The consumer market for medical IT devices and apps has exploded in recent years, with over 435,000 health-related apps currently available. That market is estimated to grow from $300 billion today to almost $1 trillion in 2030. Nearly half of all Americans—led by Gen Xers and young people—wear smartwatches with apps that monitor dozens of health metrics including steps, calories burned, blood oxygen levels, heart rate, sleep patterns and menstrual cycles.
Smartwatches made by Apple, Fitbit, Garmin and others now include ECG monitors that the FDA has cleared to detect atrial fibrillation as well as Parkinson’s symptoms and respiratory illnesses. As human trials on these devices continue, they will become FDA-approved to monitor an ever-increasing number of conditions. Major retailers like Best Buy are betting heavily on wearables and home medical devices as a significant new area for technology sales. Currently, few of these expensive over-the-counter devices are covered by insurance and are marketed only for higher income populations. While the cost of consumer technology tends to come down over time, private or government insurance programs will have to change policies for the larger population to benefit from these advances.
Cameras on cell phones can document and facilitate the diagnosis of skin diseases, including carcinomas. FDAapproved apps treat substance use disorder, ADHD and sleep disorders. Virtual and augmented reality games and apps are already being used as therapeutics to treat neurological disorders, manage pain and monitor physical therapy progress.
Perhaps the most significant change will be the next generation of wearables that will constantly monitor blood pressure, stress hormones, blood sugar levels and other metabolic health markers. Combined with population-level data sets, these biomarkers will help predict the onset of heart disease and type 2 diabetes, two conditions most responsive to diet and lifestyle changes. Early awareness and intervention could save millions of lives and significantly decrease healthcare costs.
SELF DIAGNOSIS AND AT-HOME MEDICAL RESEARCH
Early 2023 saw an explosion of new AI apps such as ChatGPT, growing within a few months to over 100 million active users. Trained on massive amounts of data from the internet, ChatGPT will answer most any question, including medical queries. Unfortunately, ChatGPT often provides factually inaccurate information—it has no mechanism to distinguish good information from bad. This new “generative” technology is still in development but will certainly be another way that people learn about their health challenges.
A new generation of off-the-shelf consumer products to use at home are emerging to monitor health metrics once available only in a clinic—vital signs, food intake and calories, changes in cognition, and mental health status. Weight scales in your home can now measure BMI, body fat, subcutaneous fat, body water, skeletal muscle and muscle mass, and are wirelessly linked to apps that collect and analyze health trends. Environmental sensors measure indoor air quality. Increasingly, these “always-on” networked devices will share and interact with each other— and eventually with wearables and other personal data—creating a remarkably holistic understanding of an individual’s health.
Here are a few examples of what’s arriving to equip the smart home of the future:
Diagnostic toilets will automatically test for signs of health and diseases in urine and stool, including blood, nutrition and gut microbiome.
Alexa-like interfaces will listen to your voice for signs of stress or depression or the onset of disorders like Parkinson’s and other neurological conditions.
Through 30-second selfies taken on tablets and smartphones, we will check vital signs and run hundreds of diagnostics, including markers for hypertension, stroke, heart disease and diabetes.
Touch screens on tablets and smartphones will also monitor changes in finger dexterity as a sign of depression or other mental disorders, and the onset of dementia.
GPS tracking will trace geographic exposures to diseases—STIs, monkeypox, Covid, flu, measles, etc.
Handheld kitchen spectrometers will analyze your food for toxins, allergens and nutritional components.
At-home devices will analyze your breath for biomarkers of diseases, including bacterial infections, cancer, Alzheimer’s and Parkinson’s.
Smartwatches and other wearables will monitor you as you sleep, ready to alert family and medical personnel of any signs of atrial fibrillation or stroke.
Diagnostics will arrive by Uber-style delivery or by drone.
The home is the next frontier in terms of where you can best ensure value-based care, and we are at an inflection point.
Andrew Agwunobi, MD
President of Humana’s Home Solutions
phe·nom·ics | f ‘nämiks | noun
the study of how the environment and a person’s lifestyle interact with the expression of their genes to influence their health and risk of disease
Consumers and patients have gotten used to ordering profiles of their DNA to look for certain health indicators. A limited number of FDA-cleared tests that provide risk factors for acquiring a serious disease are also available, including the APOE4 gene variant that increases a person’s risk of Alzheimer’s disease, and BRCA2, which significantly increases the risk of breast cancer. Providing these tests to consumers, however, is controversial, with most physicians preferring that trained medical caregivers deliver news for diseases that either have no cure (Alzheimer’s) or may entail a radical medical intervention (breast cancer).
And it turns out that genomically identified markers for most common diseases have proven to be less important in many cases than lifestyle and other factors. This is leading to a more expansive range of tests—phenomics—that can measure everything from a person’s gut microbiome to profiles of their epigenome, proteins and metabolites.
