• Wearables
  • Is data from wearables reliable enough?

    As the number and type of wearables increase, doctors seem divided about the value of the data they provide. A report in Medical Economics refers to comments by John Sharp. He’s a senior manager at the Personal Connected Health Alliance, a non-profit organisation set up by the Healthcare Information and Management Systems Society (HIMSS). Its goal’s to support activities in the wearables market. 

    One of the benefits of wearables is the opportunity for patients to share data with their doctors. Sharp says wearables can help improve healthcare outcomes and help doctors with patients needing to control chronic conditions, such as diabetes or high blood pressure. Readings from wearables between visits to doctors can indicate the status of their patients’ conditions.

    He also points out that some doctors won’t rely on data from wearables. In contrast, some encourage patients to use them and report on the data to help achieve better outcomes for patients. Which group has the proven approach? Medical economics doesn’t shed light on it.

    It does say the number of patients using wearables is expected to grow significantly. Research and Markets identified almost 250 health wearables in its report Smart Wearables in Healthcare, 2016-2030. Most are activity and fitness trackers, but the emphasis’s switching to more advanced wearables that produce data. Examples are Electrocardiograms (ECG), blood pressure readings and blood glucose data. Overall growth in the wearable healthcare market is estimated as nearly 14% a year for the next 15 years. 

    As more clinically valuable wearables become available, they play an increasing role in Africa’s health systems. Initiatives that combine wearables and mHealth apps could have a valuable role in improving healthcare across much of Africa. However, engaging doctors from the outset’s vital to realising the benefits.

  • There’s a new wave of wearables

    Wearables in mHealth act as an extension of the wearer’s body and brain. The device usually works in partnership with smartphones that allow us to access digital content without being distracted from the physical environment. The increase in the use of wearables is highly driven by the growth in mobile apps which are designed to monitor and improve the users’ health and wellbeing. MobileEcosystem Forum has estimated that the global health and fitness app market is approximately $4 billion now and could be worth $26 billion in 2017.

    Mhealthwatch has a new report on wearable from ABI Research. It says there’s good reason for immense growth in mHealth wearables. Data shows that these devices boost patients’ healthcare, both inside and outside hospitals. The surge in patients using wearables to monitor their healthcare’s is helping to reduce readmission risks and prevent the occurrence of serious medical traumas. It’ll help alleviate the growing performance pressure on healthcare services and providers too.

    Devices include blood pressure monitors, continuous glucose monitors, pulse oximeters, and newer devices, like Fatigue Science’s fatigue monitor. These send prompt, real-time alerts about condition, deteriorations or fluctuations. It’s effective by reducing response times by health workers to potentially life-threatening changes, saving healthcare resources.

    Stephanie Lawrence, Research Analyst at ABI Research, sees a new wave of wearable benefits. “While previously professional-grade patient monitoring largely limited itself to a doctor’s rounds, new wearables allow medical professionals to remotely and continuously monitor patients in the hospital and beyond.” These offer Africa’s health systems new opportunities to improve health, healthcare and resource utilisation.

  • Mamaope’s a biomedical jacket that diagnoses pneumonia

    Pneumonia accounts for 16% of all deaths of children under five, killing roughly 920,000 children globally each year. It’s a massive challenge for Uganda, where nearly 24,000 children die each year. A lack of access to laboratory testing and infrastructure in rural communities means that health workers often have to rely on simple clinical examinations to make their diagnoses. This often leads to misdiagnosis and preventable deaths.

    To tackle this problem, Olivia Koburongo Brian Turyabagye and a team of doctors from Uganda, created the MamaOpe (Mother's Hope) kit to help diagnose pneumonia. It comprises a mobile app and a biomedical wearable smart jacket, says an article in Daily Nation.  

    MamaOpe kit is simple and easy to use. Health workers simply slip the smart wearable onto a child so the sensors on the jacket can detect his or her breathing rate, temperature and the lungs’ sound patterns. The information’s then sent via Bluetooth to the mHealth app. An analysis determines the severity of the disease. Once the information’s captured and stored in the cloud, doctors can access it remotely, helping health workers make better decisions.

    Although the smart jacket’s still a prototype, early results are promising. Studies by the engineers indicate that it can detect and diagnose pneumonia three times faster than a health worker can. It reduces human error too.

    The team’s currently patenting the kit, which’s shortlisted for the 2017 Royal Academy of Engineering Africa Prize. Plans are underway to pilot the kit in Uganda's referral hospitals, then distribute it to remote health centres.

