Protocol Manual: Health Care

The future of staying healthy is sitting on your wrist

The pandemic has shined a spotlight on the reams of data that wearables are collecting on their owners at all times. Now doctors are starting to see the value in it.

Wearable smart blood pressure monitor

Getting your blood pressure taken in your living room is a lot less stressful than at a hospital. Is this what the future of health care looks like in the U.S.?

Photo: Fabian Strauch/picture alliance via Getty Images

In 1965, a simple device called manpo-kei was introduced in Japan. Its name literally translates to "10,000 steps meter," and the small mechanical pedometer was endorsed by local hiking and walking groups. That nice round number has since been adopted by groups like the American Heart Association and the U.K.'s NHS as a recommended goal for people to hit each day to keep healthy. Although that number was based more on marketing than science, it gave birth to the wearables industry we have today.

From those humble beginnings, wearables are now more powerful than early smartphones, with some capable of tracking heart rates, blood-oxygen levels, your heart's electrical signals, temperature, sleep and, yes, steps. For the most part, these devices are built by consumer electronics companies looking to sell people on healthier lifestyles. Early Fitbit ads focused on helping you "find your fit," and the now-defunct Jawbone aimed to inspire consumers to compete against their own personal bests. Even Apple, when it first launched its own watch in 2015, marketed the product as a lifestyle and fitness device.

But over time, the positioning of wearables (and the iPhone) has evolved from simple exercise tracking to being the nexus of your personal well-being. Two years ago, Apple opened up its electronic health records API to developers, and it has since introduced partnerships with the VA to store veterans' health records in their Apple Wallets, as well as the records for patients of major health systems, including Johns Hopkins Medicine, Cedars-Sinai and Penn Medicine. Companies like Quest Diagnostics and LabCorp, two of the largest lab-services firms in the U.S., now also support their lab results being imported into Apple Health.

But things are still not as simple as they could be. With COVID-19 devastating the U.S., many people are stuck at home, unable to see their usual doctors. Telemedicine is booming, but for the most part, electronic health records are stuck in the past, and doctors can't do much with any diagnostic information that patients might be able to capture with devices they have at home. One exception: The FDA recently allowed certain Apple Watch models to take echocardiograms (EKG, a measurement of heart health) for diagnosis on a telemedicine call. Previously, doctors couldn't use a patient's Apple Watch's rudimentary EKG reading. Now they can, at least for the duration of the pandemic.

With a few more hurdles cleared, wearables could help create a revolution in the way we receive health care in the U.S. Gone would be the annual (or less frequent) checkups and the idea that you only go to the doctor when you're sick. Instead, devices could alert you — and health care professionals, if wanted — when issues appear to arise, helping doctors address them before they become full-fledged problems. It's a future the pandemic has helped reveal, and it could soon become a reality.

What wearables can diagnose now and what's next

The first connected wearables arose as the smartphone boom began in the late 2000s. Devices like miniature Bluetooth transceivers and accelerometers, popularized in smartphones, became affordable to put in other products, like early connected step-trackers from Fitbit and Jawbone. Over time, other miniature sensors and algorithms have been developed to track things like heart rate, sleep quality and heart issues like atrial fibrillation (or AFib). These wearables, originally the domain of fitness enthusiasts and data nerds interested in learning more about themselves, have slowly morphed into devices that clinicians can leverage in diagnostic situations.

Even before the pandemic, this trend was already emerging, according to Mathieu Letombe, the CEO of Withings, a connected-device company that makes scales, wearables and other products for tracking your health. His company, which founder Éric Carreel bought back from Nokia in 2018, has pushed deeper into the medical-device industry, creating blood-pressure monitors, sleep trackers and EKG monitors in its watches. Withings also started working with clinical partners and organizations dedicated to weight loss and diabetes management when it launched its Med Pro business last year. Health care professionals can sign up to manage data sent from patients' Withings devices and follow up on any troubling issues they see — for example, if someone's blood pressure or weight has steadily been rising for a few weeks. In some cases, insurers will reimburse patients for their devices.

Letombe said that the medical-services business accounted for about 10% of Withings' revenue last year, and he expects that number to rise to 20% this year. It was a marked shift from the company's past strategy of just selling through big-box channels like Best Buy or Amazon, but one that likely has been aided by the pandemic. "We got tons of requests from hospitals," Letombe said, adding that the company's forthcoming ScanWatch can check things like blood-oxygen saturation and sleep apnea, so health care systems were interested in using it to keep tabs on COVID patients. The French government gave Withings special dispensation to let hospitals offer it to patients for just that cause before it's officially available. It helped them free up beds for the worst afflicted patients, while still monitoring those they had sent home.