A wave of phenomics-oriented startups will combine advanced AI, using ever more sophisticated models to predict and prevent disease. Most phenomic tests now are either in early human-testing stages or need to be ordered by a physician. In the future, consumers will be able to perform these tests with home devices with no or minimal input from traditional medicine. (See the Wellness and Nutrition section for more on this subject.) While this might benefit some patients who get alerted early to a serious condition, there is a downside as well. Health facilities could be overwhelmed by symptom-free individuals seeking unnecessary or even dangerous treatments for diseases predicted through these new technologies.
The plethora of health apps and devices are mostly coming from tech startup founders who know less than medical professionals and researchers about the human body’s complexities. The IT industry also frequently runs afoul of the strict regulations that govern medical and health devices and treatments. This disconnect has led to devices that aren’t always accurate or well-grounded in medicine and human biology, a gap between IT and biomedicine that is lessening as engineers and biologists work better to connect their worlds.
Personal data and financial safety are also at risk. Unscrupulous marketers of health apps will have the means and profit motive to target those with health vulnerabilities. We’ll need to develop safeguards and establish ethics rules and laws to better protect people from potential abuses of their digital health data by hackers, advertisers, companies and governments.
We found that app development processes significantly lack the involvement of relevant healthcare professionals or agencies. … Their absence from the process can lead to poor quality of content.
Saba Akbar et al
Center for Health Informatics, Macquarie University
Traditional medicine has been slow to integrate new over-the-counter selfhealth tools, in part because so many of these devices haven’t been tested and verified for accuracy or approved by the FDA.
To date, most health data from wearables and at-home devices is being collected and analyzed by organizations outside traditional medical systems. This started in genomics with companies like 23andMe and Toolbox Genomics collecting DNA data through home kits and informing consumers of certain disease risks. The Seattle-based company Arivale offered hundreds of phenomic tests to customers, combining everything from Fitbit data to DNA profiles to measurements of metabolites, proteins and other molecular data, all independent of a doctor or clinic. The company eventually closed down because of the high costs of some testing. As costs go down, look for more companies to make meaning from the home-created health data. For instance, testing one’s complete genome—all of the ACGTs inside you—recently dropped to a cost of about $200 from millions of dollars just 15 years ago. Integrating self-health data from wearables and home devices also represents a culture shift for everyone: most patients now go to doctors and clinics for testing by approved labs in controlled settings. As more devices and app-based algorithms are rigorously tested and cleared, healthcare’s incumbent powers will be pressured to integrate self-health data with clinical tests and electronic health records (EHRs).
In the coming years, the combination of clinical and self-health testing will profoundly change healthcare by predicting diseases far in advance of symptoms. This will lead to personalized and early targeted interventions to prevent or mitigate disease onset. Currently, over-the-counter devices, like smart watches, that gather health data are marketed mostly for consumers with higher disposable incomes. Delivering effective care for all will also require collecting a generation’s worth of data from socioeconomically and racially diverse populations.
We currently drive cars that have dashboards that monitor the health of the vehicle but we have no real equivalent for humans. We should be continuously collecting data on people while they are healthy so we can see when things are going off the rails.
Michael Snyder, PhD
Director, Center for Genomics and Personalized Medicine at Stanford University
In recent years there has been an explosion of medical advice on social media and the internet. YouTube hosts 600,000 videos about prostate cancer alone. The information ranges from serious medical research to quack cures. Currently, there are few restrictions on social media platforms as to who can masquerade as a medical expert and what type of advice they can offer. Social media sites like TikTok, Facebook and YouTube not only host medical quackery, their recommendation algorithms are encouraging users to consume more and more of it.
The self-appointed medical gurus who populate social media sites have encouraged a new wave of mostly young people to experiment on themselves with new devices and unproven remedies. Sales of drugs and supplements—including controlled substances—are booming on the internet. Facebook and Instagram have become the cyber equivalent of open-air markets for prescription and illegal or unregulated drugs.
41%Users who have shared wearable device health data with their doctor
Despite some dangers, the self-health trend is largely positive. More people will start taking their own health in hand by improving their diets, exercising more, and increasing their understanding through self-collected data. The ever-lowering cost of consumer health IT technology will make self-monitoring devices increasingly accessible for those with lower incomes. (For more on healthy living, see the Wellness and Nutrition section.)
At the massive 2023 Consumer Electronics Show, hundreds of startups demonstrated advances that will give every home the diagnostic tools of today’s doctors’ offices. (See the Wellness and Nutrition section for more on this subject.)
U-Scan – At-Home Urinalysis Scans users’ urine for biomarkers such as hydration and vitamin levels.
Evie – Medical Grade Health-Monitoring Ring Ring designed to give women a full picture of their health.
NuraLogix’s Anura – Potentially Life-Saving Selfie App can check vital signs from a cell phone selfie.
Epicore Biosystems – Connected Hydration Monitor Electronic sweat patch continuously measures sweat fluid and electrolyte levels while monitoring skin temperature and movement.
Whispp – Amplifying Hidden Voices Mobile app converts whispered speech, vocal cord–impaired speech and severe stutters into a natural-sounding voice in real time.
Opteev Technologies’ ViraWarn – Portable Virus Detector This breath analyzer is intended to detect Covid-19, influenza and RSV in less than 60 seconds; under FDA review.