1) Wearable technologies can help create a more individualized and preventative approach to healthcare that significantly reduces costs by monitoring vital signs and activity levels in real-time. 2) Sharing health data from wearables with doctors and insurers allows for timely feedback and treatment while also incentivizing individuals to engage in preventative care through rewards programs. 3) However, using wearable data in healthcare raises privacy issues that must comply with regulations like HIPAA, and organizations collecting and sharing health data could face legal liabilities depending on how the data is used and interpreted.

1. 10 CLOSEWORK® GLOBAL REVIEW 2015
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CLOSEWORK® GLOBAL REVIEW 2015 11
An individualized approach will enhance healthcare and quality of life while
significantly reducing costs, argue Adam Kersgard, Nayan B. Shah and Kerry
Sims. Wearable technologies are helping this revolution become reality.
Wearing Your Heart
On Your Sleeve.
may change the way data is collected and
shared between individuals and with
primary care providers.
Creating a link between an individual’s health
data and the various stakeholders across the
healthcare system is challenging, but necessary.
Healthcare service providers have discrete and
isolated IT systems within organizations (e.g.,
hospital emergency room and cardiac critical care
unit) and do not typically allow interaction across
users. New standards coming into place, such as
ICD-10, should facilitate better standardization
of medical classifications, allowing easier access
to patient records, physician initial diagnoses and
progress notes across providers. If implemented
correctly, it will help all stakeholders.
To achieve a more efficient, healthier
relationship between patients and providers,
we must anchor and integrate current IT
infrastructure in local communities with regional
The US is also facing the beginnings of a
demographic tidal wave, making change an
imperative. In the US, population age 65 or
older totalled 39.6 million in 2009. By 2030,
that number projects to about 72.1 million,
more than twice the number in 2000. This
means more demand for elderly care
services and facilities.
Lowering The Temperature
Of Healthcare Costs
Overall, the cost of healthcare in the US
continues to increase at 17.9% of GDP.
Actionable intelligence is essential to control
healthcare spending related to chronic
conditions. Using real-time data collected via
wearable technology can aid, preventative
treatment for key chronic conditions and
reduce overall treatment costs. Current
technological advances allow the measurement
of one or more vital signs using wearable
technologies. The Apple Watch, for example,
Cost of Chronic Disease, a Breakdown
1 Cisco, “Cisco Visual Networking Index: Global Mobile Data Traffic Forecast Update, 2013–2018,” February 5, 2014, Visual-networking-
index. 2 Endeavour Partners, “Inside Wearables,” Endeavour Partners Wearables, January, 2014. 3 BW Ward, JS Schiller and RA Goodman,
“Multiple chronic conditions among US adults: a 2012 update.” Preventive Chronic Disease, Vol. 11 (April 17, 2014), Multiple Chronic
Conditions. 4 American Diabetes Association, “The Cost of Diabetes”.
or national grids10
engaging all stakeholders
in the health system. Such integration opens
up the opportunity for value added services at
both the local and national levels.
The Rise Of The Machines
Connected technologies enable wellness to start
and end with the consumer. Web, mobile, wearable
devices, bio-sensors, Wi-Fi and cloud-based
systems integrate with the patient and connect
into the provider/payer ecosystem.
The disruptive power of new technologies and
the accompanying waves of innovation they
have sparked are transforming the healthcare
industry. Large employers are rapidly adopting
employee wellness programs that make use of
wearable technology, and a rapidly increasing
percentage of consumers are using activity
trackers. This shift is a step towards a holistic
approach to healthcare, one that is tailored
around each individual to promote preventive
care. An individualized, consumer-centric
Chronic disease imposes an enormous financial
and societal burden, accounting for 70% of the
deaths of all Americans and 75% of annual
healthcare costs. Patients with chronic conditions
are treated on a condition-by-condition basis,
resulting in fragmented care and patients
n 2013 the number of connected
wearables in North America reached
over nine million and is projected
to grow to over 60 million by 20181
.
These technologies have mostly enabled 25-34
year olds to focus on improving their fitness2
.
While users from age 55 and above are primarily
focused on improving overall health and extending
their lives. The potential at this moment in time
to revolutionize healthcare by providing vital
signs to individuals, their healthcare providers
and health-related institutions is unprecedented.
Actionable information could deliver a 10 -15%
reduction in costs in target populations, and can
make medicine more proactive and focused on
prevention. The potential productivity gains that
come from better health and quality of life using
wearable technologies help put the individual
at the center of healthcare for the benefit of
society as a whole.
Currently The Demographic Prognosis
Is Not Good
As of 2012, 117 million people, about half of all
adults in the US, were diagnosed with one or
more chronic health conditions, and 1 out of 4
adults had two or more chronic health conditions3
.
shuffling between multiple providers.
Ineffective treatment also contributes to the
rising costs of healthcare. Annual healthcare
spending for diabetes, cardiovascular disease
and non-adherence to medication is as high
as $300 billion per year4
.
