Wearable Devices and Biosensing: Future Frontiers

Since the 1950s, toxicologists have utilized novel technologies to advance our understanding of poisonings while improving our availability to physicians and patients [1]. From rolodexes and telephones to head mounted computers, advanced biosensing, and ingestible sensors, toxicologists have always been pioneers leveraging advanced technologies to solve problems [1, 2]. As smartphones, fitness monitors, and connected devices become ubiquitous, toxicologists are naturally equipped with advanced tools that augment our bedside exam of poisoned patients.

A new generation of toxicologists continually pushes the boundaries of technology in an effort to facilitate improved patient care and access to our expertise [1–5]. Head-mounted wearable computers can provide a toxicologist with a first-person view of a poisoned patient, while a wrist-mounted sensor can stream key biometric data (e.g., heart rate, respiratory rate, skin temperature, and electrodermal activity). Ingestible biosensors can provide historical records of medication ingestion, and linked webcams can stream toxicology lectures to centers seeking expertise on the poisoned patient [2–4, 6].

In an era of integrated care and bundled payments, toxicologists and fellows in training have a unique opportunity to develop novel technology-based methods that respond to a need in our specialty. Creating novel applications using everyday technology requires a contemporary approach—integration of patients, physicians, engineers, and software developers into a multidisciplinary research team.

Integrating Biosensor Data with Patients

Wearable biosensors, like Fitbits, noninvasively collect real-time biometric data. Each wearable device or biosensor provides an additional stream of data on our patients. As wearable biosensors become accepted and commonplace in patients—95 % of emergency department patients interact daily with smartphones—they can be leveraged to gather important data correlated with various disease processes [7]. Integration of a suite of devices can provide a comprehensive profile of the poisoned patient which, when evaluated remotely, provides increased precision and effectiveness of toxicologists [8]. Changes in heart rate using a wearable biosensor in a patient at a critical access hospital may signal worsening calcium channel blocker toxicity; a wearable camera may help a toxicologist guide the bedside clinician in the administration of physostigmine for the anticholinergic patient, and the virtual assessment of an altered patient can change a toxicologist’s recommendation to triage a patient to an inpatient bed or emergency department observation period [3].

Much like endocrinologists use insulin pump data in diabetics, toxicologists who practice substance abuse treatment can use biosensor data to discover episodes of relapse and tolerance [4, 9]. Advanced algorithms and improving technology can provide a noninvasive, yet accurate understanding of real-time substance abuse and relapse. This knowledge may help toxicologists tailor substance abuse counseling, by understanding real-time triggers of tolerance, addiction, sobriety, and relapse [9].

Integrating advanced technology tools in patient care will require nontraditional evaluation methods including patient-centered acceptability, hardware design, and engineering [10]. The accuracy of biosensor data is dependent on how patients interact with these devices and sampling accuracy of the device, for example, the promise of remote heart rate tracking with commercial wearable biosensors has revealed variable diagnostic accuracy [11–13].

Opportunities for Toxicologists

Toxicologists play important roles in the evaluation of advanced technology. As bedside diagnosticians who care for a wide variety of patients in person and remotely, our experience evaluating biosensor data can improve our ability to care for our patients, anticipate adverse events, and monitor medication safety [3, 4, 6, 9]. Capitalizing on these experiences provides a good opportunity for research evaluating and helping to develop new devices.

New research opportunities bring similar challenges as traditional research and toxicologists who initiate investigations in biosensor research will require funding. A variety of funding mechanisms through the American College of Medical Toxicology (ACMT), Medical Toxicology Foundation (MTF), and American Academy of Clinical Toxicology (AACT) in addition to traditional NIH funding mechanisms exist to support junior investigators in nascent investigations. Technology-based investigations are especially relevant in toxicology and substance abuse and are recently identified priorities by the National Institute on Drug Abuse (NIDA) in an effort to understand and intervene in the opioid epidemic and HIV-related substance abuse [14, 15]. Gaining expertise in technology development and evaluation can be of particular appeal to fellows in training by providing a skill that is easily translated into various fields of medicine.

What’s Next in Technology Studies for Toxicologists?

As evaluation of advanced technology wearable devices yield discrete data streams, the toxicologist will need to decide how to integrate disparate data streams in the context of the patient. Virtual bedside exams combined with multiple streams of biosensor data can provide a toxicologist with a comprehensive overview of a patient. Integrated technology begins to allow toxicologists to anticipate the course of a poisoned patient, deliver tailored therapy, and offer guidance to bedside clinicians. In substance abuse, the integration of multiple biosensor streams give a toxicologist new tools to evaluate tolerance, dependence, and addiction. As technology continues to intercalate itself into our daily lives, we should leverage an advancing field of wearable devices and biosensors to improve the way in which we care for our patients.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Sources of Funding

The author is supported by the Medical Toxicology Foundation.