Digital technology is becoming increasingly important in modern healthcare. As society becomes faced with an abundance of new healthcare challenges, such as a rise in the number of chronic diseases and an ever-aging population, public health will undoubtedly benefit from the expanding role of digital technology.
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The World Health Organization (WHO) determines digital health to be “the field of knowledge and practice associated with the development and use of digital technologies to improve health.”1
The term has broad implications and incorporates an extensive range of digital technologies: from software solutions that facilitate better management of patient data and offer easy access to both patient support services and new diagnostic tools and drug delivery devices.
In this article, Sensirion will explore some of the big questions surrounding digital health, including why digital health is needed in modern society and how digital health is implemented and organized. Finally, the article will focus on some of the sensing technologies that drive the implementation of digital health.
Modern health challenges: A driver for digital health?
Today, global healthcare providers are faced with an increase in the incidence of noncommunicable diseases, including cancers, cardiovascular diseases, diabetes and chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD).
While this is linked to the reduction of deaths from infectious diseases such as tuberculosis, noncommunicable diseases pose catastrophic health consequences and socioeconomic effects. According to the WHO, noncommunicable diseases are a significant challenge that must be addressed.4
As the global population continues to age, the occurrence of such diseases is increasing. By 2050, the WHO has estimated that the proportion of the world’s population over 60 is likely to double as birth rates decline in conjunction with access to improved healthcare in many regions.
This aging population requires global health, activity, and medication monitoring. Hospital stays are expensive and pose an increased risk of infection; therefore, drug delivery in a safer setting, such as the home, and perhaps remote monitoring, is believed to reduce healthcare costs and improve outcomes.5
However, some of the diseases mentioned above are on the rise due to environmental conditions such as ultrafine particles caused by urban traffic, industrial processes, pollution, and increasing wildfires worldwide. These issues are worsening environmental conditions for those suffering from asthma and COPD and are even becoming associated with diseases such as cancer and dementia.
Digital health takes up a central role in modern society, allowing healthcare systems to advance and meet these challenges: from digitizing patient records to online appointment booking and continuous glucose monitors.
Many of these provisions – such as video call appointments – were accelerated during the COVID-19 pandemic, and in the space of just a few months, necessity pushed through years’ worth of advancement and reforms.6
The current infrastructure of digital health is now being defined and consolidated by healthcare providers, governments, and industrial partners.
How is digital health organized and implemented?
“Digital health” is a wide-ranging, all-encompassing term for the roll-out of digital technology in the healthcare industry. Organization of healthcare services (for instance, digital real-time patient data management, medical act management and billing tools) is one of the main ways in which digital health is currently being implemented.
However, digital health encompasses much more than this. Emerging applications of digital health include advanced medical devices (including drug injection devices) that perform new monitoring and diagnostic functions.7
These medical devices are positioned within close proximity to the patient, typically as wearable devices (such as an insulin pump) or hand-held devices (such as smart inhalers). Moreover, new well-being devices such as smart watches, sleep monitors, and breath analyzers offer an increased amount of health-relevant information.
At the patient level, digital health allows health-relevant information to be connected and shared directly to connected drug delivery devices, well-being devices, homecare devices and patient support services.
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In time, these devices, services and apps have the capacity to share patient information with relevant service providers, where it can be analyzed and stored.
Sharing this information with healthcare providers facilitates efficient diagnoses, treatments and disease management procedures, which in turn can be assessed and relayed to patient management systems and shared with insurers and relevant healthcare organizations.
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The expanding availability of health-relevant patient data can play a key role in drug development, facilitating the development of personalized therapy or drugs on a large and practical scale.
Moving further along the healthcare value chain, interconnected medical devices make monitoring healthcare and managing therapies easier for both caregivers and patients.
Clinical studies and research have outlined the potential of digital health technologies to limit non-adherence.8 Non-adherence to asthma treatment is a significant problem that can result in exacerbation, hospitalization, and increased costs.
However, patients that have access to state-of-the-art smart inhalers can track the quality of their inhalation, access instant feedback on the drug delivery efficiency and even on the development or changes of the disease.
There are still significant improvements to be made in terms of how patients interact with such devices, which would lead to better outcomes and lower healthcare costs.
