Can the pandemic help 'smart clothes' to catch on?

[Lisa Brooks, BSN, MSN, RN]

There is a lot of hope that 'wearables' can detect COVID-19 before symptoms start. For example, Fitbit recently reported devices detecting physiological signs of disease at the same time or just before study participants report symptoms.

However, the messages are mixed on whether 'smart clothes' - items like jackets, tank tops, and even underwear - will ever take off. Last year one of the pioneers of smart clothing, OMSignal, declared bankruptcy and sold off their patents.

However, 2020 has seen everyone from Northwestern University to the NBA looking for ways to monitor health down to what we wear.

For example, items like a 'smart Band-Aid' that detects COVID symptoms from a patient's skin builds on 'smart wound dressings' that monitor healing and deliver programmed doses of medication.

This year the NBA required players to wear Oura's titanium smart ring. Measuring pulse, movement, and temperature, players in 'the bubble' wore it in an effort to detect early COVID-19 symptoms.

If it catches on, 'smart clothing' could be the next evolution of remote patient monitoring. Nurses need to be prepared for these new ways health data will be gathered.

What are 'smart clothes'?

'Smart clothes' are items a person can wear combined with technology to provide more functionality. These include things like smart textiles and fabrics, smart garments, smart jewelry, and even smart shoes.

The items may incorporate circuitry, sensors, or other hardware to make it 'smart.’ Many of these products connect to apps, Bluetooth, or Wi-Fi.

One fun example is Pizza Hut's 2018 smart shoes called, wait for it - the 'Pie Top.’ The company made these smart sneakers to pause a user's television and order pizza through buttons on each shoe.

Consumer applications for smart clothing range from these types of silly promotions to extensions of smart phones.  Levi's and Google paired up to make a smart jacket that connects to the wearer's mobile device so they can speak into their sleeve like James Bond.

The smart clothing market has obvious applications in healthcare. With the creation of smart fabrics with sensors woven in, companies like Hexoskin and Nanowear hope to monitor heart rate, temperature, and even EKGs and oxygen saturations through tank tops and underwear.

Impact of the pandemic on the smart clothes industry:

The 2019 smart clothing market was at $1.1B. However, it is now expected to grow to over $6B by 2027.

Prior to the pandemic, most smart clothes makers focused on athletes and the military. However, COVID-19 provided the catalyst for research into how smart clothing could be used to detect infection before symptoms start.

COVID-19 created the need for low-touch ways to monitor patients, bringing telehealth into the mainstream and giving a use case for remote patient monitoring (for more on telehealth in 2020, please see my article Telehealth in 2020: Why This Time Is Different).

Hoping to detect even small changes to temperature and breathing, universities like Tufts and Northwestern, as well as wearable device makers like Fitbit and Apple, focused their energies on fast-tracking products. Hackensack Meridian Health in New Jersey is collaborating with Nanowear to use smart clothing to monitor COVID-19 patients.

Smart clothing presents a potential solution for monitoring that could be done in clinical as well as non-clinical settings.

Challenges to smart clothing adoption:

Challenge 1 - Security:

One of the biggest challenges facing telehealth and the digital technology connected to it is security. Having more health data available through remote monitoring technologies like smart clothing increases the risk of bad actors.

The first death of a patient linked to a cyber attack occurred on September 9th. A German hospital was caught in a ransomware attack that caused patients to be diverted to hospitals further away.

As events like this occur, more focus will be given to security of patient information transmitted through sources like smart clothing.

Challenge 2 - Evolving regulations:

The FDA has worked to encourage digital health innovation recently, for example the September 22nd launch of their Digital Health Center of Excellence.

One goal of the Digital Health Center of Excellence is to find less burdensome approaches to oversee new products, as well as ensure consistency of digital health technology policy and oversight.

Clear regulatory guidelines will be needed to make providers, payers, and other healthcare entities comfortable using these technologies.

Challenge 3 - Insurance reimbursement:

CMS removed barriers to telehealth reimbursement early in the COVID-19 pandemic. However, CMS has not yet defined regulation around remote patient monitoring, nor provided clear guidelines for insurance companies to follow.

This leaves providers in a gray area in terms of whether use of items like smart clothing will be reimbursed.

Adoption will likely remain spotty unless there is a clear path to reimbursement, or smart clothing proves as effective but less expensive than conventional monitoring.

Trends nurses should be aware of:

There are three main areas of smart clothing emerging that nurses should know about:

#1: Smart medical garments

There are several companies making smart garments with medical application specifically in mind.

Hexoskin is a smart clothing maker of tank tops and headbands. These items can monitor 1-lead ECG, heart rate, QRS events, heart rate recovery, respirations, minute ventilation, VO2 max, activity intensity, steps, cadence, positions, and peak acceleration.

The data collected goes to their platform and displays on a dashboard for each wearer. The company also makes a product for use in space programs offering 3-lead ECG, blood pressure, skin temperature, and blood oxygen level monitoring.

