The next phase for medical wearables

Wearable technologies are already beginning to revolutionise medical care, with a host of devices now capable of monitoring an ever-growing array of vital signs and biomarkers. But how can this data be used? Abi Millar talks to Dr David Nickelson, VP of healthcare at digital health consultancy Nerdery, to find out more about the next steps for wearable tech in the medical field.


ver the last ten years or so, the consumer wearables market has grown in scope and scale. Ranging from GPS watches for amateur athletes, to wristbands that track your sleep, wearable devices are changing the way people monitor their health and fitness. 

As these devices become more sophisticated, and better able to monitor their users’ vital signs, we are starting to see some blurring of the bounds between consumer and patient. 

Digital health tracking tools are being used not just for general ‘wellness’ purposes, but also for disease management – connecting patients with healthcare providers and proactively flagging up any issues. 

Perhaps unsurprisingly, the Covid-19 pandemic has expedited this trend. A recent report by Stanford Medicine and Rock Health found that the pandemic kicked digital adoption into high gear, both with regard to wearables and other telemedicine tools. 

In their survey of nearly 8,000 US adults, 43% of respondents said they owned a wearable, up from 33% the year before. More than half of those users (51%) use the wearable to manage a diagnosed health condition, up from just 29% the previous year, and 54% tracked a health metric digitally, up from 42% in 2019. 

Who’s using wearables?

Dr David Nickelson, VP of healthcare at the digital health consultancy Nerdery, thinks we’re seeing a genuine shift in the way these devices are being used.

“In the past, wearables were primarily used by folks who are already interested in tracking health and wellness – athletes and the ‘worried well’,” he says. “Before Covid-19, while people with chronic diseases would often buy these devices, they would stop using them within 30 to 60 days. The Stanford report found that Covid-19 seems to have changed that.”

The new wave of adoption, he adds, comes not from the ‘worried well’, but from average people who realise they need to take better care of themselves.

“Every piece of information we have seems to indicate that that’s going to stick after Covid-19 resolves itself, and that bodes very well for what wearables will be able to do going forward,” he says.

Can we use machine learning to identify the incidents a physician should pay attention to?

He thinks the next iteration of wearables will be more sophisticated and accurate, and better able to provide the kinds of insights patients and providers can put into practice.

“For example, we're working with a big medical device company right now, which has a tool for tracking cardiac arrhythmia,” he says. “Although it’s a wonderful tool that gives you tremendous amounts of data about every patient, physicians don’t have time to look at every data set and make sense of it.

“The next level of thinking there is, can we use machine learning to identify the incidents a physician should pay attention to? That’s where good design matters – creating interfaces and data visualisation tools that patients and providers can use easily.”

A matter of trust

So if wearables are here to stay, how best can this data be used to inform patient care, and what are some of the challenges?

Nickelson thinks we need to consider several aspects of the equation – not least data accuracy, information security, cost and business models.

Regarding data accuracy, improvements are happening all the time, to the point that manufacturers like Apple and Fitbit have started to pursue US Food and Drug Administration (FDA) approvals for some of their consumer sensor technologies. This in turn will make doctors more inclined to trust those devices.

The big challenge here is that patients don't trust big tech with that data.

“The big challenge here is that patients don't trust big tech with that data,” says Nickelson. “Going back to the Rock Health/Stanford study, when you look at patient willingness to share data, the person they trust the absolute most is their individual physician.

“The next group they are potentially interested in sharing their data with is their health insurer. But big tech is near the bottom of the list of who consumers trust with that data.”

The upshot here is that if a technology company wants to get the most out of wearables data, it may be wise for them to partner with individual physicians or health systems rather than trying to do it single-handedly.

Why healthcare business models need an overhaul

Two further problems are cybersecurity and costs. Hospitals and health systems remain poorly equipped for collecting and analysing data from wearables, and their cybersecurity readiness is lagging behind other industries.

“All of a sudden, they're waking up to the fact that they probably have some significant security challenges with the systems that they've built to manage Covid-19,” says Nickelson.

“Their electronic health records were not built to collect third party data, or to analyse that data and provide meaningful insights back to the physician. So the challenge remains, who’s going to pay for making that happen?”

He points out that in the traditional healthcare payment process, payers, providers and device manufacturers are misaligned. Under a fee-for-service system, none of these parties has a financial incentive to use wearables for what they’re best at – namely prevention and chronic disease management.

Their electronic health records were not built to collect third party data.

“We've seen a big shift in the United States towards value-based healthcare and value-based payments, which means you get paid by keeping patients healthy,” says Nickelson. “As those models come on, I think wearables have enormous potential.”

He cites Apple as an example of a tech firm that’s getting it right. Apple doesn’t want to be a health company – it wants to be a trusted consumer brand that collects health information via the Apple Watch. Over time, it hopes to create an ecosystem of big data, which third parties can collect, integrate and use creatively.

“We will start to see some interesting business models focused on health, wellness and prevention, where those collaborations create revenue streams or savings for all the parties involved, as well as improving health,” he says.

How wearables might be used in future

Further down the line, these kinds of changes to the healthcare marketplace could have profound implications – not least for flagging up public health events like pandemics.

“I think wearables are an incredibly important piece of that, because then you could say, hey, we're seeing spikes in people's temperature, or we're seeing sleep patterns being disrupted,” says Nickelson.

“At some point, we will be smart enough with big data to be able to say, we're seeing a cluster of activity happening in a certain geographic space. And because of that, we can predict that there is some kind of health concern happening.”

Nickelson thinks this scenario may not be as far away as many people think – although it will depend on healthcare providers and health insurers being proactive about collecting wearables data.

Consumers will recognise they need to take a more proactive approach to their own health.

“They have to be open to developing the kinds of partnerships we need for a really excellent digital health ecosystem happen at a regional or even a national level,” he says. “We’ll see more providers trying to figure out how to build the right collaboration, and we’ll get third party entrants coming in, opening up electronic health records so more people can get to them.”

We’re also likely to see an even greater convergence between the consumer wearables market and traditional medical devices.

“The consumer technology companies will come from one side, and the regulated medical device manufacturers from another, converging on a space where their sensor technologies have FDA approval, broad appeal and a low-cost point,” says Nickelson.

“My prediction is that consumers will recognise they need to take a more proactive approach to their own health, and that digital tools can be an important part of doing that. So, I think the trend that started with Covid-19 is going to stick.”