Given the high value for the patient, pharma and technology companies are beginning to form key partnerships around the world, resulting in the development of a range of new drug delivery devices.9
GSK, for instance, recently entered a partnership with Propeller Health to design a digital inhaler; while AstraZeneca partnered with Adherium to develop an adherence monitor to support AstraZeneca’s Turbuhaler medication.10,11
Digital health implementation is also being supported by governments. New legislation – such as DiGA in Germany and Article 51 in France – lays the groundwork for digital health by facilitating new care pathways, such as doctors’ prescription of digital health apps.12,13
Moreover, the definition of remote patient monitoring in the USA, with additional Current Procedural Terminology (CPT®) codes since 2022, is being extended, thus further advancing the application of connected devices.14
These devices are capable of monitoring non-physiological information to assist with the assessment of patient adherence to a prescribed therapy: for instance, by establishing whether patients are keeping up with their care regimen and how the therapy is working.
This means that the likelihood of potential failures of patient adherence can be predicted, and the industry can thus be prepared to make the necessary adjustments.
The successful implementation of advanced digital health technologies – such as drug delivery systems or smart inhalers – is contingent not only on software solutions but also on the advancement of new measurement and feedback solutions.
Such solutions are most effective if they are able to interact with the patient by collecting data, analyzing it, and delivering feedback to the patient and the healthcare provider - the appropriate sensor technology offers a strong value proposition by gathering usage, safety, and diagnostic data.
Sensing solutions: What are the benefits for the patient?
How a patient interacts with a wearable device ultimately comes down to the sensor that is in use. However, choosing the right sensor solution can be a major challenge from a design perspective, as it must meet the expectations of the intended function and integrate seamlessly into the patient’s user experience.
As Sensirion moves deeper into the digital healthcare industry, it has developed various sensing technologies.
Air flow sensing
Smart inhaler add-ons are medical devices that offer standard inhalers extra functionality by gathering data relative to inhaler usage. This information can be easily transmitted to a smartphone application and give patients and caregivers feedback on inhaler usage.
This information may relate to how well the patient adheres to the prescribed therapy as well as details on how the inhaler is being operated, such as exhaled volume, inhaled volume, and a comprehensive inhalation flow profile, including inhaled flow rate over time such as the timing of inhaler actuation.
This feedback means that the caregiver is able to identify patients that are falling short of adherence to the therapy or who require urgent additional training on correct inhaler usage.
The significance of the problem is outlined in a number of studies. A study on in-vitro lung deposition, for instance, reported that patients are prone to making at least one mistake when using an inhaler as often as 70–90% of the time, meaning only 7–40% of the drug is actually delivered to the lung.16
The feedback the patients receive regarding using the inhaler correctly can also be motivational and affirmative. It can also ease the concerns of parents regarding their children using an inhaler, as it will confirm the correct use and dose being administered to the lungs.
This is a powerful tool as physiological inhaler usage data can be recorded every time the inhaler is used without interfering with the patient’s user experience. In turn, this has been shown to improve patient control and usage of the inhaler.
Recent studies have demonstrated that the collected data relating to peak-inspiratory flow or inhaled volume already supply an information base to evaluate the course of the disease and prevent hospitalization.17
Obtaining accurate physiological data on each inhaler-breath taken will help reveal many more insights and improve inhaler-based therapies in the future.
Air flow sensors are a key component in smart inhalers. Sensirion’s SDP3x line of differential pressure sensors is optimized for air flow sensing in smart inhaler-based applications enabling sensitive and precision measurement of air flow rate while offering additional benefits in various healthcare applications:
- Facilitates breath-triggered drug release by delivering fast response time and high sensitivity for even the smallest flows.
- Instant feedback on the inhalation procedure due to direct and rapid measurements.
- Meaningful feedback and a boost in patient confidence and usage of the inhaler by precision inhalation-to-inhalation and breath-profile comparison facilitated by high accuracy and time resolution.
- Monitor the course of the disease over time, and predict and prevent exacerbations by measuring and monitoring lung function parameters from the recorded breath profile.
- Seamless user experience as the small size of the sensor and the low power consumption of a coin cell are compatible with small form factors.
- Robust and durable to withstand various environmental conditions and endure user errors thanks to the two-port design and operation of a coin cell beyond one year.
