A note on the authors: This article was co-authored and published simultaneously by Keith Deutsch and Peter Orban.
In “A New Division of Labor: IoT, Wearables and the Human Workforce”, the authors introduced the need for a new human-machine interaction paradigm centered around wearable technology driven by the emergence of increasingly autonomous automated systems including AI and robotics in the Industrial world.
Observing the challenges presented by the lack of sufficient detection capability of the Novel Coronavirus causing COVID-19, this article expands on the wearable technology focused rationale for human-digital integration, exploring its potential in the medical and consumer worlds, and expanding where it can be expected to go.
To frame the benefit of such an approach, imagine that the availability of self-administered test kits (and processing capacity) is unlimited, results are returned in a few seconds and the cost associated is negligible. This could immediately identify the affected, enabling an individualized quarantine (and treatment) while responsibly eliminating the need for a widespread lockdown and associated economic penalty.
At the current state of medical technology, using physical samples, reagents, and dedicated laboratories, this is not realistic. But a wearable path to human-digital interaction may offer another approach.
A Wearable Universe Emerging
For the purpose of this article, we consider wearables to be portable devices that people attach to their bodies and operate primarily without the use of hands. The majority are worn on the wrist but there are also eye, ear, finger, neck, and body-worn devices. The category has roots in defense, sports, entertainment, and health, but started to coalesce into a single, consumer category with the introduction of the iconic Fitbit, more than a decade ago. Measured by value, today the vast majority of consumer wearable devices are smartwatches and fitness trackers with an increasingly blurring line between the two categories.
The major innovation that has driven the emergence of these devices is the ability to make and make use of, detailed measurements related to the physical state of the Wearer. Whereas the earliest wearables were limited to using accelerometers to detect and count steps, as sensor technology evolved, wrist-worn devices were packed with additional sensors measuring pulse, heart rate variability, blood oxygen level, ECG, blood pressure, and galvanic skin response. These, in turn, were combined with other sensor data (e.g. GPS) and increasingly sophisticated analytics to create “virtual” measurements of sleep, stress, calories burned, and overall health indicators. However, all these share one common attribute: the data produced has been good enough for consumer use, but not regarded as adequate for clinical use in a more formal healthcare setting.
Upping the Ante: From Casual Measurement to Clinical Imperative
The healthcare industry today spends vast sums of money on complex devices which produce extremely high quality, but narrowly scoped data snapshots about the inner workings of a patient’s body. Think MRI or CAT Scan machines. The monitoring equipment in an ICU also produces very high-quality data, and does it over a longer interval, but also in a highly constrained setting. The problem with these snapshots, as valuable as they are, is that they cover only a narrow window of time. Because they’re so expensive and focused, these tools are primarily diagnostic in nature. A physician is generally already observing a problem and seeking specific information to guide diagnosis and, because the data is being used in such a definitive way, there is very little tolerance for noise or uncertainty. This emphasis on definitive diagnosis places an enormous premium on precision and certainty that has come to characterize the notion of clinical data use.
Most of life, and most of what happens in and to our bodies, happens outside the clinical diagnostic window, and over much longer periods of time. Capturing insights from that stream of life requires a more ubiquitous approach to data gathering and the gathering of data from inherently noisy environments. Moreover, most of the time outside the clinical setting, we are clinically “normal”. The data that’s gathered and any insights garnered would be mostly of the nature of “baseline” observations, perhaps tracking the baseline as it drifts over time. When things go wrong, they might show up as variances or anomalies in that baseline, but detecting these requires ongoing collecting and storage of the baseline data. Because the clinical community has never had the means to capture broad baseline characterizations on an individual basis, it has never developed methodologies that depend on it. Ever wonder why your primary care provider has no interest in all that Fitbit data you’ve accumulated?
On the other hand, as the current crisis so deeply illustrates, there is a need to expand the clinical window from a reactive view to something more proactive and predictive. This is leading to a transformation in how the data that can be captured from wearable devices is used. In part, this transformation is being driven by improvements in the quality of the data produced by wearable sensors, (e.g. Lifesignal’s unique sensor) in some cases sufficient to warrant FDA approval. However, equally important is the growing sophistication of the analytic methods applied to the data. In the industrial context, it is increasingly a given that large, diverse streams of data, analyzed over prolonged periods of time can produce remarkably reliable and precise predictive, pre-emptive, and diagnostic indicators. Rather than service a jet engine on a schedule, or wait until it fails, a detailed and comprehensive picture of the internal condition of the equipment is continually derived from hundreds to thousands of sensors embedded within it. As important, by examining its historical data, and that of many other engines in the field, anomalies can be detected even when the equipment seems to be in perfect operating condition. In this way, data can be used to detect not only known failure conditions but also unknown ones.