  • Clinical health apps to outpace fitness trackers

    Fitness apps and wearables have been flooding the market. There’s a fitness app to track just about anything these days. From how many steps you take, your heart rate and your eating and sleeping patterns. If you can imagine it, there is almost surely an app for it.

    While the popularity of fitness apps continues, there may be a change coming. A survey by Silicon Valley Bank shows that clinically-focuses health apps and devices are more likely to be more popular this year than consumer-focused products. Innovators and investors are more interested in the switch too, an article in HealthcareITNews says.

    Of the 122 executives and investors in health-tech companies interviewed, 45% said clinically-driven health programmes will have grow most. Only 8% selected mobile health apps and 7% named wearables. The report says “Investment trends in digital health are shifting from consumer wellness applications to clinically driven solutions that drive better health outcomes at lower costs. This next wave focuses on encouraging consumers and patients to change health-related behaviors, underscoring the greater opportunities for companies with solutions that create value for payers, providers, employers and consumers.” 

    About 55% of all digital health investments since 2011 have been in companies providing consumer-facing tools. Investors have recently preferred clinically-focused startups, seeking tools designed to affect patient behavior and generating better health outcomes and cost savings.

    In 2015, 60 early-stage funding deals in clinical enablement, totaled US$600 million. In 2016, there will be more than 70 deals, up by more than 16%, amounting to more than US$850 million, up more than 40%. The average deal value’s increased from about US$10 million to over US$ 12 million. Consumer deals for fitness and wellness are heading in the opposite direction, There were 45 deals valued at US$550 million in 2015 compared to there will be 10 deals at less than $20 million in 2016. The change’s a drop in deals of about 80% and average deal values down by from about US$12 million to about US$2 million.

    Disease management and remote monitoring companies are shifting to specific disease to help patients and providers manage conditions better. Instead of providing general solutions,  “Now the focus is on digital solutions for disease management. Going forward, clinically proven software and hardware will be integrated to drive better health outcomes and cost savings.”

    These are encouraging healthcare development. Its potential benefits are considerable, although often in eHealth, potential benefits are seldom realised fully. Hopefully, this trend will make it way to African countries soon and add to its mHealth ambitions.

  • OMsignal launches smart sports bra

    Wearables are quickly becoming part of our everyday lives. Helping us track and monitor our health and fitness levels. OMsignal, which makes smart clothing and companion apps, has officially launched OMbra, a smart sports bra. Its available online on the company’s website and in select retail stores across the US and Canada says an article in Mobihealthnews.

    The smart bra is embedded with sensors to capture biometric signals like heart rate and respiration, delivering actionable insights via the wearer’s mobile device on OMrun, the personalized running app. OMbra’s sensors also count steps and measure cadence, pacing and running rhythm. The OMrun app determines each runner’s intensity level to enable them to progress and maximize fat-burning results, while also helping to reduce the risk of injury and fatigue.

    "OMbra came to fruition through years of research, development and experimentation with female runners of all levels," Stephane Marceau, CEO and Co-Founder of OM said in a statement. "From the hundreds of women who tested the bra, we tried to enable a very simple and mindful approach to running that strikes a balance between the will to progress and achieve specific fitness goals, and the simple, healthy pleasures of running."

    Joanna Berzowska, head of electronic textiles at OM said "Boasting specially engineered fabrics and advanced sensory technology, OMbra truly is a product of science and engineering that simultaneously features innovative and inspired design."

    OMbra is the company’s first available product. With wearable technology constantly evolving, we look forward to what they come up with next.

  • Surgical stitches’ll be wearables

    As wearables are extending to our clothes, a team and Massachusetts Institute of Technology (MIT) has taken them further and into surgical stiches. In Microsystems & Nanotechnology, a Nature publication, the team describe its initiative. It builds from threads used in clothes because they’re seen as promising material for creating tissue constructs and biomedical implants for organ replacement and repair. Thread’s wicking property and flexibility offer opportunities to create 3D microfluidic circuits. The result’s a Thread-based Diagnostic Device (TDD) platform.

    It’s part of a trend where wearables are extending into a range of clinical uses. They offer effective investment for Africa’s health systems as part of the mHealth initiatives.    

     Physical and chemical sensors are fabricated from nanomaterial-infused conductive threads and connect to electronic circuitry using thread-based flexible interconnects. These readout, signal conditioning and wireless transmission functions support TDD to measure strain and gastric and subcutaneous pH in vitro and in vivo.

    Using 3D for the device is a technological step-up from the 2D devices used in most Implantable Diagnostic Devices (IDD). TDD overcomes the 2D limitations of used on tissue surfaces. TDD offers the capability to integrate functional components, such as sensors, actuators, and electronics so they can penetrate several tissue layers. This fits our 3D topology and helps to monitor complex 3D structures in conditions like wound fractures and orthopaedic implants.