Drug flow sensing
Wearable automated subcutaneous injection devices, such as large-volume injectors (LVI) – also known as on-body delivery systems, patch pumps, or wearable drug-delivery devices – have been superseding traditional intravenous infusion.15
These devices allow patients to automatically receive precision-controlled drug dosages continuously and with minimal disruption to their everyday lives.
LVI systems facilitate the application of “red biotechnology” approaches, which make use of biological materials, including proteins and large molecules, to effectively treat disease targets with fewer side effects when compared to existing pharmaceuticals.
Generally, these therapeutics are costly, viscous, highly-concentrated formulations, typically requiring lyophilization (freeze-dried) and reconstitution before administration.
This means that they cannot usually be administered orally; instead, they necessitate subcutaneous or parenteral (IV) administration in high volumes of up to 50 ml. LVIs offer a simple, dynamic platform for the administration of these advanced therapeutics.
Moreover, LVIs will be pivotal in delivering precision medicine for preventative, predictive, personalized and participatory patient care.
With prices and reimbursement levels predicated on evidence-based criteria, such therapies will be dependent on proof of patient compliance – LVIs offer a simple and measurable approach to making sure patients adhere to their treatment schedule, thus optimizing the efficacy of personalized therapies.
Controlling and closely monitoring flow rate for failures is vital when administering automatic drug delivery systems. Sensirion’s LD20 liquid flow platform of single-use flow rate sensors provides a unique solution for LVIs:
- Accurate measurement of the flow with the LD20 technology platform allows for a reliable assessment of the drug remaining inside the cartridge and can become crucial as prices and reimbursement levels are rolled out based on evidence-based criteria such as proof of correct drug delivery and patient compliance. Precise measurement of the delivered drug is key when the dosage is vital to the patient, such as with specific painkillers or chemotherapy drugs. It is also preferable with expensive, viscous, or highly concentrated formulations, including some oncologic treatments.
- Detecting failure mechanisms such as open flow and occlusion is another key application feature. In fact, as wearable LVIs sit close to the patient’s body, occlusion may occur for various reasons, such as tissue growth or clotting of the cannula outlet. In some instances, an open flow condition may occur if the patient mistakes the assembly of the parts of the LVI or the reconstitution of the drug. The ability to remotely detect such failures aids and enhances the journey and optimizes the benefits of the therapy while saving costs by facilitating remote drug administration.
- Due to the LD20 technology platform’s modularity, the flow range, size and interfaces can be adjusted for extremely compact integration into the LVI. This is a key feature when it comes to addressing the versatility of the drug delivery systems contingent on the drug type, concentration, and viscosity while ensuring the system remains as compact as possible so that the wearable device does not impede on the physical and social comfort of the patient.
- Sensor compatibility with various drugs is crucial, facilitating the use of a single device platform for various drugs and for the reconstitution of lyophilized drugs. This feature is facilitated by Sensirion’s in-house sensor calibration for one or more drugs, taking various viscosities and properties into account.
Breath analysis delivers a non-invasive insight into the human body, facilitating rapid, pain-free, and low-cost diagnostics. Presently, it primarily covers gases such as CO2, O2, acetone, and NO, as well as other gases that are being studied by medical research teams around the world.
Sensirion’s STC31 platform enables the measurement of CO2 concentration under complex conditions, such as when measuring human breath.
Compared to optical-type sensors, which are applied in capnography applications and typically in the lower 4-digit price range, the STC31 platform facilitates access to new applications with its low-cost technology structure.
Applications in both medical and consumer sectors offer added value to the user by delivering measurement-based insight into their own body metabolism or fitness.
- Easy solution for a compact integration of the STC31 into portable medical devices with the compact form factor. This enables discrete and portable products that can be used in a variety of environments, such as at home, outdoors, or in the gym.
- Enhanced user experience thanks to the extremely robust and reliable sensing solution - there are no sensitive optics or moving parts involved.
- New applications and use cases in compact and discrete portable devices that only require small batteries and enable extended run times without the need for charging.
- No complex assembly or alignment during manufacturing helps to save on the cost and form factor side.
The 21st century has seen the emergence of completely new healthcare challenges: this includes increased numbers of chronic diseases, such as asthma, cancer, COPD, and diabetes in an aging population; and extensive changes to both environment and lifestyle that intensify the occurrence, consequences, and overall cost of such diseases.
