Wearable remote patient monitoring is gaining momentum, especially in the face of the COVID-19 pandemic. Devices developed with accurate biosensors, advanced algorithms, and accompanying apps are providing unprecedented access to health insights that are helping medical professionals and end users proactively manage preventative care needs and chronic conditions. "In the old days, the talk was about the quantified self—counting steps, monitoring heart rate, but without insights. Today, there are more analytics and more insights into your health—and what you should do," Andrew Baker, one of Maxim Integrated's healthcare technology experts, said during a recent webinar.
In his session, "The Critical Role of Actionable Insights for the Wearable Healthcare Revolution," Baker explained what wearables need to provide—and how—to help improve health outcomes while stemming rising healthcare costs. Presented as part of Maxim's virtual Sensors Experience, the webinar is now available on demand.
Globally, healthcare costs are at $9T, roughly 10% of the global Gross Domestic Product (GDP). What's more, costs are growing at a rate higher than inflation. Wearable healthcare technologies, said Baker, can help mitigate this growth. "This is really prompting a shift in mindset. It's really taking charge of an individual's overall health. Hopefully you can prevent some of these conditions from getting worse by identifying them, treating them with lifestyle changes or medication," he said.
What's considered an actionable insight? It's simply data that drives a user to some meaningful action. Consider a chronic disease like diabetes. With a continuous glucose monitor and accompanying app, a user receives data on the highs, lows, and other trends of glucose levels, along with insights such as the impact of diet and exercise on those glucose levels. Armed with this data, the user can better manage the condition. For preventative care, a wearable that, for instance, continuously monitors cardiac health can provide alerts to any anomalies that might require further evaluation.
"These conditions can be much more carefully and effectively monitored and managed through the use of these remote patient monitoring devices," Baker said.
Baker outlined three stages of patient monitoring where wearables can play an integral role:
- General predictive monitoring, which happens outside of a clinical setting to provide first-level insight on overall health
- In-home monitoring (point of use), which is prescribed by a physician to monitor for a specific condition and provide diagnostic support
- In-hospital/clinical monitoring (point-of-care), which happens in a hospital or healthcare clinic
During this pandemic, he said, there's been a drive towards point-of-use monitoring via clinical-grade measurements of health parameters including SpO2 (blood-oxygen saturation), respiration, and temperature. As the coronavirus pandemic might cause some people to feel hesitant visiting a healthcare facility, remote monitoring provides a great way to access care, Baker said. A doctor, for instance, could prescribe a wearable that continuously measures and analyzes a particular condition to uncover actionable insights and help the doctor to provide a diagnosis. That's the vision, he said, of personalized, connected healthcare.
In fact, the current pandemic is uncovering other use cases for remote monitoring wearables. The PGA Tour is giving players, caddies, and other essential personnel WHOOP fitness straps for early detection of COVID-19 signs. The WHOOP Strap 3.0 was designed to give users insights into fitness parameters like recovery, strain, and sleep. WHOOP has now identified an algorithm that can detect 20% of COVID-19 cases two days before a person shows symptoms and 80% of cases by the third day that a person becomes symptomatic; the company's study has been submitted to a medical journal for peer review and publication. The PGA Tour is taking advantage of the fitness wearable to keep its golfing community safe. With an early alert, tournament officials can more quickly isolate those who might be infected. What the PGA Tour is doing presents a use case that can be replicated by other sports or other organizations that are planning their strategies for getting back to business during this pandemic.
Wearables are merging the realms of wellness/fitness with clinical-grade care. Traditional consumer devices for wellness/fitness are not subject to any regulatory approvals. Medical devices, on the other hand, are used purely in a clinical environment and are regulated. Now, we're seeing more consumer devices implementing regulatory agency-approved measurements, such as SpO2 or atrial fibrillation detection.
This trend provides another mechanism for virus detection. During a virus pandemic, remote patient monitoring can offer many use cases:
- Predictive screening of indicators such as temperature and SpO2. If the indicators imply infection, then the individual gets tested.
- Onset monitoring, which adds to the mix heart rate/echocardiogram and respiration monitoring via a remote monitoring device for high-risk individuals who test positive for viral infection. (The WHOOP Strap 3.0 monitors respiratory rate. PGA Tour golfer Nick Watney noted a spike in his respiratory rate from the WHOOP app, which prompted him to get tested for COVID-19. While he did not have any symptoms, he did test positive for the virus.)
- Post-hospital monitoring, which measures all of the above parameters and adds a telemetry component for remote physician visits.
- Deteriorating condition monitoring, which provides the above along with blood-pressure monitoring
Now that we understand what remote monitoring wearables can do, let's take a look at what goes inside to make them accurate and reliable. Key components include:
- A clinical-grade sensor
- Advanced algorithms
- Efficient power management ICs (PMICs)
- Low-power microcontrollers
- A space-saving and smart opto-mechanical design
With an extensive portfolio of wearable health technologies, Maxim Integrated can address each of these areas. During his webinar, Baker highlighted one of the company's newest optical sensor solutions: the MAXM86146, which is the industry's thinnest such solution. The MAXM86146 combines two photodetectors, an optical analog front-end, and a microcontroller with built-in algorithms. Having two photodetectors allows the device to support both heart rate and SpO2 measurements, which each have their own opto-mechanical requirements. Its ready-to-use biosensing algorithms provide simultaneous heart rate and SpO2 measurements to the most rigorous medical standards. Compared with a discrete approach, the MAXM86146, available in a 0.88mm package, offers a 45% thinner optical design. Since you won't have to spend time on algorithm development, the solution can reduce your design cycle by up to six months.
An optical sensor such as the MAXM86146 can be accompanied by a low-power microcontroller such as the MAX32670, also a new device. The MAX32670 is based on the Arm Cortex-M4 processor with floating point unit and features 384KB flash memory with error correction code, flexible clocking schemes, and robust security. It's part of Maxim's DARWIN family of ultra-low-power Arm microcontrollers (WHOOP, by the way, uses the MAX32652 microcontroller from this family, along with the MAX14745 power management IC and MAX17223 nanoPower boost converter.)
To alleviate opto-mechanical design challenges, consider the MAXREFDES103 wrist-based SpO2, heart rate, and heart-rate variability health sensor platform. This platform includes an enclosure and a biometric sensor hub with embedded algorithm for heart rate and SpO2 and a photoplethysmography analog front-end.
"Not only are we implementing solutions for today's pandemic, but we're also providing technologies for the longer term remote patient monitoring trends—enabling better predictive and preventive solutions as well as healthcare and chronic disease management," concluded Baker.