Wearable Devices in Healthcare - Literature review Example

Wearable Devices: The Next big thing in Healthcare? Introduction By 2017 the national healthcare spending in America is suggested to reach $4 Trillion a year (Patrick et al, 2009) fueled by a growing ageing populationand increasingly high healthcare costs. At the same time, many researchers and healthcare practitioners are hopeful about the use of advanced technological devices and equipment to help decrease healthcare costs and increase patient care quality across a range of medical practices. Over the past few years, the technological revolution has resulted in devices which are extraordinary in their sensing, communicating and analytic powers-smart phones and other gadgets used for entertainment, business and commercial purposes are only one side of this revolution. As humans have become increasingly dependent on and familiar with the computing powers of these sophisticated devices, the use of smart technology for assisting in healthcare diagnosis and healthcare provision seems to be the next logical step. The convergence of increasing computing power, personalization, and mobility is driving the future trends in information technologies (Patrick et al, 2009). People have become increasingly comfortable with using wearable devices that are embedded with IT enhanced capabilities for their entertainment, leisure and professional activities. An IDC report stated that it is expected that consumers and businesses will purchase nearly 112 million wearable computer devices by 2018 a 78.4% growth rate from the predicted sales for 2014 (Heneghan, 2014). Given the close proximity of these devices to their owners and the continuous use pattern that has developed for the average user, it is not a stretch of imagination to conceive of these wearable devices for healthcare monitoring and support especially for maladies which already require constant and remote reporting. Both the academic and commercial industry has undertaken efforts in recent years to closely study the use of smart wearable systems (SWS) for health monitoring (HM). The following literature review will attempt to collate existing data about the trend, its future possibilities as well as the challenges the medical sector will face in trying to adopt these wearable systems for effective and efficient patient care. Literature Review Most of the research on wearable technology and healthcare has focused on the evolution of pervasive computing along with the spread and accessibility of miniaturized and sophisticated mobile or embedded information and communication technologies (ICT).Understanding the supporting infrastructure for these technologies such as ‘artificial intelligence’, network connectivity and streamlined user interfaces has also been given importance as the devices cannot exist without these supporting systems. Given the unobtrusive ability of these devices for “analytical, diagnostic, supportive, information and documentary functions,” the medical community is optimistic for their utilization in improving traditional patient care (Orwet et al, 2008). It is expected that the healthcare landscape will change drastically with the introduction of these technologies which will allow greater individual patient management and continuous monitoring of a patient’s health status. Consisting of various different class of devices and components, from sensors to multimedia and communication devices these new healthcare application systems can potentially create low-cost, wearable and remote operated alternatives to the inpatient monitoring systems at present being utilized for traditional healthcare (Appelboom et al, 2014). The smart wearable devices with health related functions currently available in the market can be categorized into three groups based on their independent operation capability. Complex accessories such as Nike’s Nike+ FuelBand, Fitbit and Jawbone UP are accessories that assist in health exercise regimes and can operate semi-independently though they need a supporting smartphone or computer for complete functioning, these types of devices are currently the most popular amongst consumers. “Smart wearable” like Samsung smart watches and Google Glass provide the same connectivity and functioning as a mobile device, but it is debatable if their technical hardware could be changed enough to provide extensive health care support (Heneghan, 2014). The future of health care devices is more in line with Smart accessories that are consumer health care products that would be compatible with third-party apps; with research stating that that this will be the fastest growing category in the future (Pantelopoulos and Bourbakis, 2010). “Body area Networks” (BAN) comprise of a complex system of hardware and software technology that can be used to remotely monitor physiological signs of a human body. At this point the BAN technology is seeing a lot of interest from the corporations that see the potential for their use in various applications; however the widespread integration of these advances in the monitoring device industry remains limited in the medical practice due to several research challenges relating to application, functional, and technical requirements of the BAN.