Health applications and wearables: impacts on the medical ecosystem and practices

In producing health data, smart objects bode well for a revolution in the health sector. Curative until now, practices are becoming more preventive, personalised, and collaborative around multidisciplinary teams. These smart objects impact the health ecosystem and raise questions on the evolution of responsibility as well as the modes of operation of public and private health insurances.

"Thanks to smart objects, medical practices, which until now were mainly curative, are evolving towards more early screenings, more preventive and more predictive medicine."

Watches, bracelets, armbands, clothes, plasters, implants, etc. Wearables or health-related smart objects abound. On the market for the past four or five years, until recently they were still considered to be gadgets. But with the development of Medical Devices (MD), little by little they are earning their legitimacy, giving reason to believe in a true transformation of the health sector. These smart objects not only encourage users and patients to pay more attention to their health and manage their chronic illnesses, but they also have an impact on the ways in which all health professionals work: doctors, analysis laboratories, hospitals, clinics, paramedical professions, nurses, social security, etc. Thus, medical practices, which until now were mainly curative, are evolving towards more early screenings, more preventive and more predictive medicine. These smart e-health objects also encourage the entire profession to coordinate and collaborate more, and to develop remote monitoring. Finally, these technologies provide patients with more autonomy and place them at the heart of the medical process.

Blood sugar levels, blood pressure, infections, etc.: smart objects reveal certain malfunctions of the body

Equipped with all kinds of sensors, many smart health objects are capable today of spotting a wide range of malfunctions in the human body: blood sugar level imbalance, variation in blood pressure, atrial fibrillation, infections, etc. Thus, CardioNexion from @-Health, integrated into clothes, detects strokes thanks to a device that captures and analyses biomedical signals in real time; the Apple Watch Series 4 or smart watches Move and Move ECG from Withings and presented recently at the Las Vegas CES are, for their part, capable of producing an electrocardiogram in just a few minutes thanks to the integration of a digital stethoscope; the Withings smart blood pressure monitor BPM Core detects valvulopathies (malfunctioning heart valves). The market also offers smart plasters that can identify infections and smart patches that measure blood sugar levels and inject the correct doses of insulin.

When these smart objects are linked to the medical network, health professionals are informed in real time of any abnormalities and can then take action remotely.

Smart health objects to the rescue of medial deserts

Medical deserts or remote areas are ideal for using this type of tool. Thanks to these objects, health professionals can monitor elderly people and patients with chronic diseases, or carry out post-op follow-up remotely. An alternative that is interesting on two levels. On the one side, these connected tools enable patients to be kept at home in complete safety, and on the other, they reduce hospitalisation costs and unclog hospitals and clinics.

It should also be noted that data-sharing and videoconferencing tools enable health professionals to remotely obtain a colleague’s opinion on a diagnosis or a protocol. Doctors are supported and “augmented” in their actions and patients receive better care.

Many obstacles still need removing

Although the health benefits of these objects are real, the market is having trouble breaking through. According to Philippe Marcel, south-east interregional director and manager of the CAP’TRONIC* programme, several elements are at the origin of this situation. “Among the main reasons: the difficulty assessing the benefits of these technologies. Thus, the value created by smart health objects is not always proven. Not only can users question the reliability of the data collected, but also the conditions under which they are collected because, when taken out of their different contexts, the data are sometimes meaningless to the medical staff. These objects will therefore fully play their part if they simplify the actions of health professionals and cater for their needs”, he highlights. Another obstacle is the lack of interoperability between the objects and data collection and processing platforms, as well as insufficient network infrastructures in certain regions.

The law: “Under French law, health data, which is recognised as being sensitive, receives enhanced protection. Gathering data from these smart objects requires user consent. Some health professionals still fear that users and/or patients will do without their services. So, once data provides certain conclusions, patients can for example contact a specialist directly without going through their GP. A fear that is also present in analysis laboratories: with certain smart objects being able to perform some of their tasks”, Philippe Marcel adds. Finally, it’s highly likely that other technologies such as AI or machine learning will revolutionise the entire health ecosystem. Let’s not forget that Watson, IBM’s AI, is said to not only have succeeded in diagnosing lung cancer with a success rate of 90%, versus 50% for a doctor, but also to have offered a patient treatments after having worked out their degree of relevance.

Health insurance and professional insurance forced to evolve

All of these technologies are not just going to spread without raising a number of questions. “Who is paying for these MD (medical devices)? Are they reimbursed by Social security? At what rate? And what about liability?, questions Philippe Marcel. Who gets blamed for the mistake when a doctor bases their diagnosis on an AI? Who is responsible, the doctor or the AI? All professional health insurance companies are currently studying these types of topics. And complementary health insurance won’t be left out either.” It’s in this way that for two years now, Generali has been offering its member companies a behaviour insurance programme. Named ‘Vitality’, this programme enables voluntary employees to receive vouchers in exchange for following certain nutrition rules and a certain lifestyle. On their side, Axa and Harmonie Mutuelle reimburse some smart e-health objects so as to encourage their members to adopt healthy living. Nevertheless, in France insurers cannot access their members’ health data and thus use it to price or terminate a contract.

The use of these smart objects evidently raises the question of their security: how to ensure they won’t be the target of piracy or data theft, or even failure through intrusion. And even if there is no such thing as zero risk, putting certain good practices into place can help prevent these wrongdoings: choosing recognised brands, updating software regularly, changing passwords, checking internet connection security, etc.

Although all of these elements are slowing down the deployment of these e-health objects, they could rapidly disappear in the face of the benefits and the enthusiasm of all the stakeholders engaged in this field. Apple, Amazon, Google, but also Samsung, Sony, Philips, Panasonic, or LG; not to mention all the traditional pharmaceutical companies such as Sanofi, Novartis, Roche, Johnson & Johnson, or Merck; medical device manufacturers; brands like Nike or Adidas, and of course startups (Visiomed, Withings, Voluntis, Bluelinea, iHealth, etc.), today they are all investing massively in this market. Lastly, entered into the DMP (the French shared medical record), the data from these smart objects has, since November 2018, enriched the medical knowledge of all patients.

* CAP’TRONIC Programme: Helping French startups and SMEs to improve their competitiveness thanks to the integration of electronic solutions and onboard software in their products.

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