    TDD’s threads are flexible building block that can be constructed in a flexible substrate or sutured into any biological tissues in a 3D geometric form. It integrates physical, chemical, and biological functions are sensors, microfluidics and electronics. Physical measures are strain and temperature. Chemical measures are the numeric scale specifying the acidity or basicity of an aqueous solution

    (pH) and glucose markers. In vivo functionality’s evaluated by measuring pH and strain in different parts of the body.

    The primary benefits are the low in cost and biocompatibility of the TDD’s threads. They can be used as a part of patients’ skin, clothing or be implanted. It’s feasible that it could be part of a range of applications, such as smart sutures for surgical implants, smart bandages to monitor wound healing, integration with textile or fabric as personalised health monitors and point-of-care diagnostics and embedded in engineered tissue constructs for organ-on-a-chip platforms. These opportunities could be part of a development programme that uses sensors to measure more than strain, pH or glucose.

    Examples are implanted chemical sensors in tissues to measure proteins, DNA and other biomarkers.

    Africa’s health systems and eHealth strategies need to include programmes to adopt these wearable clinical technologies as they’re proven. It’s an expanded mHealth plan.

  • Wearables can be clinically reliable

    A founder and chief medical officer (CMO) of an mHealth company has challenged the appropriateness of the “snake oil” metaphor used by the Vice President of the American Medical Association (AMA), reported by eHNA. AliveCor develops and provides mobile Electrocardiogram (ECG) technology, including Kardia Mobile, and mHealth Intelligence has reported that it has several peer-reviewed studies that support its apps.

    Dr David Albert, AliveCors’ founder and CMO and a cardiologist, says “Patients are becoming more and more responsible for their own healthcare, and that creates opportunities for engagement.”

    Both consumers and healthcare providers “Have to understand that (patients) have to be integral in their own care.”

    Dr Albert says it seems that healthcare has erected a barrier for consumer-facing wearables by saying that wearables and other types of personal monitors won’t be accepted by the clinical community until their data’s proven as reliable and relevant. Despite this constraint, people are still using the devices, boosting the health and wellness industry to record heights.

    He says the AMA did itself no favours by describing the mHealth as rife with “snake oil salesmen.” He’s also critical of “the Theranos effect” of mHealth providers that focus on hype instead of validity. Theranos provides a laboratory service direct to people and hasn’t satisfied USA regulators. BizJournals had a report in February this year that the Centers for Medicare and Medicaid Services (CMS) was waiting for a plan from Theranos to fix problems revealed by a 2015 inspection of its services from the company’s Newark laboratory. CMS said problems in one area at the lab “pose immediate jeopardy to patient health and safety.”

    AliveCor’s solution to the divergence is seen as mHealth providers combining clinical veracity with users’ experiences. Dr Albert says it’s easier for a clinically proven mHealth company to expand into health and wellness than it is for a product meeting consumers’ needs, such as fitness wearables, to succeed in providing medical services.

    This approach by AliveCor will have to satisfy the stringent requirements of medical professionals. eHNA has recently reported on a USA study that says few mHealth services for heart failure meet quality, content, or functionality requirements. In a parallel initiative, the European Commission (EC) has “Opened a public consultation on the safety of applications ("apps") and other non-embedded software as part of an effort to ensure a high level of health, safety and consumer protection.” It seems that mHealth’s facing increasing closer scrutiny.

    The debate seems to emphasise the need for the USA mHealth market to develop further before mHealth can fulfil its potential. It includes the need for mHealth services to be clinically driven. For Africa’s health systems, it highlights the need for their mHealth strategies to include:

    Market development requirements

    • Product assessment and approval
    • Effective regulation, including safety, quality, reliability and functionality
    • Provider certification
    • Rigorous business cases before buying
    • Effective Monitoring and Evaluation (M&E).

    The overarching goal of these initiatives’s to encourage the sustained use of valuable mHealth. It’s not a brake.

  • When will wearables play a big role in Africa’s mHealth?

    As Africa’s mHealth initiatives move ahead, wearables are extending their role as a medical device. In an article in the Journal of the American Medical Association (JAMA), Prof Kevin Patrick from University College San Diego (UCSD) sees challenges and opportunities ahead, but it may still be too early for African countries to embark on large-scale investment programmes.

    While new types of wearables can collect clinical data from sweat secretions, such as glucose levels, Prof Patrick says “Most of the devices are really at the “proof-of-concept stage” Consequently, more work’s needed to move from the development stages before they can be used clinically. It’s especially needed for devices that can help older people or people with chronic disease.