(Patel and Jianfeng Wang, 2010). These challenges include understanding the reliability and usability of these devices, as well as the accessibility to the relevant technology by the layman. While initial research on the topic focused on possible applications for the technology purely on a technical basis for prevention, prediction, and management of diseases, more current research is discussing the challenges for widespread acceptance and adoption of the technologies which now exist (Appelboom et al, 2014). People have shown an affinity for exercise related wearable gadgets which for example monitor calorie count and exercise undertaken; the fitness bands industry was valued at $1.5 billion in 2012 (Heneghan, 2014). Research is underway to develop similarly convenient, ubiquitous and unobtrusive devices to assist in more pressing issues like glucose level monitoring, blood pressure measurements, cardiac monitoring, respiratory rate, blood electrolyte systems, neurological monitoring, as well as physical therapy and rehabilitation medicine.This success of these efforts is evidenced by the fact that advanced medical device technologies have significantly increased in their comfort, ability and lifespan and likely contribution in enhancing the quality of life of individuals (Orwat et al, 2008). Besides the smart wearable body sensors that are developed to treat specific maladies, the range of wearable systems can also be extended to include everyday use mobile devices such as smart phones as supporting hardware due to the innovative combinations of software applications with existing communication technologies like Bluetooth and instant messaging (Patrick et al, 2008). Aligning the existing smart phone network with possible healthcare technology will have the biggest benefit in terms of ease of accessibility, there were 239 million registered mobile users in the U.S in 2007 with the number expected to increase exponentially in the coming years. This creates a network that can has not only streamlined communication and contact between n health professionals and patients by removing barriers of time and location, but which can also be utilized to create sophisticated messaging systems based on a person’s individual health needs. Two developers in Korea, Pei-Cheng Hii and Wan-Young Chung, proposed an innovative use for the patient’s Android™ smart phone device by converting the Smartphone into a mobile monitoring terminal that could “observe and analyze ECG (electrocardiography) waveforms from wearable ECG devices in real time under the coverage of a wireless sensor network (WSN)” (2011). ECG is one of the core medical references utilized for diagnostic and medication purposes; the market has already produced commercialized ECG mobile monitoring applications including wireless pulse/ECG watches to assist patients in self-monitoring. The invention by Hii and Chung, however, removes the need for any specific device and instead makes it more convenient and comfortable for patients to apply smart technology in their own health care. At the moment the smart wearable sensors industry has two main consumer groups: the health care professionals (i.e. medical personnel, including nurses and professional caregivers, paramedics, physicians) and the lay persons (i.e. patients and private caregivers, such as family members) with the health care settings predicted to be affected by these technologies differentiated into ambulatory, home and mobile, clinical, care and rehabilitation (Orwet et al, 2008). Even with the advances in the available technology catering to all these settings, both categories of users have to be able to understand and accept the utility of these devices before large scale adoption takes place. This is the point where market forces, economic interests and marketing dynamics come into play in the development of the healthcare sector (Olson, 2014). As with any other technological innovation these devices are expected to have early adopters form both individual and intuitional groups. However, given the necessary nature of health care provision any market-based approach to advocating such devices will fall short of the ultimate goal of creating a low-cost, effective and modernized system for everyone. Popular devices such as Nike’s Nike+ FuelBand is a luxurious product purchased by only those who have access to disposable income (Heneghan, 2014). There is a chance that future trends in the technology will be driven not by patient’s needs and healthcare concerns but by the amount of profit that can be made by creating complex accessories and smart wearables. A recent controversial Forbes article discusses how instead of the medical industry the early adopters of the Smart Wearable systems have turned out to be the corporations and insurance companies who are interested in getting continuous health data regarding their employees and clients (Olson, 2012). This data collected through remote sensors can provide indicators of employee activities andlifestyle which in turn is utilized by complex algorithms to calculate the costs of employee insurance and premiums. The points to one of the biggest concerns with wearable medical devices: the issue of privacy. As recent corporate trends show the safety of patient data may be at risk if these devices become more ubiquitous; healthcare payers could potentially use the steady stream of data to set higher premiums according to patient physiological activity.The effectiveness of such devices may depend on the number of groups who are authorized to receiveconstant data transmission (e.g the individual patient, his physician, emergency contacts etc) and this would increasepossible points for data leaksas well (Hii and Chung, 2011). For the medical industry and academics as well, these rising privacy concerns are becoming a noticeable issue. Deployment issues that are being studied for these wearables include:organizational and personnel issues, privacy and security issues, and financial issues (Appelboom et al, 2014; Orwat et al, 2008). However, meta analysis of the existing literature has also shown that there needs to be greater concern about these issues as in the long run unless such practical issues are solved there will be low acceptability by the mass market. The development of these smart wearable systems and their increasing abilities for tracking track mobility, health indicators, and symptoms has the potential to completely change the traditional health care system and patient behavior. Unfortunately, market perception matters a lot in today’s consumer driven world and unless these devices can be advocated for by the healthcare industry itself and in a timely manner there is a possibility that the devices will simply become another tool for the insurance companies and corporations as a way to circumvent individual privacy rights (Patel, Jianfeng Wang, 2010). Current use