I
Non-adherence 5 Diabetes 6
Hypertension
Statistics 7
Dyslipidemia
Statistics 8
Medication
non-adherence
resulted in an
economic burden
of $100 to $300
billion in 2012
The estimated total
econmomic cost of
diagnosed diabetes
in 2012 in the US
was $245 billion,
a 41% increase from
the previous
estimate of $174
billion 2007
In 2010, high blood
pressure cost
approximately
$93.5 billion in
health care services,
medications, and
missed days
of work.
Dyslipidemias are
associated with
numerous medical
conditions
including heart
disease, peripheral
vascular disease
and stroke.
Note: The total direct national cost of non-adherence for adults diagnosed with diabetes,
hypertension, or dyslipidemia was $105.8 billion, or an average of $453 per adult, in 2010.
The average per adult non-adherence cost by state was found to vary from $284 to $634.9

2. 12 CLOSEWORK® GLOBAL REVIEW 2015
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CLOSEWORK® GLOBAL REVIEW 2015 13
population can benefit from the wearable
technology as well. A study performed by the
Tokyo Institute of Gerontology and the University
of Toronto concluded that an increase of physical
activity in the elderly could achieve savings of
approximately 3.7% of total medical expenditures,
including nursing care.
Wearing, Sharing And Caring
In The Smart City
As part of Hitachi’s vision of a “smart city,” each
country would have a national infrastructure
in place that works closely with state/local
authorities and private entrepreneurs to plan,
provide and sustain long-term viability of
power distribution, transportation, water,
sewage, and other services. Such essential
services can be harnessed by proper IT
infrastructure in the form of grids that support
the needs of every individual. Because such a
grid would contribute to the operation of the
health system, we could call such system a
health grid. It can be designed to maintain
the accuracy of healthcare data, keeping the
privacy and security of citizens in mind.
In the US, the Centers for Disease Control
and Prevention (CDC) is the federal agency
responsible for the health grid. It acts as a
hub for sharing non-personal data across
approach can further enhance the health and
the quality of life, while significantly reducing
the cost of the healthcare.
Taking Better Care Of Yourself
Wearable technology empowers individuals
and caregivers to take charge of their own
health, giving them the tools to make informed
decisions for disease prevention. They provide
information on activity minutes, calories burned,
oxygen saturation of the blood, medication
taking, sleep quality and heart rate monitoring.
All the data gathered by wearable technologies
can be synced with a smartphone or computer,
and individuals can analyze their habits, gain
insight into their health and wellbeing, and take
charge of their health.
Sharing this information in real-time enables
caregivers to provide timely feedback and
individualized treatment, all while keeping
costs under control. Wearable technologies can
also be beneficial for outpatient monitoring,
decreasing readmission rates and increasing
patient education. Insurance companies have
created programs that integrate wearable
gadgets into their policies, with the goal of
getting people invested in taking better care of
themselves and being more active. Walking on
its own may not solve diabetes, hypertension or
heart disease, but increased activity results
in better health.
A growing number of physicians are formally
using wearable technologies to improve
patients’ health by spurring people to get
moving. For example, a group of doctors
gave FitLinxx pedometers to 126 patients
with Type-2 diabetes, often related to poor
diet and excess weight. Participating patients
did a better job of controlling their
blood-sugar levels.
The Mayo Clinic used Fitbit devices to track
activity levels of cardiac-surgery patients, and
found that patients who moved more the day
after surgery were more likely to be discharged
sooner. Using a virtual coach paired with activity
trackers also helped overweight or obese people
increase their activity levels, and the aging
states, cities and towns. Increased sharing
of data across government agencies and
private service care providers will enable
new frontiers for patient care.
In today’s technologically advanced
environment, users have many ways to
communicate healthcare related information.
Regulation encourages and guides health
agencies to proactively report any disease
or perceived epidemic to various stakeholders
within a health grid. Once new actionable
data is available, primary care providers,
caregivers and users can take action in order
to prevent illness from happening, or to
correct patient treatment. For this data to
become actionable, it needs to be structured
and organized in a way that is readily accessible
in the right format, delivered securely, including
clinically meaningful context, and provided in a
useful, pragmatic way to healthcare providers,
patients, families, healthcare organizations,
health systems and policy-makers.
There are currently wearable technologies
available that enable automatic data collection
without the need of going to a healthcare
provider. An extensive list of stakeholders can
take advantage of the information generated
by these devices to reduce the cost of health-
care, improve patient outcomes and, most
importantly, prevent illness from happening.
HIPAA Is Designed To Make
Everyone Feel Better
Health-related data used for real-time and
predictive reporting can be collected from
sources such as social media, personal health
history, and reports of day-to-day activities and
eating habits. However, many legal and ethical
questions come into play, so any time health
data is being transmitted, it is prudent to
analyze whether the Health Information
Portability and Accountability Act (HIPAA)
applies. If it does, the organizations transmitting
and using the data captured from wearables
must be careful to stay compliant with federal,
state and local statutes.
