The doctor will see you now: wearables and home devices

In the second of a three-part series, we explore how subscription telehealth services, augmented by wearable tech and home devices, are delivering medical care outside the surgery.

As disruption of face-to-face treatment continues due to the COVID-19 pandemic and the adoption of Technology Enabled Care Services (TECS) accelerates, telehealth is becoming a major component of healthcare, with the rise of home devices and wearables. Using ambient devices that many already have in their homes, faster diagnoses and treatments can be sought digitally, reducing time to care.

Wearables
The market for healthcare wearables is anticipated to grow to $64 billion by 2024, stimulated by the pandemic. In the US alone, 30 million of them are anticipated to be shipped in 2020, though diminished supply as a result of the pandemic is compounded by the growing demand for smartwatches and other devices.

Wearables could act as early warning systems for COVID-19, and to manage treatment without intervention from medical professionals, with Fitbit announcing in August preliminary research indicating that their devices could detect the virus before the onset of symptoms. Not only applicable for patients, such early warning devices have the potential to be deployed for frontline workers to indicate risk of exposure too.

Meanwhile, Amazon is the latest company to debut a subscription health service to compete with the likes of Fitbit and Apple; its Halo health monitoring service combines a digital wristband and app to analyse and provide, reportedly, the most accurate health reading outside of a clinical environment. Though Amazon has a contentious data-sharing contract with the UK’s NHS, there is no indication yet that Halo will integrate with NHS provisions.

During the pandemic, marketing of wearables has increasingly pivoted towards touting their health benefits; “The future of health is on your wrist” according to Apple Watch, the first wearable device to be cleared by the FDA, after being declared “substantially equivalent to another (similar) legally marketed device.”

Several firms worldwide are taking wearables one step further, such as the French-based duo of Chronolife and Servier, who have partnered to develop a smart t-shirt for monitoring patient vital signs such as skin temperature, breathing patterns and ECG data for biomarkers of a series of illnesses, including COVID. In the US, Otsuka Pharmaceutical’s Abilify MyCite is a digital pill, first approved by the FDA in 2017, containing an ingestible event marker (IEM) that transmits data from within the patient’s body to smartphone via a sensor patch on the arm that detects the signal from the pill after ingestion.

A similar digital pill by Proteus Digital Health, intended to be consumed so healthcare professionals could track when patients had taken other prescribed medication, had been piloted in UK pharmacies back in 2012. However, once a darling of the digital health world, the company filed for bankruptcy earlier this year, with one-time partner Otsuka now courting a takeover purchase.

Despite the many obvious benefits of wearables, they are currently not subject to the same patient privacy rules as other treatments, sitting at the crossroads of personal and health data, with the usual patient privacy codes of practice largely out of step with advancing technologies. Last year, a British Medical Journal survey found 19 of the top 24 health apps to be sharing data with major tech firms such as Facebook and Google.

Home devices
As seeking treatment at health facilities becomes an increasingly risky prospect for the most vulnerable, the need for and adoption of at-home care plans will only increase. Devices monitoring symptoms allow patients to be monitored at home, with self-service tools for patient self-treatment and self-administration of medication.

Despite solid growth, the broader market for smart devices slowed in the first half of 2020, as manufacturing output slowed, economies contracted and prohibitions were placed on in-home installations. However, sales are anticipated to pick up again in 2021, with purchases of home healthcare devices such as MediPense’s automated pill dispensers, for example, likely to be a growth area, supported by remote functionality and email / SMS reminders offered on a subscription basis.

The NHS has been trialling and providing IoT-powered health monitoring home devices for some years now. Not only for monitoring heartrates on the morning jog, these devices can collect data from prescribed remote monitoring equipment such as blood pressure monitors, glucometers and gut microbiome tests. Meanwhile, 2,050 Facebook Portals were provided to care homes and hospices earlier this year, allowing vulnerable patients to receive remote diagnoses as well as communicating with friends and family while shielding.

For patients in Hertfordshire and North London, an NHS trial scheme has been rolled out for those with cystic fibrosis and those recovering from COVID, combining apps and oximeters to measure blood oxygen saturation without having to leave home. Deployment of a wider set of home monitoring devices to patients in East London and Liverpool is also underway, in partnership with Docobo.

Taking care one step further, TytoCare’s Remote Medical Exam Kit allows users to perform basic medical examinations at home, using a range of attachments including an otoscope, a stethoscope and a tongue depressor, with the option to be connected to a medical professional for full diagnosis if needed.

It is perhaps no surprise that the go-to business model for many of these home healthcare devices is subscriptions. Whether used for access to an ongoing service, or to spread the cost of expensive equipment, subscriptions and usage-based pricing models are an effective means of delivering the latest healthcare technology, and can be paid for by either patient or healthcare provider.

One such example is ResMed, a global provider of home medical devices for respiratory issues and sleep apnoea, who use our subscription billing platform, Cerillion Skyline, to provide a convenient and affordable route to access their products, via a network of pharmacies and resellers. A full case study on ResMed can be found here.

Be sure to read the first of this blog series, focusing on health apps, and look out for the upcoming final part where we explore health teleconferencing services.