By Olivia R. Weidner, DHIT Global Intern | June 1, 2020
On Friday, May 29th, 2020 the Digital Health Institute for Transformation (DHIT) hosted the fifth installment of its digital web series in collaboration with the ASSIST Center at North Carolina State University.
The DHIT Frequency Webinar Series, which takes place biweekly, is a way to keep our community connected while many work from home. Each segment will be co-hosted by DHIT’s President, Michael Levy, and Adam Curry, ASSIST Innovation Ecosystem Director. The series will spotlight distinguished guests from across the ecosystem to discuss the state of digital health in the time of COVID-19.
Amidst widespread fear and uncertainty, DHIT explores the role of digital health in the global response to COVID-19, gaining insight into the ways this crisis has catalyzed the usage and acceptance of telehealth and other digital health technologies. Last week’s panelists included:
- Geoffrey Ginsburg, Director at the Center for Applied Genomics & Precision Medicine, Duke University School of Medicine
- Steven LaBouef, Co-founder & President at Valencell
- Alper Bozturk, ASSIST HET Testbed Leader at North Carolina State University
Friday’s webinar extended last week’s conversation about the use of wearable technology for collecting biometric data. More specifically, this installment centered on the value of remote pulmonary monitoring in the detection and recovery of patients with COVID-19. Panelists also discussed the ongoing role of remote monitoring within value-based care and precision health, a conversation that is likely to continue beyond the current pandemic. Topics of conversation included: technical, clinical, and commercial aspects of wearables, the viability of advanced monitoring, and the possibilities and challenges that currently exist in the field.
Moderator Adam Curry kicked off the discussion by telling viewers: “Remote health monitoring allows patients and caregivers to stay connected, beyond an initial virtual or in-person visit. It allows caregivers to monitor changes in symptoms as well as underlying health conditions and provide guidance.” After drawing attention to the potential of these technologies, Curry introduced viewers to the first panelist, Dr. Geoffrey Ginsburg. Ginsburg serves as Director at the Center for Applied Genomics & Precision Medicine at Duke University’s School of Medicine, where he recently launched a remote monitoring clinical trial called COVIdentify. Ginsburg provided a brief explanation of his work on this project:
“We launched the COVIdentify project to answer the question of whether smartphones and wearable devices could identify those vulnerable to infection, identify early signs of infection, as well as to map out the illness trajectory…we’re collecting symptom surveys, and, in some cases, laboratory tests from participants, and then correlating this with self-report data as well as data gathered from wearable devices.”
“At the time, the industry wasn’t receptive to remote monitoring technology. The medical field wasn’t ready to accept this kind of technology. Now, this type of thing is getting a lot of attention. What a lot of people don’t know is that the devices you currently wear have the capability to provide metrics that can be used to let you know that you might be coming down with something.”
By collecting and utilizing multiple sources of information, Ginsburg and the COVIdentify team are working to discover how wearable technology can play a role in the early identification of infection with COVID-19. Right now, the study has over 5,000 participants, but the goal is to conduct the study in hundreds of thousands of people, in order to collect broader population data and subsequently draw generalizable conclusions.
The second panelist, Dr. Steven LaBeouf, shared his perspective from the commercial side of wearable devices. LaBeouf is the Co-Founder and President at Valencell, a leading maker of biometric sensors headquartered in Raleigh, NC. LaBeouf discussed the considerable changes to the digital marketplace over recent years, and recalled a time in 2008 when bluetooth earbuds were used to track biometric data. According to LaBoeuf, there was a pattern of users experiencing dramatic changes in heart rate variability. Researchers ultimately determined that this persistently elevated heart rate corresponded with swine flu infection; these dramatic changes in heart rate variability were visible two days prior to users becoming symptomatic. However, this realization was not enough to generate widespread use and acceptance of similar wearable technologies.
Today, we are seeing an increased acceptance of and demand for remote monitoring technologies, especially in the face of COVID-19. Nonetheless, characteristics of today’s pandemic pose obstacles to identifying at-risk individuals:
“In the case of COVID, what makes it more complicated is that the symptoms aren’t so universal. Some people don’t have any symptoms at all, so it would be interesting to find out how heart rate variability comes into play for these individuals over the course of their illness.”