Digital health infrastructure is being pushed towards addressing the healthcare challenges. Automating the sharing of patient data, making access to sites of care easier and simplifying the payment flow further empowers patients to monitor their own health from their homes.
Moreover, patients are also able to access their drugs and have them administered without needing a healthcare provider to be present while also delivering feedback on drug delivery and the progress of the disease.
Such functions are facilitated by portable, wearable and interactive devices that utilize advanced sensors to monitor the patient. Sensirion is actively involved in the advancement of the sensor ecosystem that is geared towards addressing these needs: measuring patient air flow, drug flow and patient breath gases.
As this journey is still in its early stage, Sensiron is working on expanding the technologies and sensors that can be offered in digital healthcare environments. To discover more about Sensiron products, get in touch with the team today.
References and further reading
- Global Strategy on Digital Health 2020-2025 | World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/344249/9789240020924-eng.pdf.
- Covid-19 Created an Elective Surgery Backlog. How Can Hospitals Get Back on Track? https://hbr.org/2020/08/covid-19-created-an-elective-surgery-backlog-how-can-hospitals-get-back-on-track.
- Ham, C. The challenges facing the NHS in England in 2021. BMJ 371, m4973 (2020).
- Noncommunicable diseases. https://www.who.int/health-topics/noncommunicable-diseases.
- Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.
- PricewaterhouseCoopers. Global Top Health Industry Issues 2021. PwC https://www.pwc.com/gx/en/industries/healthcare/top-health-industry-issues.html.
- Dossier: Medizin der Zukunft. https://www.handelsblatt.com/technik/dossier-zum-download-dossier-medizin-der-zukunft/24958036.html.
- Alsumidai, M. Non-Adherence: A Direct Influence on Clinical Trial Duration and Cost. Applied Clinical Trials (2017).
- Exciting Partnerships Forming Between Big Pharma and Tech. Pharmacy Times https://www.pharmacytimes.com/view/exciting-partnerships-forming-between-big-pharma-and-tech.
- Ricci, M. GSK and Propeller prepare to launch digital inhaler -. https://pharmaphorum.com/news/gsk-propeller-health-expand-rd-partnership/ (2017).
- Adherium. Adherium - Adherium Releases Next Generation Adherence Monitor, SmartTurbo Model 4, for AstraZeneca’s Turbuhaler. Adherium https://www.adherium.com/news/adherium-releases-next-generation-adherence-monitor-smartturbo-model-4-for-astrazeneca-s-turbuhaler/.
- Why Germany’s DiGa is the future of Digital Health. Why Germany’s DiGa is the future of Digital Health https://vertrical.com/.
- Townsend, A., de Trogoff, H., Szwarcensztein, K., & participants of Giens XXXIV Round Table “Health and economy”. Experimentation to favor innovation: Promoting the success of Article 51 transformation projects. Therapie 74, 51–57 (2019).
- Remote Therapeutic Monitoring (RTM) Codes | CareSimple. https://caresimple.com/remote-therapeutic-monitoring-rtm-codes/ (2022).
- Liquid flow sensors for drug delivery. https://sensirion.com/products/product-insights/specialist-articles/subcutaneous-drug-delivery/.
- Biswas R, Hanania NA, Sabharwal A, “Factors Determining In Vitro Lung Deposition of Albuterol Aerosol Delivered by Ventolin Metered-Dose Inhaler”. J Aerosol Med Pulm Drug Deliv, 2017, Vol 30(4), pp 256–266.
- Levy ML, et al., Presented at ERS 2020. Abstract in ERJ 2020;56:1361
About Sensirion AG
Medical devices must meet the highest standards in terms of quality and reliability. Doctors, nurses, and patients benefit daily from applications in the field of medical technology that are getting smarter by the day.
The use of proven Sensirion sensor solutions contributes to this and offers the possibility of making applications safer, more reliable and more convenient. Our many years of experience in the field of medical technology make us the preferred experts for leading medical-technology companies.
- Home Care Devices (Ventilation)
- Critical Care Devices (Ventilation)
- Point-of-Care Diagnostic
- Drug Delivery / Infusion
- Smart Inhalers
- Metabolic measurements
- Digital Health
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