PDD, we have developed our own innovations in terms of attachment, including adhesives and materials research to find a solution that can be as unobtrusive as possible. Our work included the research of current designs and off-the-shelf options, concept development, refinement and visualisation, early-stage modelling and two stages of user testing. The solution adds value in allowing for long term use and wear, improved compliance and rich data whilst being minimally apparent to the user.

With wearables becoming more popular within healthcare we need to remember that they will be used by a wide range of users from those who are digitally literate to those who are technology averse. Therefore, it is important to consider and research the varying user needs to ensure that what is developed fits a variety of user profiles.

At the same time, we need to consider aspects relating to data protection and privacy. Given the amount of data that is available through the use of wearables and the complexities relating to data storage, consent and management – there is a need to adopt a carefully designed process to research and development.

The road ahead might be complex, however, the opportunity for wearables to have a positive impact in our healthcare ecosystem in the long term is well worth the investment.

 

Mobile phone software applications are a ubiquitous part of society. In 2018, there were estimated to be 205.4 billion smartphone health app downloads (worldwide). In 2021, this figure is expected to rise to over 352.9 billion. The adoption of digital tools to track and improve health is a big part of this trend and offers the potential to minimise the cost of care and reduce the chances of suffering from a disease.

In this piece, we explore some of the recent innovations in this area and consider how they will make a difference. Healthcare gadgets are enabling us to take control by monitoring our lifestyle and storing health records. With modern technology this burden can be reduced, placing data tracking tools under an increasingly favourable light.

Artificial Intelligence (AI) has long been a topic of interest across the tech industry and it will continue to prove useful within the healthcare context by streamlining administrative and clinical processes. Because AI applications cannot yet make clinical decisions, they can be used to improve staff productivity and make back end processes more efficient. According to Accenture analysis, several major applications are set to reshape the healthcare sector by 2026.

Source: Accenture

As illustrated above, each application has an associated value and the higher the value the more likely implementation becomes. Hence, robotics is likely to become prevalent and offer new capabilities (for example incorporation of information from medical records during operations in real-time). This analysis also forecasts that virtual nurses will become another frontrunner –  AI applications will allow users to have their symptoms checked remotely and results sent to clinicians only when patient care is required, avoiding unnecessary visits to hospitals.

What do tech giants have in store for healthcare?

By combining data stored on mobile phones with health records from multiple institutions, Apple is generating a holistic overview of user health. Apart from allergies and medications, users can also access details about their own mental health, which are generated through changes in screen time or drop-offs in social interaction. Eventually, users are notified and alerted to address such issues. Technology is, therefore, serving as a way of understanding personal wellbeing.

                    Image credit: Apple

At the same time, binge-watching TV shows, replying to work emails and catching up on the latest social media posts might not lead to a balanced life (for example overuse of technology could lead to sleep deprivation and/or a disturbed sleep-wake cycle). Researchers suggest that poor sleep is related to the risk of cardiovascular disease (for example). However, technology can be used to address this concern – for example, sleep tracking devices might help diagnose when sleep patterns are unusual and/or flag issues.  For instance, the sleep tracking app Urbandroid was developed for Android users and monitors sleep. The awake-detection process is depended on users’ sleep phases, heart rate and movement patterns. It uses Philips Smart Light to wake them up at an optimal time, therefore, facilitating sleep quality.

Image credit: Urbandroid

Good quality sleep is regarded as beneficial as it can help users lower their anxiety and feel refreshed and rested. Wearables can also play a role in this – offering personalised suggestions on how to improve health. Reviews suggest that the latest addition to Fitbit’s charge generation – Fitbit Charge3 smartwatch will place the brand at the top of the list for smart wearable devices.

Image credit: Fitbit and Wired

Across many applications, customers are increasingly looking towards technology-mediated support. For example the emergence of autonomous and internet-enabled appliances ready to provide nutritional advice adjusted to individual need. Innovative fridges, such as Samsung’s Family Hub™ Multi-door Fridge Freezer incorporate a recipe app, inner view cameras and shopping reminders into a kitchen appliance – ready to feed the appetite of the health-conscious consumers.

Image credit: Samsung

With this array of modern technology, unhealthy living will hopefully become a thing of the past especially with the emergence of autonomous and internet-enabled gadgets ready to assess your performance and provide suggestions for improvement based on your lifestyle. Nevertheless, it is still to be established whether wearable devices will ever replace doctors; and not because they are lacking in precision or information, but because the social interaction between patients and the medical staff goes beyond sensors and a smart screen.

A few PDDers and I attended the Wearables 2015 conference in London, which was a great chance to see the latest trends in the wearable tech field. A range of exhibitors from startups to industry giants were displaying impressive devices such as Open Bionic’s 3D-printed Prosthetic Limbs and Samsung’s Oculus Rift-based VR headset.

I was particularly curious to see whether the industry has finally developed something that has the potential to change people’s lives and provide real benefits, because in the past few years, there have been very few products that deliver a meaningful user experience (see a previous blog post on the “Why of Wearables”).

So it was interesting to see that wearables might provide real value in the workplace. Wearables for work can be tailored to the needs of a specific task instead of being designed for general use, such as Intel’s smart Jacket prototype which allows workers in hazardous environments to detect dangerous gases using sensors built into the jacket. Likewise, smart glasses could provide access to critical information in an urgent situation, allowing people to see the needed information without having to turn their gaze toward a screen. Boeing are testing Google Glass with their employees, and medical professionals are exploring the benefits of giving smart glasses to their staff.

Moreover, the health benefits could be huge. Along with the usual wearable health programs to encourage employees to exercise more, wearables could be used to track posture and muscle strain, identifying health problems before they can cause serious damage. Wearables like Sun Friend UV sensing smart band could make sure employees in outdoor environments are not overly exposed to sunlight. Innovations like these could ensure a healthier happier workforce with less time lost due to injury.

A doctor uses Google Glass. Image vcredit: valeira.com

Like any new field of technology however, this progress comes with a dark side. With the rise of wearable tech and better ways to monitor employee data, we will soon start having to ask ourselves some hard questions about how much information employers should know about their employees.

For example, do you think your mid-week hangover is hard enough to hide already? Wait until your line manager can use an accelerometer to spot your slower-than-usual walk patterns. Having a tough time in your personal life but would rather not talk about it at work? Too late, your HR manger wants to talk about your sudden increase in blood pressure. Think personal reviews are tough? Well now your boss can use the GPS monitor in your smartwatch to calculate just how much time you wasted making coffee. Want to talk to a colleague about how your boss is turning your office into a police state using wearable tech? Unfortunately they forgot to switch their smart glasses live stream off and now the whole office is watching. Not even your thoughts are safe. As electroencephalogram (commonly known as EEG) headbands get cheaper and more accurate, management will be able to tell just how hard you are concentrating on work at any one time. And let’s say you are lucky enough to work for a company who respects your data and will never use it against you. That’s fine, until your company gets hacked and suddenly your personal body data is in the public domain.

I should probably stop describing this workplace dystopia before this turns into an episode of Black Mirror (which I recommend you should watch if you haven’t done so already.) Either way, as I stated at the start of this post, I still believe that wearables have potential and looking at what benefits they could bring to the workplace they are too big an opportunity not to explore.

What are your thoughts on wearables at work? Tweet @PDDinnovation #wearablesintheworkplace

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