**Wearable Digital Health Technologies in Medicine** Stephen H. Friend, M.D., Ph.D., Geoffrey S. Ginsburg, M.D., Ph.D., Rosalind W. Picard, Sc.D., Guest Editors, and Jeffrey M. Drazen, M.D., Editor # Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine Erica S. Spatz, M.D., M.H.S., Geoffrey S. Ginsburg, M.D., Ph.D., John S. Rumsfeld, M.D., Ph.D., and Mintu P. Turakhia, M.D., M.A.S. Paper - [[nejmra2301903.pdf]] [[Digital Phenotyping]] [[Paper - Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine]] --- Read this on [[0_PARA/Archives/Daily Logs/Daily Log 2023/05-02-2024]] - My take is that this sounds like AMI HOPE. - TAU: Frequent in-person measurements are not frequent enough to pick up early signs. The patient incurs a cost to come into the clinic. - Similarly, maybe the contact point for patients with mental illness is not frequent enough to pick up early signs. - Practical Challenges - The amount of regular data needed depends on the disease. For example, the requirements for Hypertension and Diabetes are different. - Accuracy of Sensors - because of the shelf products, different phone models have different sensors. How does that impact the sensing and, later on, data analysis? - Long-term effectiveness is still unknown - how long should it be monitored? - Different studies have different study designs and heterogeneity, which makes comparing difficult. - Sampling bias - More motivated participants - Hawthorne effect - changes in behaviour because of being observed - Implementation in Clinical Practice - We must re-design jobs, new staffing models, team-based care, and redesign workflows. ^3aa094 - It's interesting to me that cardiology has been using remote-monitoring hubs/teams to remotely transmit data from pacemakers and implantable cardioverter-defibrillators since the 1990s. What is that? - Veteran Affairs - Hub and Spoke - Remote/telepsychiatry. Some of the challenges and limitations in this paper are: - **Accuracy and validity of wearable DHTs**: The paper acknowledges that the signal quality and diagnostic performance of wearable DHTs vary across different devices and manufacturers, and that some devices may not be suitable for certain patient populations or clinical settings. The paper also notes that there are no standardized performance metrics or thresholds for regulatory approval of wearable DHTs, and that the accuracy of some devices may be affected by factors such as skin pigmentation, movement, and position. The paper calls for more rigorous validation studies and implementation trials to evaluate the effectiveness and safety of wearable DHTs in clinical practice. - [**Reimbursement and payment models**: The paper points out that the reimbursement models for remote patient monitoring and wearable DHTs are nascent and may not align with the value and outcomes of these technologies](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C0%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Reimbursem...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A7%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A67%2C%22highlightText%22%3A%22Reimbursement%20models%20for%20the%20use%20of%20remote%20%5Cr%5Cnpatient%20monitoring%20and%20wearable%20technologies%20%5Cr%5Cnare%20nascent.%22%2C%22snippets%22%3A%5B%5D%7D%7D)[1](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C0%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Reimbursem...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A7%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A67%2C%22highlightText%22%3A%22Reimbursement%20models%20for%20the%20use%20of%20remote%20%5Cr%5Cnpatient%20monitoring%20and%20wearable%20technologies%20%5Cr%5Cnare%20nascent.%22%2C%22snippets%22%3A%5B%5D%7D%7D). [The paper also states that the current Medicare reimbursement for remote patient monitoring requires the collection and transmission of physiological measurements on more than 50% of the days of the month, which may not be appropriate for all conditions or patients](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C1%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Monthly%20re...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A7%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A69%2C%22highlightText%22%3A%22Monthly%20reimbursement%20for%20remote%20%5Cr%5Cnpatient%20monitoring%20from%20Medicare%20requires%20the%20%5Cr%5Cncollection%20and%20transmission%20of%20physiological%20mea%5Cu0002surements%20on%20more%20than%2050%25%20of%20the%20days%20of%20the%20%5Cr%5Cnmonth%2C%20which%20may%20be%20unnecessary%20for%20some%20con%5Cu0002ditions%20(hypertension)%20and%20insufficient%20for%20others%20%5Cr%5Cn(diabetes).%22%2C%22snippets%22%3A%5B%5D%7D%7D)[2](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C1%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Monthly%20re...