    Wei Gao, an engineer and postdoctoral fellow at the University of California, Berkley supports this view. He says “Before these sensors can help physicians monitor their patients in real time, more clinical validation is needed to ensure their measurements correlate with blood levels of the measured compounds and the individual’s physical condition.”

    Some of the challenges are:

    1. Usability, so ease of use
    2. Supporting doctors and other health professionals to use the large volumes of data these wearables provide
    3. Decisions on regulation as medical devices or as the mHealth part of eHealth are needed; a knotty issue.

    While African health systems wait the wearables’ new dawn, they can start preparing to ease their way through the challenges they’ll bring. This goes beyond the strategic. It needs activities, working groups with an emphasis on implementation, and rigorous business cases with a viable affordability plan. This preparation work will bring good returns for Africa.

  • Apple Watch can identify your stroke risk

    Atrial Fibrillation (AFib) can cause the heart to beat irregularly. While people with the disorder don't necessarily feel any symptoms, they're at risk of a stroke or heart failure. If a device close to a patient, such as an Apple Watch, could identify people at risk, that would be a great advantage.

    UC San Francisco and Cardiogram experts are collaborating in the Health eHeart study to investigate whether sensors in the Apple Watch can be used to identify people at risk of strokes. mRhythm, the observational study aims to "Contribute your data and save lives." Brandon Ballinger, a cofounder of Cardiogram, tells Fast Company that researchers have two major goals for the study:

    • Quantify the accuracy of the Apple Watch sensor for clinical research
    • Collect evidence that the Cardiogram app and algorithm can detect AFib.

    Experts are not convinced that a smart-watches have yet proven their ability to monitor and track heart rates safely enough to support making medical decisions. A chest strap that closely emulates an electrocardiogram (ECG) is more accurate than wrist-worn devices. Perspiration and rapid movement, for instance, can affect a smartwatch's ability to measure heart rate accurately.

    Ballinger is more upbeat. "We are trying to understand the distribution of errors when you're sitting or walking, or male versus female’"  He’s hoping to recruit 10,000 patients for the study. His team will test other devices that track heart rate, such as Fitbit.

    Medical device startup Alivecor has created a medical-grade ECG band for Apple Watch. It measures electrical activity in hearts and analyses it for problems. The company claims it’s the first wearable to provide instant ECG analysis approved by the US Food and Drug Administration (FDA). Kardia band has an app that displays the EKG in real time. When users touch their Kardia Band's sensor, it sends information to the app. The algorithm then looks for signs of AFib. The system also includes a Normal Detector that indicates if heart rates and rhythms are in the normal range. Another feature notifies users when they need to retake their ECGs. Users can share their data with a health professional at any time.

    AliveCor spokeswoman Rebecca Phillips says the Kardia Band only needs good contact between the electrode and skin, "anywhere on the forearm to the fingertip." Neither sweat nor tattos diminish the ECG results. Kardia’s intended for patients diagnosed with AFib. It could make a big difference for these patients in Africa too.

  • Wearables to predict and prevent asthma attacks

    Wearables are already quite good and measuring vital signs. A team at North Carolina State University has developed Health and Environmental Tracker (HET) to help people with asthma. It incorporates several novel sensing devices in a wristband and a patch that adheres to each patient’s chest.

    Research by a team at Edinburgh University, and published in Pub Med, found “An increasing prevalence of asthma in Africa over the past two decades. Due to the paucity of data, we believe that the true prevalence of asthma may still be under-estimated.” There was an estimated 74.4m asthma patients in Africa in 1990. By 2010, there were over 119m, an increase of about 60% in 20 years. The prevalence’s geographically skewed, being higher in urban areas than rural communities. The new wearable can have a valuable role in Africa.

    The patch includes sensors that track patients’ movements, heart rates, respiratory rates, oxygen in their bloods, skin impedances and wheezing in their lungs HET’s wristband focuses mainly on environmental factors. It monitors volatile organic compounds and ozone levels in patients’ surrounding environment and ambient humidity and temperature. It also has sensors to monitor motion, heart rate and oxygen in the blood. There’s a non-wearable spirometer that patients can breathe into several times a day to measure their lung function. This data’s transferred into HET’s data analysis system.

    HET users can track their wellness, and the correlated data can give patients notice to take corrective and avoiding action if it’s needed. This could simple changes such as going indoors or breaking exercise.

    HET’s still being tested, so won’t be available in Africa for a while. Its approach to correlating data in wearables can offer Africa’s mHealth developers a more sophisticated development model.