Table 4.

Implantable and Wearable Technologies

Best practices	Description
Identification of disease states and patient types in whom wearable technologies can provide hospital grade information	Identification of the accuracy of each application may result in some applications converting in-patient to “at-home hospital” monitoring.
Identification of disease states and patients in whom implanted devices are preferable	Certain scenarios may be better served by implanted devices, such as patients with existing pacemakers and defibrillators at risk for serious adverse outcomes.
Definition of states of wellness that can be tracked by wearable devices	Tracking and maintaining some states of wellness may effectively prevent transition to disease.
Gaps and challenges	Description
Interoperability standards between devices and electronic health systems	Data ownership needs to be defined, while interoperability standards enable data sharing and auditing between stakeholders, thus reducing barriers for third-party firms to innovate.
Definition of new sensor reference standards for key cardiovascular metrics	Not all sensors are equally accurate across clinical scenarios.
Identification of robust, disease-based applications for each device	Clinical trials may reveal differential accuracy among devices across populations (eg, atrial fibrillation screening for an older patient versus a young athlete).
Cost-effectiveness, implementation, ethics, privacy, and safety	Effect assessment of wearable and implantable devices on resource utilization, costs, and clinical outcomes.
Evolution of regulatory boundaries	Establishment of regulatory approaches between different groups, even for the same disease.