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From the Apple Watch to Fitbit, wearables are seemingly everywhere tracking peoples' steps and heart rates and sleeping patterns and so on. However, this data really doesn't have much value in a clinical setting, Richard Milani, chief clinical transformation officer at Ochsner Health System in New Orleans, said at the 2017 Connected Health Conference in Boston. To Milani, a healthcare wearable would and could provide real value in clinical settings if it were able to monitor glucose levels or detect health conditions such as atrial fibrillation (AFib).
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In this Q&A, Milani paints a picture of how healthcare wearables could provide value in a clinical setting and discusses the challenges.
What use case do you find most valuable for healthcare wearables in the clinical setting?
Richard Milani: Currently the data is quite limited in terms of what we collect from wearables. Obviously what's coming around the corner is very exciting so if we talk about glucose monitoring, obviously that's more than just a wearable because today it requires a little bit of an implantation and it doesn't last very long. And now the duration is extending longer and longer with the better technologies and ultimately it won't be anything invasive, it will be a wearable that will provide that. Now that would probably be top of my list. ... We obviously get activity data, which is quite important in a wearable. They like to talk about sleep data, but it's not very valuable because you can't rely on it; it's not accurate enough. So I can get activity data, I can get steps data, I can get hours that you're sitting and I can get all the things like that. If you just go to any provider organization saying, 'Is that going to be useful to you?' most providers will say 'Absolutely not.' If you're starting to give me continuous glucose monitoring, now that's something that's going to be highly valuable. I think what's going to be really valuable is going to be game-changing from a wearable perspective ... now we can track AFib using wearables. I mean that's a relatively new technology and obviously that would be something very important. ... I would say probably that's the biggest breakthrough that I've seen in a standard wearable that I could see being impactful today.
What are some obstacles facing healthcare wearables in a clinical setting today?
Richard Milanichief clinical transformation officer, Ochsner Health System
Milani: Wearables are an important component of our future, but what we seek is information. You want the best information that's the least expensive and most passive and it's not always a wearable [that will achieve that]. So I can determine by asking a question via text or by telephone traffic depression and I can do it quite accurately. I can detect dementia based on telephone traffic. I don't need to have somebody wear something all the time to be able to know certain things and that's a very low-cost intervention that gives me an enormous amount of information that I could design interventions around. The second thing is for any intervention to work we have to prove it. I mean it's enough to say that we can learn something, but that learning has to be more cost-efficient than an alternative and so there are a lot of proofs that have to occur. We go through a lot of trouble to look at total cost of care, is this affordable, who's paying, and so on and so forth. ... These are all highly variable and I have a responsibility to provide my interventions for all people that walk in my door, not just one particular plan that might cover something. So these are all considerations that we have to make in the delivery of care that gives us the best outcomes at the lowest cost that is the most passive for any of the entrants of the system, including the elderly. So I have a lot of 90-year-olds in my program that are not using necessarily wearables, but never the less I need information. Now we haven't broken into the device side of this exchange, but from a wearable perspective I think the future is bright. But today what's applicable to wide populations is still relatively small, but we can collect information via other mechanisms.
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