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Published: 29 Feb 2016
Wearable technology in healthcare is a hot topic right now and the benefits of wearables in terms of helping people improve their health are undeniable.
"Wearables can help by keeping both parties [doctors and patients] engaged, by preventing readmission [and] by preventing chronic conditions from reoccurring," said David Chou, former CIO at the University of Mississippi Medical Center in Jackson, Miss.
One example is chronic conditions such as diabetes, which the International Diabetes Federation estimates will affect one in 10 adults by 2030.
Unfortunately, the populations that tend to struggle with chronic diseases such as diabetes and could benefit from the use of wearables are the people who can't afford them. According to the World Health Organization, more than 80% of diabetes deaths occur in low and middle income countries.
In addition, a 2014 Centers for Disease Control and Prevention study shows there is an obesity disparity among varying racial groups in the United States, with the highest rates of obesity in the South. The most cases were found in African-Americans, followed by Hispanics. Further, it is well known that obesity often leads to other significant problems including diabetes, heart disease and cancer.
Iana SimeonovPublic Health Institute
"Wearables are still in a range that's out of reach for many consumers," Iana Simeonov, principal investigator and project director at the Public Health Institute in Oakland, Calif., said.
And Lisa Gualtieri, assistant professor of public health and community medicine at Tufts University and founder of RecycleHealth, a nonprofit, agrees: "I think that the cost is a real barrier for a lot of people."
But it isn't the only reason wearable technology in healthcare remains out of reach for the people from these populations -- the people who could really benefit from these devices. It's much more complex than that.
The financial factor of wearable technology in healthcare
Some wearables have a price tag of hundreds or even thousands of dollars -- think the rose gold Apple Watch -- while others cost around $20 which may not seem like a lot of money to some people.
Gualtieri explained that if people don't see the value in wearables, they won't invest in them -- even if they only cost $20.
"If you knew that your $99 was going to be well spent, maybe you would go out and make that decision," she said. "But I think for a lot of people, it's something that's really on the periphery."
That is especially true if someone has to decide whether they should spend that money on groceries or a wearable and they don't fully understand how a wearable could help them improve their health long term. If that's the case, chances are that person is not going to spend their money on a wearable.
The lack of marketing targeting low-income populations
Furthermore, this population isn't often targeted or marketed to by wearable device companies.
"I don't know if anybody goes into business in wearables thinking that this is an obvious market. People that are at risk and underserved are that way because there isn't a lot of attention being paid to them," Simeonov said. "You don't necessarily look at consumers who you think don't have a lot of money as an obvious market for you. You go after... more people that want your product rather than need it."
Simeonov added that companies may enter a space to solve a problem but they are also looking to make money and stay in business. That means they must target and cater to the people who are going to buy their product.
"You can't fault them for that," Simeonov said. "Every business has to start somewhere."
SearchHealthIT tried to contact Fitbit and Withings for a comment but they could not be reached.
Unfortunately, this is part of what causes people of lower-income populations who may have a chronic disease to be left in the dark on how wearables can benefit them and help them get healthier.
The difficulty of understanding data from wearable health technology
On top of all that, the data wearables collect and present back to the user can be difficult to understand.
"The data has to become much more accessible. And by accessible I mean it has to be more easily understood," Simeonov said. "Right now, you can compare it to getting a printout of your lab tests in the mail ... and as an uneducated consumer, those results can be impossible to interpret. What you see there and what a trained physician see[s] there are completely different."
Simeonov added that the average healthcare literacy in the United States is at a fourth grade reading level. The companies making and designing these wearables aren't trying to confuse users -- in fact, their goal is to present complex data and in a way that the user will understand. "[But it can still be really difficult for somebody ... to take a look at that data and understand how that applies to them and make decisions about their health based on that data," Simeonov said.
This is especially true for the populations that could benefit from wearables the most.
"The people who'd benefit most from tech have lower health literacy," said Ahmed Albaiti, founder and CEO of Medullan, Inc., a digital health consultancy headquartered in Cambridge, Mass. "They have chronic conditions that they're dealing with, they are in an age group that [makes it] difficult to pick up new technology and so on. I don't think the current crop of wearables [has] the kind of utility where they would pick it up."
Wearable technology in healthcare: Where to go from here
Historically, the price of technologies has almost always gone down and the same will be true for wearables, Chou, Simeonov and Albaiti all agree. And, ultimately, it will make wearable devices much more affordable.
Regardless, understanding the data remains an issue, Simeonov said. Although wearable devices may become more affordable as time goes on, "unless the nature of the information changes I don't believe they're going to do any good in the present form," she said. "They're just too complicated."
However, Simeonov believes that a lot of thought is being put into how the data is being presented when it comes to wearables right now "because nobody wants to confuse their audience," she explained. "The current crop of wearables has really… tried to have unique data visualization tools and unique algorithms and this is something they've spent a lot of time and money doing."
Wearable developers have also spent a lot of time trying to understand their customer, Simeonov said.
"We now have to spend the same amount of time and the same amount of thought into understanding other segments of the market," she said. "Perhaps [wearable device companies] have and… it's not viable. I don't know."
In Gualtieri's opinion, integrating wearables into the more formal healthcare system and process would help a great deal.
"What if the doctor was able to give someone a device and to say, 'Let's see what your baseline activity level is on average for the next week and let's work on increasing it to 100 steps a week,'" Gualtieri said. "[It's] really trying to meet people where they are and then [creating] small doable increments."
Integrating wearables into the normal healthcare process would not only help engage patients in their own health but would also help them better understand their baseline health. However, Gualtieri said she suspects wearables have not yet been fully integrated into the formal healthcare system because of cost.
Although this may not be happening now, Chou predicts that wearables will ultimately become a part of the healthcare strategy.
"Whether you're an insurance carrier or a health system, [wearables] should be part of your strategy as far as providing that to the patient you want to target," Chou said. "Giving them a few hundred dollars' worth of devices in terms of wearables, it may save you thousands in the long run."
Chou believes healthcare organizations are beginning to think this way, although there is resistance to fully integrating wearables into the healthcare cycle because it means extra work will be put on the providers.
"There's extra work on somebody to stay engaged with you, [the provider]" Chou said. "By having a wearable device, constant communication and constant feedback will always be expected."
Despite all the obstacles in the way of wearables becoming part of the healthcare system and reaching the populations that could most benefit from them, Chou still believes that "wearables will be part of our lives."
He believes this because healthcare is moving away from fee-for-service payment models toward value-based care.
"Wearables can be a part of that solution," Chou said. "The challenge is most organizations are still in the fee-for-service reimbursement model. So until we get at least 80% of our reimbursement from value-based care, then it is going to be hard to entice folks to start thinking outside the box."
Simeonov added: "My own research has shown that [lower-income people who could benefit from wearables] are highly sophisticated users of technology and that there is a real opportunity for using technology to at least increase their access to health information and then potentially deliver care."
Learn more about wearable health technology:
Wearables and HIPAA: What is and isn't covered
The wearables revolution: What's stopping it from happening?
What to do with unused wearables? Donate to RecycleHealth