With the rise in telemedicine during the pandemic, more patients and their doctors are seeing the value in systems like Withings'. "Telemedicine and remote patient monitoring really went onto the radar of pretty much every clinic, every government even," Letombe said. And he's confident that that trend will continue after the pandemic.

"You spend 20 minutes every six months with your physician or your cardiologist: He has to make a decision or a medication change based on one measurement," Letombe said. "And then you go back home without someone to monitor you, without someone to motivate you, and then you go back six months later just to see you have the same results."

With Med Pro, or similar systems developed by other companies like TytoCare or Vivify Health, the goal is to produce an ever-constant stream of information that patients and their doctors can take action on when issues arise, not just when they have a physical scheduled. "Everyone is finally realizing that through COVID," Letombe said.

In the future, wearables will likely help us realize that we're sick even before we do — and help us prevent illnesses rather than treating them after the fact. Even with COVID, some early trials have suggested that data that existing wearables can collect could be enough to help people know when they've contracted the virus.

Michael Snyder, chair of Stanford Medicine's Department of Genetics, set up a database of heart-rate data from wearable owners who opted in to share their data with the university. His team is trying to determine whether changes in heart rate can detect whether someone is getting sick — and given the state of the world right now, that illness would most likely be COVID-19. Snyder himself has been tracking his heart rate with wearables for two years, and told Protocol that every time he has been sick, the watch has shown an uptick in his resting heart rate before he's shown any other symptoms. "We think smartwatches and rings can be very powerful sensors for when you're ill," Snyder told Protocol.

Another company finding something similar is Oura, maker of the smart rings that the NBA recently bought to monitor the health of the hundreds of athletes taking part in the truncated season at Disney World. The smart rings can track the wearer's heart rate, skin temperature and sleep quality. Oura is conducting a similar study to Snyder's with UC San Francisco to provide rings to front-line workers to help track outbreaks of COVID-19. Echoing Letombe, Oura's CEO Harpreet Singh Rai recently told Protocol that the U.S. doesn't have health care — it has "sick care." Doctors prescribe blood-glucose monitors to diabetics, rather than work to treat the underlying issues before they turn into problems. "Our society and medical devices, unfortunately, has always been reactive instead of preventative," he said.

Wearables are half the battle

Devices like those from Apple, Oura or Withings, designed with everyday consumers in mind rather than doctors, could help to lead to a revolution in the way we take care of ourselves. And these devices are only increasing in popularity. Last quarter, nearly 120 million wearable devices were shipped globally, growing more than 80% over the same period the year before, according to IDC. (Apple led the charge with 43.4 million devices, primarily from its AirPods and Apple Watch lines of products.)

But the wearable revolution is about more than just the devices themselves — it's the data they can produce and who has access to it. In the U.S., digital health records have been adopted in fits and starts, with health care systems primarily relying on massive systems that tend not to be flexible or prone to easy data sharing. As Protocol recently reported, it still takes doctors an average of 16 minutes and 4 seconds per patient to enter data into EHR systems, and that's before you even wade into data collected by the users themselves.

But in March — separate from the pandemic that was soon to hit U.S. shores — the Department of Health and Human Services finalized rules on how patient health data could be easily shared between providers and third-party services, which could help pave the way for easier access to services like Withings' Med Pro. But rules are still needed to figure out how to use data that isn't currently protected by HIPAA — like what patients collect from their wearables and want to share with their doctors.

Data privacy remains a stumbling block for many customers. Sensitive data leaks from massive companies have given people reason to think twice about sharing data as sensitive as their own vitals. "You can't always go and see all the places your data is going afterwards, and I think that can become a problem for users," said Daniel Castro, vice president at the Information Technology and Innovation Foundation.

Withings' Letombe said his company has made it clear from the start that his customers' data is their data, and they can delete it whenever they would like. But he admits that other data-privacy scandals can make it tough to win over some customers — and doctors. He said his company wouldn't sell patient data to anyone, because they would never want that to happen to themselves if they were in that position. "When you explain that to someone, you need to be really clear because it's easy to lose someone with a ton of sentences, like terms and conditions," he said. "In that case, you have to be simple and clear."

Some health care providers have more quickly jumped at programs like Med Pro as they're already more digitally native. The trick, Letombe said of selling the service to clinics, is to find that digitally-savvy director or clinician, and have that person sell the rest of the team on why it's needed — especially during the pandemic.

From the patient side, Castro expects to see more remote patient monitoring and more connected devices regardless of whether we're in a pandemic — especially for those who can't easily get to a doctor's office. That could be people with limited mobility or parents with young children. "I expect you're going to start seeing more connected devices because that's the fastest way to get an answer from the doctor," Castro said. "You want to be able to check their mouth, their ears, check for a rash and be able to show that to a doctor."

Next in Protocol's Health Care Manual: The pandemic has caused a huge mindset shift in health care. An investor sees opportunities.

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