of Wearable Devices in Health Care: Currently there are substantial varieties of wearable devices being designed for monitoring the safety of individuals. Wearable devices are being created which help people suffering from illnesses and to help those who have a high risk of injury, making it easier for people to get help and assistance from medical services. Many of these are fall detectors, to help the elderly and those with life altering illnesses such as Parkinson’s and Cerebral Palsy. More than one-third of home-dwelling people aged 65 or above and two-thirds of those in residential care fall once or more each year, (Lord et al, 2001) therefore, over the past ten years many fall detectors have been designed to protect them. When considering the elderly, wearable devices may not be the ‘next big thing’ as ‘it may be too uncomfortable for some people to wear’ and ‘the device might be neglected to be worn at all’ (Mohamed et al, 2014). However, suitable devices have been designed to combat this problem, in 2006 Kang et al developed a wrist-worn integrated health monitoring device and in 2007 Almeida et al presented a walking stick with a gyroscope embedded at its base for detecting fall and measuring walking pace (Pannurat et al, 2014). Recently more emphasis has been placed on sensors placed in smart phones but as more accurate readings of falls can be taken if the sensor is attached to the center of mass, mainly the chest area (Pannurat et al, 2014), smart phones may not be able to provide the most reliable readings to tell whether someone has fallen. Another factor to take into consideration is that an elderly person may not wish to use a smart phone app; this may be more likely to be useful for a younger person who has the same issues concerning falling e.g. someone suffering from a life altering illness. In the field of wearable sensors, using this type of technology refers to the system’s ability to detect changes in a patient’s status requiring medical intervention. A research by Jovanov et al 2005 explores advancements in the role of wearable devices due to increased system processing power, such as the Wireless Body Area Network (WBAN) which has changed the way in which wearable devices can now be used for long-term home rehabilitation. WBANs are smart miniaturized devices which can be worn and can transmit necessary information to specialized medical servers without interfering with the patient (Crosby et al 2012). These devices can have a far ranging impact, and the benefits that these systems can bring to patients, hospital staff and society are numerous. In an article from Hadjidj et al 2012, the advantages of these devices are summarized as being cost effective, easy to install, creating care access improvement, helping with patient mobility, and increasing motivation and multi-modal sensing. For recovering patient, they can give them control over when and where they want to complete their rehabilitation. The use of wearable sensors can also help to increase motivation and engagement according to Patel et al 2012. The article states how using a virtual reality environment in terms of rehabilitation being focused around an interactive game can also help to engage patients with their rehabilitation. There are also specific benefits for the physicians and therapists. Allowing patients to rehabilitate themselves with minimum supervision and eliminating the need for specialist staff to be present, gives the physicians and therapists more valuable time. The system has the ability to issue alarms for the patient (Jovanov et al 2005) as well as sending a response to a specialized service in an emergency, this can provide psychological support to the patients, giving them the reassurance that the risk associated with rehabilitation at home is covered and help can be instantly at hand in case of emergencies. Providing an inexpensive and effective alternative for rehabilitation provides benefits to physicians, patients and society. It provides convenience and reassurance for patients and gives time back to health care staff. Specific examples of Health Care Wearable devices under research One specialized example of these devices is a wearable haemodialysis system. In 2007 Dr Andrew Davenport and others completed a study to assess the safety and efficiency of the device. Davenport states that ‘Hospital Haemodialysis and satellite unites generally do not have the capacity to offer patients more frequent haemodialysis treatments’ therefore a wearable device would be useful to help patients have dialysis at home.’ Though the device will need further research and testing, this shows that wearable devices are becoming a new way of providing treatment to patients which would make life easier and hospitals more efficient. A new device called the Wearable Cardioverter Defibrillators can serve as a bridging therapy and help avoid unnecessary permanent implantation of defibrillators in patients who ultimately may not need them (Baldwin 2013), this can provide life-saving shocks to a patient when needed and is only worn underneath the shirt. According to Malizu et al (2014) people with Parkinson’s disease often find that they cannot walk for short periods of time due to ‘freezing of gait’ experienced by them. An ankle motion sensor has been developed for this period which sends information via bluetooth to an android phone which can notify concerned persons for help. This technology is also used for children suffering from Cerebral Palsy who have this issue (Bre´gou Bourgeois et al, 2014). Patel et al, 2012 states that for Parkinson’s disease ‘the use of a sensor based system to monitor PD symptoms is a promising approach to improve the clinical management of patients in the late stages of the disease. The use of a ‘portable tri-axial accelerometer placed on the shoulder can monitor the severity of dyskinesia,’ (Manson et al, 2000) caused by a side effect of medication for Parkinson’s. This allows for an analysis of the drugs and prescriptions prescribed to individual patients. Uswatte et al, completed a study to show how motion sensors on the wrists and ankles helped ‘monitor the outcome from constraint-induced movement therapy – a rehabilitation method that improves impaired arm use in people with chronic stoke.’ (2005) Studies being completed on wearable devices show how seriously they are taken in terms of medical health. If successful, these devices could change the way of life for critically ill patients, therefore research will continue and studies will be done to assess how useful wearable devices are. Patel et al 2012, describes the use of wearable technology to help manage chronic obstructive pulmonary disease (COPD). Using an ear worn sensor, which uses a sophisticated algorithm, the system was able to detect different types of physical activity and the intensity of the activity. Lin et al 2010, mentions the use of wearable devices in patients with cardiovascular disease (CVD) in the shape of a telecardiologysystem which is able to accurately detect AF. Atrial fibrillation (AF) is the most common cardiac arrhythmia. The system then alerts both user and medical personnel, therefore acts as a facilitator to early detection of disorders. Using this type of system for a disease which is currently predicted to kill over 20 million people by the year 2015 (World Health Organization, 2008) can help to save lives, which would be lost without the implementation of this type of system. The Optical Society 2014 have recently developed an optical technology to detect early complications of both Type 1 and 2 diabetes, called diabetic autonomic neuropathy. The pupilometeris mounted onto a pair of glasses and analyses the pupil’s size to detect the complication. Treating the condition early can lead to better health outcomes and preventing the condition from developing and affecting the vital organs. Looking at the potential for this technology to help wide range of groups of people suffering from a wide range of conditions, it is clear to see the benefits of using wearable devices to improve health care in the future. The ability to prevent and detect serious and life-threatening conditions can improve both the quality and length of life in a patient as well as ensure that those with terminal conditions can have a better quality of life. Conclusion The rapid changing and improving technology available to the modern society has a deep impact on the quality of life experienced by the people. While entertainment, communication and commerce are some of the fields which are making good use of the faster and more powerful systems available now, the health care sector is similarly investing in research to develop miniature, wearable healthcare devices that can be used by patients to monitor their own health or to assist those suffering from restricting illnesses. These wearable devices are considered to be the next big step in the health care revolution, moving towards a system which will need less direct input from physicians and specialists while providing more autonomy and support to the patients. The rising cost of health care is one of the motivations behind the development of these devices, but equally important is the research indicating the various possible benefits of these devices which can be availed once they pass through strict health standards. The types of devices being developed currently are focusing on two different functions: monitoring the physical condition and indicators of patients and providing necessary help and streamlining instant communication between the patients and healthcare givers in case of emergencies if these physical indicators change. Recovering patients and those with life-long ailments can both benefit greatly from these independent devices. Some examples of prototypes include a portable haemodialysis system, Wearable Cardioverter Defibrillators and body motion sensors which can assist patients suffering from Parkinson’s and Cerebral Palsy or elderly people in monitoring their movement. ‘Wireless Body area Networks’ which constitute a large part of the ongoing research (BAN) provide independence and choice of healthcare setting for the patients. Given current market trends and people’s comfort with other ubiquitous personal devices, it is expected that once these healthcare devices are perfected to be used by the average consumer, they will be accepted quickly by the mass market. However, the technology that allows greater communication and non-invasive data gathering for efficient healthcare also suffers from the same issues of privacy, security and autonomy that are currently being debated with regards to all other forms of modern media. There are questions about who will have access to all the health care data that will be generated by these devices and whether the systems will actually provide substantial benefits for the patients or if they will be simply used as monitoring devices by the insurance companies and corporations to control their employee’s activities. Undoubtedly market forces will play a part in the development and distribution of whatever new device is perfected for use. In any case, more research is required before wearable healthcare devices can be introduced as an alternative to traditional healthcare. There is a lot of potential in the technology that is being researched currently but the risks and ease of use of these devices need to be better understood before it can be adopted by the medical industry. However, as the literature research shows the benefits of the technology are substantial enough that it can contribute extensively to improving healthcare for all. Bibliography Orwat, C., Graefe, A., Faulwasser, T., (2008). Towards pervasive computing in health care – A literature review. BMC Medical Informatics and Decision Making,  2008, 8:26. Hii, P-C.,  and Chung, W-Y., (2011). A Comprehensive Ubiquitous Healthcare Solution on an Android™ Mobile Device. Sensors 2011, 11(7), 6799-6815; doi:10.3390/s110706799 Patrick, K., Griswold, W.G., Raab, F., and . Intille, S.S., (2008). Health and the Mobile Phone. 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