Of Sensors and Humans
Unlike a modern jet engine, humans don’t come with a comprehensive suite of embedded sensors, and the number of streams of data available for analysis is therefore much more limited. Still, the combination of wearable and portable devices (e.g. cell phones) provides a surprisingly rich source of data streams. Moreover, unlike a jet engine where each sensor reports exactly one metric about one element of the engine, the sensors we carry with us are configured to monitor much richer signals. For example, the Samsung Galaxy Watch Active 2’s motion sensor data can be processed to reveal signals that inform analysis of our gait, how much exercise we’re getting, sleep patterns, breathing patterns – or combined with pulse data – even the Wearer’s stress level. Moreover, despite technical challenges in doing so, ambient sensors already present in the environment can be added to the mix. For example, a security camera in an office, which may already be doing facial recognition, could also be harnessed to detect changes in complexion or its range could be extended into the infrared spectrum to look for evidence of elevated body temperature. Additionally, human beings have a critical feature that is lacking in industrial machinery. We can be directly queried and the assessment of our data can be iterative based on our direct input. Finally, all of this field data can be combined with clinical data from Electronic Health Records.
Once assembled, this data collection can be processed in at least a couple of ways using Machine Learning (ML) techniques pioneered in the industrial world. First, individual baselines can be used to detect anomalies that might indicate that an individual is under health stress, even when he or she feels perfectly fine. Second, when a known pathogen is being tracked, data from individuals with confirmed cases of the disease can be used to train ML models. In this way, digital “fingerprints” of a disease are created that can be applied to detect the disease in people as they go about their lives. In effect, these techniques provide a path to data-based testing and detection regimens that can be broadly and continually applied to a large population.
In fact, interested parties are already experimenting with partially similar approaches[1,2,3,4] The upshot is that, despite the inherent resistance to change in the clinical community, the critical need to expand the clinical window is driving the acceptance of data analysis techniques applied to wearable sensors as a clinically valid source of predictive and pre-emptive health indicators.
Closing the Loop: from prediction to prescription
While approaches like the ones currently being explored differ on a technical level they all share a key attribute: the one-way flow. Data flows one way from the field (wearers, the environment or labs) to a central platform where the detection algorithms are applied. In cases where the condition or disease is detected, the path to action is at best indirect.
On the other hand, as noted above, human intelligence creates the possibility of iterative, human-in-the-loop, analytic models. This, however, is just a starting point: the universe of wearable equipment is not limited to smartwatches that send data. It includes devices like earbuds (e.g. Jabra Elite Sport)_and smart glasses (e.g. Focals) that can provide a real-time feedback path to the user. In this way, wearables enable the creation of a full, human-centered, behavioral loop. This behavioral loop presents a previously overlooked dynamic: a direct influence – and possible change – of individual behavior in response to emerging threats. The behavioral loop literally allows for prescribing and monitoring the behavior of individuals in response to a possible emerging adversarial health condition, like a pandemic.
Think of the current system of Wireless Emergency Alerts (WEA) that warns the public about dangerous weather, missing children, and other critical situations. But unlike the WEA, the behavioral loop is individualized, dynamic, and able to provide specific instructions in a non-intrusive manner. A fully integrated system of wearables can be thought of as a bidirectional communication and control system. The possibilities for real-time analysis, and both group and individual behavioral influence are enormous.
Put differently, a wearables-based approach would enable society to identify members under threat at various different levels and could enable individualized action via an established behavioral loop. This could mean instructing suspected patients to shelter-in-place in dense urban environments or just “flag” the person to other, uninfected people for safe distance keeping in areas of low population density.
Any of these approaches are inevitably going to encounter the sensitivities around Personally Identifiable Information (PII), Individuals will want the ability to control and regulate their data flow. In this regard, the behavioral loop enables a form of negotiation, for example, individuals can be incentivized to opt into higher levels of sharing in exchange for higher levels of benefit, such as earlier warning, faster testing, etc. A good illustration of this principle would be the Global Traveler program where registered participants can bypass security lines at airports by volunteering PII.
Taken together, the result is that society could accomplish objectives like “flattening the curve” without major economic disruption since the reaction to infection would be individually prescribed and proportionate to the risk a single individual may represent.
- One of the most visible initiatives is archrivals Apple & Google teaming up for contact tracing.
- Another group of researchers, led by MIT aims to do the same, albeit in a more privacy-friendly manner.
- Fitbit (now part of Google) teamed up with Stanford University and Scripps Research and has unveiled an initiative that intends to use Fitbit devices to identify the early signs of infections.
- Oura, another wearable manufacturer is sponsoring research at the “...University of California, San Francisco (UCSF) to study whether physiological data collected by the Oura ring, combined with responses to daily symptom surveys, can predict illness symptoms.”