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A7%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A69%2C%22highlightText%22%3A%22Monthly%20reimbursement%20for%20remote%20%5Cr%5Cnpatient%20monitoring%20from%20Medicare%20requires%20the%20%5Cr%5Cncollection%20and%20transmission%20of%20physiological%20mea%5Cu0002surements%20on%20more%20than%2050%25%20of%20the%20days%20of%20the%20%5Cr%5Cnmonth%2C%20which%20may%20be%20unnecessary%20for%20some%20con%5Cu0002ditions%20(hypertension)%20and%20insufficient%20for%20others%20%5Cr%5Cn(diabetes).%22%2C%22snippets%22%3A%5B%5D%7D%7D). The paper suggests that more flexible and evidence-based payment models are needed to support the adoption and integration of wearable DHTs in cardiovascular care. - [**Clinical care integration and workflow redesign**: The paper emphasizes that the use of wearable DHTs requires new staffing models, team-based care, and redesigned workflows to manage the data inflow, interpretation, and actionability of these technologies](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C2%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22This%20is%20li...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A8%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A53%2C%22highlightText%22%3A%22This%20is%20likely%20to%20require%20new%20staffing%20models%2C%20%5Cr%5Cnteam-based%20care%2C%20and%20redesigned%20workflows.%22%2C%22snippets%22%3A%5B%5D%7D%7D)[3](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C2%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22This%20is%20li...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A8%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A53%2C%22highlightText%22%3A%22This%20is%20likely%20to%20require%20new%20staffing%20models%2C%20%5Cr%5Cnteam-based%20care%2C%20and%20redesigned%20workflows.%22%2C%22snippets%22%3A%5B%5D%7D%7D). The paper also highlights the challenges of data interoperability, privacy, security, and ownership, as well as the need for patient engagement, education, and support. [The paper proposes a hub model for remote patient monitoring, in which a centralized team of remote clinicians can provide data-driven and protocol-based care for patients with cardiovascular conditions, and communicate with the primary care team and the patient throughout the process](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C3%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Hub%20Model%20...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A9%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A7%2C%22highlightText%22%3A%22Hub%20Model%20for%20Remote%20Patient%20Monitoring.%22%2C%22snippets%22%3A%5B%5D%7D%7D)[4](https://edgeservices.bing.com/edgesvc/chat?udsframed=1&form=SHORUN&clientscopes=chat,noheader,udsedgeshop,channelstable,ntpquery,udsdlpconsent,&shellsig=932e1fe6e5a30f343db2c89b403f35fc2afa02f7&setlang=en-GB&lightschemeovr=1#sjevt%7CDiscover.Chat.SydneyClickPageCitation%7Cadpclick%7C3%7C169831fc-366c-4aec-9cb4-3f95ef86b078%7C%7B%22sourceAttributions%22%3A%7B%22providerDisplayName%22%3A%22Hub%20Model%20...%22%2C%22pageType%22%3A%22pdf%22%2C%22pageIndex%22%3A9%2C%22relatedPageUrl%22%3A%22file%253A%252F%252F%252FUsers%252Fmoses%252FLibrary%252FMobile%252520Documents%252Fcom~apple~CloudDocs%252FDownloads%252Fnejmra2301903.pdf%22%2C%22lineIndex%22%3A7%2C%22highlightText%22%3A%22Hub%20Model%20for%20Remote%20Patient%20Monitoring.%22%2C%22snippets%22%3A%5B%5D%7D%7D). The paper also touches on the following points: - **Patient Engagement and Education**: The success of wearable digital health technologies (DHTs) in cardiovascular care largely depends on patient engagement. Patients need to be educated about the use and benefits of these devices, and they need to be motivated to use them consistently and correctly. - **Data Privacy and Security**: With the increasing use of wearable DHTs, there are growing concerns about data privacy and security. The paper highlights the need for robust data protection measures to ensure that sensitive health information is not compromised. - **Regulatory Approval**: The paper notes that there are no standardized performance metrics or thresholds for regulatory approval of wearable DHTs. This is a significant challenge as it can affect the quality and reliability of these devices. - **Evidence Base**: The paper calls for more rigorous validation studies and implementation trials to evaluate the effectiveness and safety of wearable DHTs in clinical practice. This is crucial for building a strong evidence base that can guide clinical decision-making and policy development. In conclusion, while wearable DHTs have the potential to revolutionize cardiovascular care, there are several challenges and limitations that need to be addressed to ensure their successful integration into clinical practice. The authors of the paper believe that with continued research and innovation, these challenges can be overcome. They envision a future where wearable DHTs play a central role in patient-centered, data-driven cardiovascular care.