Geoffrey S. Ginsburg, Rosalind W. Picard, and Stephen H. Friend. "Key Issues as Wearable Digital Health Technologies Enter Clinical Care." New England Journal of Medicine 2024; 390:1118-27. DOI: 10.1056/NEJMra2307160

Abstract

Wearable digital health technologies (DHTs) offer the potential to affect health care by making behavioral and physiological patterns in daily life outside the clinic visible to patients and medical professionals. Our series to date has covered areas of clinical care in which there are reasonably robust clinical trial data showing the value of these technologies: diabetes and two types of cardiovascular disease. These trials have shown that enabling more personalized data-driven interventions and objective measurement of treatment effects can lead to results that are in many cases superior to those achieved with the use of intermittent clinical data, which is the current basis for the standard of care. We have also highlighted areas showing the nascent effect on patients and clinicians of wearable DHTs that measure movement and sleep for the management of depression and wearable DHTs that use artificial intelligence (AI) to monitor patients for seizures, improve seizure quantification, reduce injuries, and lower the risk of sudden unexpected death from epilepsy. The evidentiary basis for the broad clinical effect of wearable DHTs in these areas is in its infancy, but our series has shown the potential for real-world medical benefits. Well-designed longitudinal trials will show which of these transformative aims can be realized.

In this final review in the series on wearable DHTs, we highlight important challenges that must be met to integrate the devices into clinical guidelines and practice. We have deliberately grounded our narrative in what is possible today, but we also speculate about specific uses of wearable DHTs in the future. As Figure 1 shows, we identify six interlocking and vexing issues at the foundation of delivering DHT-informed care: data ownership; patient trust, literacy, and access; standards and interoperability; integration of DHTs into clinical care; patient empowerment and agency; and reimbursement and a return on investment for health care systems.