Patients and providers should ask whether
the organizations transmitting and using the
health data qualify as covered entities under
HIPAA. If they do not, their use or disclosure
of health data is outside the reach of HIPAA.
Covered entities include healthcare providers,
health plans, healthcare clearinghouses and
the business associates of any of these three
types of entities. Whether or not HIPAA applies
will depend on whether health data is being
collected by or shared with one of the
covered entities.11
The first question to ask is if the health
information being collected and transmitted
is individually identifiable health information
protected by HIPAA. Completely anonymous
or “de-identified” health information is not
protected by HIPAA. However, de-identification
is not as simple as removing a person’s name,
address, and year of birth from health data.
De-identification is only achieved when the
remaining data cannot be used to identify
the individual.
The second question is whether the health data
being collected will be utilized for one of the
several uses specifically permitted under HIPAA.
Permitted utilization includes public interest
and benefit activities that involve research and
disclosures necessary to prevent serious threats
to health or safety. Fortunately, the use of
health data collected by wearable devices
may be permitted under HIPAA if the person
supplying the data consents to its use. The
consent of the individual needs to be
articulated sufficiently; organizations must
clearly identify what data is going, to whom,
provide terms that allow the individual to
revoke the use of their data, and include a
clause that states an expiration date of
transmitted data.12
Be Alert To All Liabilities
Liability associated with wearables reporting
can be placed on the wearable and on all the
contributing sources of information that report
on an individual’s health. A reporting platform
needs to be intelligent enough to ask at which
point a call to action should take place. If a
threshold is met that would trigger an alert
regarding one’s health, what would be an
appropriate response? What type of liability are
all parties assuming in triggering such an alert,
and who has the legal obligation to follow up
with the person to make sure that they acted
accordingly?
Data stored on social media sites may be
used as a tool to gather information on an
individual’s health. Problems arise with the
application and algorithms that move through
the data an individual produces, including
what they post on social media sites.
Gathering data about what might appear to be
health-related issues and weighing the impor-
tance of the data in the person’s overall health
is a subjective science. How do we measure the
weight of a good or bad feeling and what does
it mean? What valid predictions in health can
we make based on health-related comments?
Answering these questions requires complex
computing and big data analysis. Sending car
advertisements to someone who posts Porsche
pictures on their Facebook site is far less of a
liability than sending an alert to someone to
seek immediate medical attention because they
feel depressed that their child left for college.
Using social media as a tool to judge their
overall health must be balanced with other
health related data to provide accurate reporting.
The other major liability to consider is
security. Providing a wearable reporting
platform requires large-scale investment in
security because the data provided to a system
can come from a number of different sources.
Each source has to have a level of security built
in that allows personal data to be used for
health reporting. Examining what targets get
hacked and how provides insight into the level
of security needed to support wearables
platform. Government targets are on the top
of the list. Using an individual’s health record
stored within the National Health Registry
would require a robust, secure end-to-end
platform. This may include clinical trials
and state and federal privacy laws.
The Mayo Clinic
used Fitbit devices
to track activity levels
of cardiac-surgery
patients and found
that patients who
moved more the day
after surgery were
more likely to be
discharged sooner.13
“
”
Percent Activity Tracker Owners vs. Percent of US Population by Age
17%
13%
25%
18% 18%
19%
16% 16%
17%
15%
20%
7%
25%
20%
15%
10%
5%
0%
18-24 25-34 35-44 45-54 55-56 65+
% of activity tracker owners % of US Population
5 American College of Preventive Medicine, “Medication Adherence Clinical Reference,” ACPM. 6 American Diabetes Association, “The
Cost of Diabetes,” October 29, 2013. 7 CDC, “High Blood Pressure,” CDC. 8 A Schultz, C Chen, W Burton, D Edington, “The Burden and
Management of Dyslipidemia: Practical Issues,” Population Health Management. [serial online]. October 2012;15(5):302-308. Available
from: CINAHL Plus with Full Text, Ipswich, MA. 9 Nasseh Kamyar, Sharon Frazee, Jay Visaria, Anna Vlahiotis and Tian Yuhong, “Cost of
Medication Non-adherence Associated With Diabetes, Hypertension, and Dyslipidemia,” AJCM, March, 29, 2012 Cost-of-Medication-
Nonadherence-Associated-With-Diabetes-Hypertension-and-Dyslipidemia.
10 Hitachi Ltd, “Hitachi’s Vision of the Smart City – Seeking a
Well-balanced Relationship between People and the Earth,”
2012. 11 Quentin Hardy, “Big Data in Your Blood,” The New
York Times Bits Blog, September 7,2012, Times.com. 12 David
Talbot and Kyanna Sutton, “Making Stretchable Electronics,”
Technology Review, Tech Review.’
13 D Cook, J Thompson, S Prinsen, J Dearani, C Deschamps,
“Functional recovery in the elderly after major surgery:
assessment of mobility recovery using wireless technology,”
The Annals Of Thoracic Surgery, September 2013;96(3):1057-
1061. Available from: MEDLINE with Full Text, Ipswich, MA.