By Chris Van Hoof, Holst Centre/imec
With an aging global population and a rise in chronic disease, recent years have tested the limits of traditional healthcare systems worldwide. Medical professionals and researchers across the globe have been focused on finding suitable alternatives to reduce or stabilize healthcare costs. That was the initial premise behind development of some mobile health apps and wearable tech: provide doctors with tools and new information, enabling them to deliver even higher standards of care, and leading to a reduction in hospital stays without compromising patient care.
Still, the long-term vision for wearables in healthcare includes an active role restoring patient health, preventing certain diseases by promoting behavioral changes, and ultimately, promoting healthier lifestyles, leading to improved overall health.
An Ounce of Prevention…
In the context of patient care, today’s health apps and wearable solutions already are able to monitor a patient’s status and report it to their healthcare provider. However, medical-grade solutions remain relatively bulky and today’s consumer solutions, while small and convenient, are lacking in performance. Device developers must create wearables that provide medical-quality data in a consumer form factor, enabling people to leave the hospital bed sooner and recover primarily in the comfort of their own homes. While this is a big step forward, it is just the beginning.
In the near future, these devices also should be able to detect early signs of anomalous levels and/or trends in certain indicators — such as spikes in blood pressure and irregular heartbeats — and automatically react to them by delivering medication, contacting a care provider, or other courses of action. Closed-loop “artificial pancreas” systems are among the frontrunners in this type of design.
Whenever possible, the goal should be to prevent hospitalization. After all, nearly 80 percent of all cardiovascular disorders are preventable. And, in most cases, such disorders are the direct long-term consequence of unhealthy lifestyles — bad eating habits, smoking, drinking, lack of activity — which can lead to hypertension, cardiovascular disease, and diabetes.
Rather than focus on managing these chronic conditions, we should work on decreasing their emergence. Around 97 percent of overall healthcare costs worldwide go to treatment, with only 3 percent focusing on prevention. That needs to change. Further, we need to tackle these issues at a much younger age, promoting healthier lifestyles amongst teenagers and young professionals.
The Personalized Virtual Coach
But, just how effective are fitness trackers and health apps that display smartphone notifications saying, “It’s Tuesday, let’s go for a run”?
Today’s apps lack intelligence. They are not taking into account people’s interests, habits, or schedules. They provide generic recommendations based on the average person. But people are not generic. They require individual advice and feedback, adapted to their lifestyle, physical condition, and overall goals. In other words, these apps should work as a personal coach — a “virtual personal coach.”
Stress management, for example, is a relevant application domain for the virtual coach. Working together with behavioral experts, psychologists, and psychiatrists, imec has been studying how different people — and population groups — are triggered by stress, how their bodies express it, and what their coping mechanisms are. The goal is to be able to predict stress-inducing moments and provide personalized advice at the right time.
Similar studies are being conducted to capture smoking behavior and encourage weight management. More than simply counting how many puffs one had during the day, or tracking calorie intake, we want to understand what triggers people to light a cigarette or to binge-eat — and teach them healthier alternatives.
Finally, these applications can’t be isolated; they need to be context-aware. They must have access to patients’ schedules, know their surroundings, and understand their personalities. That is the only means for such apps to predict — accurately and in timely fashion — those behaviors we want to prevent, and to steer people towards healthier lives. Once we manage to develop these prediction and personalization capabilities, a “virtual personal coach” may become as compelling and effective as a real one.
The Bigger Picture
This future is close: medical-grade wearables will be a common part of our daily lives within 10 years. However, before the future can arrive, a few conditions still need to be met.
Once the big players in mobile communications and healthcare systems start developing and commercializing wearables that provide sufficient added value, people will start buying them. Of course, doctors will only start prescribing apps and wearables — and applying data from said devices to care decisions — if they know which products are trustworthy.
To create this surety, the industry needs a certificate, similar to an “FDA approved” designation. However, for apps this can be a problem, since they are updated regularly and can’t go through an in-depth approval cycle every time. A special regulation will need to be developed, and this could delay the use of apps and wearables in the medical scene. Thus, in order to advance, respected opinion leaders must come together and endorse these types of apps and devices based on scientific and clinical trials. This collaboration must be accompanied by regulatory bodies recognizing — and acting upon — the need for a recognized standard that can grow alongside the rapidly evolving ecosystem of apps.
But a deeper, more drastic change must take place in the healthcare models for this vision to become reality. We must focus more deeply on patient outcomes in our evaluation of the work of healthcare professionals. Reimbursement models already are shifting towards this vision, with an increased focus on proving the effectiveness of prescribed treatments for the patient. Once there are certified apps and wearables, and their use is incorporated into most doctors’ training curriculum, this focus on outcomes will permeate through both the medical community and society in general. Only then will wearables begin to have a tangible impact in preventive medicine, which in the long term will have a major impact on cost reduction in healthcare systems. While insurance companies already are starting to see the benefits of medical-grade wearables, it’s in governments’ hands to further promote these changes.
About The Author
Chris Van Hoof is program director for Wearable Healthcare and a Fellow at Holst Centre/imec, where he is currently developing solutions for chronic-disease patient monitoring and preventive health through virtual coaching. He completed his PhD in Electrical Engineering at KU Leuven in 1992, where he is now full professor. His work in the healthcare domain has already resulted in the creation of three health start-ups. He has published over 600 papers in journals and conference proceedings and has given over 60 invited talks.