The “wearables” buzzword has been floating around the healthcare technology ecosystem for decades, and the consumer market for these devices has grown rapidly over the past several years. However, despite the 325M that are currently active globally (Statista), wearables have not lived up to their potential in driving improvement in patient care.

I have personally fluctuated between wearing an Apple Watch and a Fitbit Charge for the last 3 years, but the key drivers of my adoption stem primarily from aspirational personal goals of working out more and living a healthier life. Unfortunately, neither of these tools has made much of a difference in my own habits - but that is a story for a different day. I don’t know many people who swear by these devices, and I wanted to do some digging myself to better understand where they are making a difference. Punchline: I was disappointed with what I found.

The Wearables Market

Revenue from the sale of “consumer wearable” devices is expected to reach $45B per year by 2020, with smartwatches constituting a 49% market share (Statista). However, there are also several other types of devices that are growing in popularity, with smart clothing expected to have largest growth in market share over the coming years:

The “medical wearables” market, while smaller, is also growing rapidly - expected to reach revenue of $14.4B by 2022 (MarketsAndMarkets). This segment includes devices for measuring blood pressure, tracking glucose levels, monitoring falls, and many more use cases. Because they have been designed specifically for a particular medical purpose, these devices tend to have greater adoption (also driven by insurance coverage and integration with the clinical ecosystem). However, they also tend to be more uncomfortable for patients to wear and much more expensive than consumer wearables.

Primary Use Cases

While each device has a variety of sensors designed to track several metrics, the underlying reason for the purchase and adoption of these devices can be summarized in two use cases:

Patient Autonomy: Empower patients with the data they need to better manage particular health conditions or overall fitness without regular clinical intervention
Clinical Decision Making: Enable physicians with the data points needed to better tailor clinical interventions and recommendations to the needs and behaviors of a patient

Currently 48% of individuals over 65 and 47% under 65 are interested in using wearables (17%, 20% adoption rate, respectively). Excitement continues to build among consumers motivated to improve or maintain their health status. However, despite the size of this market, we still see daily abandonment rates reaching upwards of 30% for specific devices. This trend is more indicative of a passing fad than a meaningful solution. Why?

Failure of Consumer Adoption

I cannot tell you how many times I have fluctuated between using and not using my wearable devices. For me, it comes down to lack of a clear use case for the data that it presents to me. I have a hard time knowing when I am meeting my goals or even trusting some of the proprietary metrics established by vendors. In general, consumers cite similar reasons for not continuing to utilize their devices: use case is unclear, easy to lose, unattractive / uncomfortable, short battery life, does not sync well with Smartphone, etc.

However, there are actions that device manufacturers can take to motivate usage:

The other major barrier for wearable proliferation is the initial purchase decision. Devices can be expensive ($100-$300) for many consumers, but there are also several additional factors that consumers consider important:

In the end, it really comes down to users being able to directly tie their use of a wearable device to better health outcomes. While the next section breaks down the challenges within the clinical setting, there are several things device manufacturers can do to address current adoption challenges:

Target very specific use cases for devices with clear explanations of how to leverage the data to change consumer behavior
Include features shown to motivate consumers: Monetary Rewards (54%), Gaming for Competition (45%), Loyalty Point Rewards (43%), Attractive (36%)
Work with Insurers or Employers to help reduce the purchase price of the devices for consumers (assuming you can prove savings in health costs / better productivity)

Failure of Clinical Adoption of Consumer Wearables

Medical Wearables designed for specific clinical purposes (e.g., blood pressure, glucose measurement, etc.) are starting to become pervasive in helping to improve patient care. The best example of this is the Abbott Freestyle Libre which measures glucose through a patch the patient wears on his or her arm. To be clear, I believe that these devices have been a resounding success to date, and the focus of this section does not specifically include these types of devices.

Instead, I believe there has been significant failure in the adoption of data captured from consumer devices in the clinical setting (when is the last time your doctor asked to see your Fitbit data?). The primary reason we typically hear is that physicians do not have time to scan through the vast amounts of raw data captured from consumer devices to glean clinically significant insights. The information is not integrated into the EHR in a way that makes it easily accessible in physician workflows. While this is absolutely a problem that needs to be addressed, I believe the problem itself is much deeper: the structure of current provider business models does not incentivize the use of this information.

As I wrote about in a previous post (Addressing SDoH For a Better Tomorrow), patient quality of life is not primarily dictated by what happens inside the clinic. Instead, patient behaviors and circumstances outside the office tend to play a bigger role in the health challenges individuals face. You would think this would mean that data captured from consumer devices could play a major role in helping inform clinical interventions - but that is not the case. There is not a profitable ICD10 code associated with the review of wearable device data in the fee for service ecosystem.

Given this dynamic, I believe there are multiple changes required to make wearable data more meaningful in the clinical setting:

Shift to business models focused on rewarding providers for maintaining the health of a population rather than just providing care during the visit (just do it already)
Develop a standardized dashboard of insights generated by wearable devices that requires minimum effort of interpretation from the provider
Invest the time and money to develop wearable sensors that provide accurate, clinically relevant results and guide them through the FDA’s approval process (now easier given the FDA’s new focus on digital health)

Path Forward

The biggest difference between consumer wearables and medical wearables is in their ability to provide information that is meaningful to practicing physicians. When consumer sensor technology becomes adequately precise in measurement (e.g., Apple EKG) and medical wearable devices are designed to meet the ergonomic needs of consumers, I believe we will see these two segments converge to meaningfully help patients. Until then, product market fit will be constrained to niche segments and wearables will remain nothing more than a tech-enabled fashion statement.