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Advances in sensors and artificial intelligence (AI) are helping millions detect and manage chronic health conditions and avoid serious illness on devices small enough to be worn on a wrist or penny-sized patch. Deloitte Global predicts that 320 million consumer health and wellness wearable devices will ship worldwide in 2022 (figure 1). By 2024, that figure will likely reach nearly 440 million units as new offerings hit the market and more health care providers become comfortable with using them. These numbers include both smartwatches, which are marketed to and purchased by consumers, and medical-grade wearables—typically called “smart patches”—which are often prescribed by health care professionals but are increasingly becoming available off the shelf.
While health care companies produce a range of devices that help patients monitor health markers intermittently—including blood pressure cuffs and ECG monitors—our analysis focuses on smartwatches and smart patches, which are seeing rapid consumer adoption.
Deloitte’s 2021 Connectivity and Mobile Trends survey found that 39% of respondents owned a smartwatch.1 Their most common uses have historically been to help people get fit, lose weight, and beat their personal best in their next race (figure 2). But increasingly, people are using smartwatches to monitor their health, not just their running pace, as new hardware, software, and apps have turned them into personalized health clinics. Heart rate monitors are now standard on most smartwatches, and some have FDA approval for detecting abnormalities such as atrial fibrillation, a major cause of stroke. As these devices get more sophisticated, the percentage of consumers using them to manage chronic conditions and detect symptoms of serious diseases will likely increase.
The pandemic highlighted the value of smartwatches for monitoring health. As COVID-19 spread, smartwatches that measure blood oxygen saturation (SpO2) became widely available, alerting people with low SpO2—a life-threatening symptom that is hard for people to detect unassisted.2 More than 10% of US consumers who own smartwatches are now using them to detect COVID-19 symptoms. The pandemic may even have encouraged smartwatch sales: Fifteen percent of US consumers who own a smartwatch purchased it after the onset of COVID-19.3
Smartwatch innovation is progressing rapidly, driven by advances in sensors, semiconductors, and AI. For example, some smartwatches now feature optical sensors that continuously measure variations in blood volume and composition using a technology called photoplethysmography (PPG). Algorithms produced and continually improved via machine learning use data from these sensors to provide insights into users’ activity levels, stress, heart pattern anomalies, and more.4
As another example, companies are getting closer to enabling smartwatches to monitor blood pressure, using PPG and other technologies such as Raman spectroscopy, and infrared spectrophotometers.5 Measuring blood pressure with a cuff is inconvenient and uncomfortable. Most importantly, periodic blood pressure measurements can miss signs of chronic hypertension, which can cause heart disease, heart attacks, and strokes. Accurate, continuous, unobtrusive blood pressure measurement could expand the smartwatch market: 1.3 billion adults worldwide suffer from hypertension.
Of course, there are limits to what current smartwatch sensor technology can do without attaching to—or getting under—a person’s skin. That’s where smart patches come in.
Smart patches, developed mostly by medtech companies, are typically small and unobtrusive, affixing directly to a person’s skin. Some “minimally invasive” smart patches use microscopic needles that painlessly penetrate the skin to act as biosensors and sometimes to deliver medications.
Unlike smartwatches, which provide a broad range of health data and insights, smart patches are typically designed for a single indication such as diabetes management, patient monitoring, and drug delivery. Smart patches also employ a broader range of technologies. For example, smart patches that measure heart rate variability often use electrocardiogram technology that tracks the heart’s electrical activity directly and more accurately than smartwatches.6
Smartwatches and smartphones still play an important role. Data from smart patches is being integrated with smartwatch and smartphone apps, sending data to these devices for display and analysis. With the right technology, including interoperability capabilities, doctors could see wearable health data on a patient’s health record, gaining access to more comprehensive information to inform diagnosis and care.
Companies of all kinds, from giants to upstarts, are developing new functionalities to meet growing demand for health care wearables in 2022 and beyond. But more widespread acceptance by consumers and health care providers may come slowly, as wearables are relatively new. Headwinds include:
Doctor skepticism. Health care providers who use wearable technology to monitor chronic health conditions and to track vitals, sleep quality, and medications are finding the technology helpful.7 However, they also report three main drawbacks:
Data privacy concerns. Since the COVID-19 pandemic began, consumers have become more willing to share health data.14 Data privacy remains a hurdle, however. Forty percent of smartwatch or fitness tracker owners are concerned about the privacy of data these devices collect, according to Deloitte’s 2021 Connectivity and Mobile Trends survey. That figure rises to 60% among smartwatch owners who use them exclusively to track their health.
Cybersecurity threats. Like all connected devices, health and wellness wearables are vulnerable to cybersecurity threats. The consequences for users could be severe. Fake smartwatch alerts could prompt patients to overdose on medications.15 Medical devices such as drug infusion pumps and pacemakers have been hacked, too.16 As more smart patches administer medications, millions more people could be vulnerable to threats. Finally, hackers have recently stolen millions of health and fitness records originally collected on smartwatches.17 With health and wellness wearables, it’s critical that companies integrate cybersecurity into their product development, software, supply chains, and cloud computing.18
Increased regulation. Currently, tech companies can decide not to classify smartwatches as health care devices to avoid regulations such as the United States’ Health Insurance Portability and Accountability Act, which requires people’s explicit knowledge and consent to share sensitive health information. But as these devices and their outputs are integrated into EHRs, and their alerts direct more patients into the health care system, regulators could require companies to adhere to more restrictive rules.19
These headwinds are not insurmountable barriers, and likely won’t stop consumer health and wellness wearables from growing in the next two years. Devices will get more accurate, and the apps will get smarter, enabling people to monitor a broader range of health indicators and conditions. It also seems likely that regulators will approve wearable devices for additional indications. For these reasons, big tech, medtech, and a legion of startups believe that the health wearables market is a strong one, and their investment and innovation could make it a self-fulfilling prophecy.
The authors would like to thank the following individuals for their contributions to this chapter: Ankit Dhameja, Wendy Gerhardt, Sonal Shah, and Glenn Snyder.
Cover image by: Jaime Austin
