Will wearable tech create a two-tier healthcare system?

As part of Apple’s latest product update, the capabilities of its Watch have been expanded to offer more health tracking, including the potentially life-saving ability to detect heart irregularities. It’s the latest chapter in a narrative where connected devices and real-time analytics combine to offer us a brave new world of personalised healthcare.

Gartner predicts that there will be 20 billion connected devices by 2020. ABI Research forecasts 485 million wearable devices will be in use by 2018. Already 60% of Americans track their weight, diet and exercise. The “quantified self”, where we all track intimate aspects of our lives, is a movement that’s clearly gaining momentum.

But these tools come with a hefty price tag. The latest Series 3 of the Apple Watch, for example, costs close to £400. The question of affordability, especially when high-end tracking devices are concerned, could easily create a section of the population unable to access a new generation of preventative technologies. Is this level of healthcare monitoring simply out of reach for many who can’t afford the hardware?

The cost of health

Growing corporate wellness programmes are attempting to combat the estimated £29 billion-a-year cost to UK business, lost because of sickness and absence. BP, for instance, offers discounts on the cost of health plans if their employees walk one million steps a year – verified with a wearable tracking device. Gartner forecasts that, by next year, two million people will be required to wear a fitness tracker by their employers.

Groups such as airline pilots and firefighters are expected to be the first to be targeted, as it’s important these groups get enough sleep and are not overly stressed when doing their jobs. However, when you move outside of these groups to ordinary workers, the use of technology for other forms of tracking becomes apparent.

No-one wants to worry that the sneaky doughnut on a Friday will impact their blood sugar levels and raise a flag with HR

SAP, for example, has encouraged its workers to buy discounted Fitbit trackers. Unfortunately, the groups most likely to take up offers such as this are already fit and are often wealthier staff. On the other hand, the level of data collection and potential intrusion into privacy discourages many employees from joining these schemes. Research from Office Genie found that 67% of respondents to their survey about using wearable technology at work were concerned about the “Big Brother” approach to surveillance. No-one wants to worry that the sneaky doughnut on a Friday will impact their blood sugar levels and raise a flag with HR.

But is insurance moving towards the ultimate in personalised risk cover, with those using wearable health technologies able to gain cheaper premiums than those not using this technology?

“I hope not,” comments Hilary Stephenson, managing director of digital user experience agency Sigma. “But if people feel incentivised by it I can see it happening. For example, car insurance companies issue apps to monitor safe driving, which resulted in lower premiums for those who scored highly.

“People choosing to manage their own health and share their data with insurers and GPs because they want to understand positive outcomes is very different to making this use of technology and data sharing mandatory in order to better qualify for a service.”

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Dr Lukasz Piwek, lecturer in data science at the University of Bath, says we’re currently living this scenario: “It’s not moving towards the ultimate in personalised risk cover – it’s already there. For instance, monthly payment for health insurance cover from Vitality will depend on how many physical activity points you earn each month when using their app via mobile devices or [the] Apple Watch. Indeed, it’s clear that insurance may very quickly grow into an example of a ‘dark side’ scenario of wearable technology use.

“I still remember a related case a few months ago where Admiral was planning to use machine learning methods to analyse the personalities of car owners on Facebook in order to establish if they are more likely to be engaged in risky driving,” he adds.

The worried well

Using wearable technologies to track and assess chronic conditions such as diabetes has clear advantages. It’s in the area of predictive and preventative medicine where the promise and the delivery can be further apart than many believe.

The use of wearable technologies as a secondary diagnostic tool is still in its infancy, no matter the claims technology companies may make about their latest devices. In many cases, the developers of these devices offer little or no empirical evidence that their devices have a positive effect on the health of their users. And the accuracy of this hardware when tracking some health parameters continues to be contentious.

“With the popularity of wearable tech comes vastly increased expectations,” says Tim Hoctor, vice president of professional services at analytics firm Elsevier. “The act of merely collecting health data leads users to believe that somehow it can be put to use to aid research and benefit healthcare.

“But the reality is that, while tech companies that make wearables are good at gathering data, they are less able to understand true scientific context and lack the expertise to actually uncover insights from the data they hold. In short, wearable devices cannot support better healthcare by themselves, but will still require the input of experts who can collate and make sense of the data.”

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Are GPs prepared for patients who bring biometric data they have collected to their consultations? We seem several years away from such a scenario, as standards of data and even device reliability are not yet in place. The NHS is moving forward with its proposals for a “kite mark” to signify if a device meets their standards. And the Medicines and Healthcare Products Regulatory Agency can classify an app as a “medical device.” But comprehensive and universal regulations aren’t around the corner yet.

It’s easy to sleepwalk into an era where health service access will be dependent on data you can track and deliver to your clinicians

Nevertheless, the quantified self – which can trace its heritage to the 1970s – now has the potential to accelerate with the widespread availability of wearable devices. What begins as a simple exercise in tracking physical activity can now be expanded and extended to every aspect of our lives. With the large tech companies driving these developments, it’s easy to sleepwalk into an era where health service access will be dependent on data you can track and deliver to your clinicians, and your ability to purchase the devices you need – which often need the latest smartphones to work.

Piwek concludes: “We have reached a point where the rapid pace of development in personalised digital technology has surpassed our ability to manage all the Big Data that this technology generates about our habits, routines and health behaviour. We predict that those issues will be in the centre of discussion about implementing wearables in healthcare, and we’re already discussing it with GPs and medical practitioners to better understand how to mitigate and address this as we engage actively on many fronts in the research on wearable technology.”

Today, the simple inquiry “how are you?” can already mean popping open your weekly heart tracking results. Ten years down the line, what will insurers and GPs do with this information? And, if you don’t have this data, what does this mean for your wellbeing and place in society?

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