Digital Wearable Trends
Currently in rheumatology, Dr. Curtis said data from digital wearables are being used most commonly for patients who seem to be doing well and can be monitored with wearable data to inform physicians of their health status. Although the state of the art of digital wearables for rheumatology patients currently lies in consumer-grade devices (e.g., Fitbit, Apple Watch), digital wearables in the near future may include specialized devices prescribed as part of a patient’s care.
Several forward-looking trends with digital wearable technologies may hold promise in the rheumatology practice setting:
- Having patients with systemic lupus erythematosus wear an ultraviolet (UV) sensor on their clothing to track their UV exposure and monitor how that exposure affects their health status (e.g., rash, flare);
- Assessing specific comorbidities common to patients with rheumatic condition (e.g., patients in a home sleep study may wear a sleep monitoring device, rather than having to spend the night in a sleep laboratory; those with chronic conditions, such as interstitial lung disease, may have their cough and other respiratory activities passively monitored);
- For patients undergoing joint replacement procedures, prescribing a biosensor brace with sensors that talk to their smartphone to monitor postoperative movement, track rehabilitation and assess desired progress toward optimal range of motion;
- Prescribing increasing activity by providing a digital pedometer and setting a step count goal for a patient with rheumatoid arthritis to monitor how an increase in exercise can reduce fatigue (Note: This approach has been tested as part of a controlled trial and showed that exercise correlated with reduced fatigue); and
- Using virtual reality to digitize a patient’s future self to facilitate shared decision making about treatment choices.
Dr. Curtis challenged rheumatologists to proactively reach out to software engineers and artificial intelligence companies with ideas and needs for digital wearable technology applications in rheumatology care.
Proactively Addressing Barriers
As digital wearable technologies emerge and evolve, two significant challenges to successful application in the practice setting remain: getting patients access to the technology and getting them to use and share data.
Digital wearables on the market for consumer purchase are costly and not available to everyone, Dr. Curtis said. He also asked: “Are you asking patients to buy their own device, or will you (or a research study) provide it? If we are using it to monitor people ‘in the wild,’ we need to make sure that we aren’t excluding patients who may not own such technology. These patients may be most at risk for bad outcomes, yet perhaps more likely to benefit from such technology.”
He stressed the value of helping patients understand how they will benefit from wearing a device and sharing collected data with their healthcare team. He noted that “long-term patient engagement is key.”
Previous research studies using digital wearables for data collection have found limited patient adherence. Privacy and security concerns are also on patients’ minds.
“People want to know what they are getting for sharing their personal data, who has access to their data and for what,” said Dr. Curtis. “If their doctor is going to use the information to help them, that’s a highly compelling use case, and it needs to be done in a secure and transparent way.”
This challenges rheumatologists to find tangible ways to give patients value for sharing their data and demonstrate how their care was improved as a result.
Given that COVID-19 has made the concept of remote patient monitoring more important than ever, the opportunities abound, but digital technology and remote patient monitoring must be implemented in a careful, thoughtful fashion.