As articulated by LeBoeuf, a lack of specificity in the symptom profile of COVID-19 presents a unique challenge to the utilization of wearable technologies. Other issues in the domain of remote monitoring include: a lack of standardization, concerns about accuracy, and insufficient battery life. Ultimately, the goal is to create and deploy technology that an individual can forget that they’re wearing; this would ensure the most continuous, uninterrupted collection of biometric data possible.
The third and final panelist on Friday’s webinar was Dr. Alper Bozkurt, ASSIST HET Testbed Leader at North Carolina State University. Bozkurt shared the work being done at the ASSIST Center as it relates to pulmonary health. The first medical application area explored by the ASSIST Center was asthma; researchers on Bozkurt’s team sought to identify important variables that might predict and thus prevent asthma attacks. According to Bozkurt, environmental context is as important as an individual’s biometric data; air quality, ozone concentration, and the concentration of other organic compounds in the air we breathe can play a significant role in triggering asthmatic symptoms. Today, the ASSIST Center is utilizing data previously collected on asthma and respiratory health to inform studies of COVID-19, which can cause significant pulmonary difficulties. According to Bozkurt, “Pulmonary health has a lot of information embedded inside it. Whether you are healthy or you have some sickness, there are some signatures there. The question is whether we can track this.” As insight into pulmonary health becomes increasingly important, Bozkurt identifies one possibility for new wearable technology:
“With COVID-19, we are entering uncharted territory with a new form of wearable — the mask. Now, everyone is requiring masks, so there is potential for using the mask to monitor breathing rate and other metrics, as well as using energy generated by breathing to power a device.”
While such technology has yet to be developed, the concept of a “smart mask” represents one way in which COVID-19 has changed the conversation surrounding remote pulmonary monitoring.
As the world continues to respond to the COVID-19 pandemic, important questions are raised about the usage of wearable devices for remote monitoring. Consumers, caregivers, and payers alike must consider issues of efficacy, accuracy, and standardization of devices moving forward. Ginsburg grants readers a useful summary of the challenges we face:
“Providers and clinicians will only want to use devices with FDA approval or similar credentials. To develop a product that will be useful for patient care, we’ll need clinician input as well as regulatory input early on…I hope to see a direct path from medical need identification to product development, testing, and payer reimbursement in the future.”
While COVID-19 has proven to be a catalyst for bringing digital health to the forefront of medical care, clinical utility, proven accuracy, and payer approval will be critical moving forward.
DHIT thanks its guests for serving on the panel, and everyone who tuned in! If you were not able to catch last week’s webinar, check out DHIT’s Media page to see what you missed. DHIT and ASSIST would also like to give a special shout out to our Program and Innovation Champions: Pfizer Digital, RIoT, Excelerate Health Ventures, and Duke MEDx.
We are excited to announce DHIT’s partnership with the ASSIST Center to launch an ongoing focus on remote care. DHIT and the ASSIST Center are partnering to launch a Virtual Incubator using Crowdicity to collect crowdsourced ideas from the digital health community. This innovation engine will serve to advance remote care by sourcing ideas from the ecosystem and nurturing them from inception to implementation. For more information, see our landing page for the Incubator and mark your calendar for Friday, June 12th for the next installment of the DHIT Frequency Webinar Series, which will focus on remote cardiac monitoring. Until then, stay safe, everyone!
The Digital Health Institute for Transformation (DHIT) is a 501(c)(3) non-profit education and research institute supporting communities through the process of digital health transformation. We collaborate with leading academic institutions, associations, and industry to cultivate talent and ecosystems with our immersive learning platform, harnessing real-world experiences that drive the adoption of next-generation skills, emerging technologies, and mindsets needed to foster the digital health leaders and innovators of the future, today. For more information, visit dhitglobal.org.
If you would like more information on this topic, please contact our Executive Producer, Brian Cooper at email@example.com.