Nanowear has the distinction of being the first FDA cleared cloth-based nanotechnology monitoring platform. They make cloth containing tiny sensors (called 'nanosensors’) that can capture more than fifteen medical grade bio markers from the wearer's skin.

The data is then aggregated by AI into meaningful insights for clinicians.

The company's initial application was cardiology, specifically congestive heart failure monitoring using smart underwear. By putting the sensors in underwear, the issue of compliance with the monitoring program is solved based on the assumption most people wear underwear daily.

These are just initial developments in smart clothing for medical use. At some point, even the coloring of a piece of clothing will be able to gather information about the wearer's health. Tuft's University has been working on bioactive inks that can detect pH and lactate levels in the wearer's sweat.

Not every condition may be a fit for smart clothing. In the early stages of COVID-19, for example, it might not have been practical to discharge every patient with a smart tank top with a price tag of $500.

This is where smaller wearable items can help.

#2: Smart patches

Researchers at Northwestern University created a smart patch to be worn on the skin that detects coughing and respiratory activity.

The size of a postage stamp, the patch is meant to be worn in the suprasternal notch. It detects coughing intensity and patterns, chest wall movements, respiratory sounds, heart rate, temperature.

The patch then transmits data to a cloud where AI-based algorithms transform the information into graphics that are easy for clinicians to interpret.

The patch was developed to address the gap between hospital and home after admission for COVID-19 infection. This is the interval in which some patients appear to recover before deteriorating.

Northwestern and other universities were able to develop these sorts of smart patches in response to COVID-19 quickly. That is because of work already underway for smarter wound care.

#3: Smart wound dressings

Researchers in many parts of the world are testing smart wound dressings - dressings that would detect issues with wound healing and deliver treatments directly to the wound.

For example, in 2018 researchers at Tufts University created a smart bandage embedded with pH and temperature sensors, and the ability to deliver antibacterial drugs.

Depending on the temperature and pH of the wound, if early infection is likely the bandage would deploy antibacterial treatment from the dressing already in place.

Where to from here?

Admittedly, many of the products in the smart clothing industry are either still consumer-focused, or undergoing research. The question of whether we will see these products make it into clinical settings depends on having compelling ongoing use cases.

Given the prediction that pandemics like COVID-19 may become a regular occurrence, smart clothing could become a necessity to navigate the 'new normal.’

Reimbursement and regulation will need to catch up at some point. If smart clothing makers can prove the effectiveness of their products compared to conventional treatment, we may see their use in medical settings spread.

This is a trend for nurses to watch. We may soon be expected to make decisions based on data from smart items are patients are wearing.

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References

Monitoring COVID-19 from hospital to home: First wearable device continuously tracks key symptoms

Smart bandages designed to monitor and tailor treatment for chronic wounds

New smart fabrics with bioactive inks monitor body and environment by changing color

A patient has died after ransomware hackers hit a German hospital

The Story Behind the Ring That is Key to the NBA's Restart

Early smart clothing firm OMSignal is out of business

Early Findings from Fitbit COVID-19 Study Suggest Fitbit Devices Can Identify Signs of Disease at its Earliest Stages

Don't miss a second of March Madness: Pizza Hut unveils the Pie Tops II Sneakers that order pizza and pause the game with the push of a button

Digital health researchers flock to smart clothing in studying sweat & COVID-19

NY-NJ Hospitals to Use Smart Clothes in COVID-19 Telehealth Program

Global Smart Clothing Market Forecast to 2027 - COVID-19 Impact and Analysis

'Reimbursement is the key element': 4 physicians sound off on remote monitoring device adoption

[tnbutterfly - Mary, BSN]

This is very interesting and futuristic.  But then, the events that are occurring in today's world seem like something out of a Sci-fi movie.  

Thanks for sharing, Lisa!!

[sirI, MSN, APRN, NP]

It does sound like some of the sci-fi movies I like.

Honestly, I can see this taking off.

Thanks @Lisa Brooks, for the Article. Great job!

[FolksBtrippin, BSN, RN]

Kind of like a high tech scarlet A.

[RNNPICU, BSN, RN]

Interesting, although I think it could violate privacy laws as well as potentially broadcasting personal health information to random strangers.

I would not want the whole world to know my medical history or illness

[Kharis, BSN, RN, EMT-P]

I used to be a firefighter/paramedic - so my first objection travels down old algorithms. What happens when someone wearing expensive techno-gear is in a nasty accident and EMS arrives on the scene? The prerequisite "strip & flip" protocol that demands we cut through this high dollar smart clothing with a pair of $5 trauma shears is likely to have a downstream impact. Ranging from the patient complaining about replacement cost to the ER doc berating us for snipping through wireless EHR connections preventing valuable insight into the patient's health status. But - we saved a life by revealing life-threatening injuries that couldn't be found otherwise. Hmmm.

As for me, the only smart clothes I want are those that keep me warm (like an electric blanket but without the wires). ? 

Cheers!

[helloimanrn, ASN, LPN]

Hello @Lisa Brooks I am a new nurse currently taking a nursing informatics class and was wondering if I could possibly interview you for a class assignment? Please let me know if you would be willing to help!