Watching the newest TV ads for diabetic monitors, I see that the "audience" are younger folks; the music is upbeat, the diabetic monitor is smaller, and the tasks on the monitor are described in techy terms. Just when case managers thought technology had peaked, the industry is enmeshed in a further burst of evolution. Remote monitoring of patients is all the rage, with wearable sensors anticipated to be a $6 billion market by 2016 (Dolan, 2012). Evaluating patient adherence has transitioned from follow-up phone calls and monthly outcomes to real-time data access through products such as biometric sensor wristbands (Fierce healthcare, Bird, 2012) and ingestible digitalized pills with embedded microchips, which record medical information (Hall, 2012). A recent article title in Telecare Aware, wrought a new trend: "'Your' weekend fashionista report: sensor couture" (Telecare Aware, 2012). What every patient will be wearing and using to manage their health and mental health this season: from watches, glasses, smart fabrics, contact lenses, small screens, rings and bracelets, hearing aid-like devices, smart badges, wrist computers to even smart skin tattoos. To quote an old adage, "You've come a long way baby!"

This next wave of product innovation looks to engage across vast generations of consumers. Younger cohort groups are responding to this evolution from "health, wellness, and fitness apps," to "mobile medical apps" and "wearables." Baby boomers are prompting technology beyond the current home health sector, with the home-monitoring share of wearable wireless devices not lost on companies and marketers. Increases in the number of devices are expected to go from 3 million in 2011 to 36 million in 2017 (Bird, 2012); some estimates go as high as 170 million devices by 2017 (Hall, 2012). The home-monitoring share of the wearable wireless device market will increase to 22% from 12% over the same time period (Bird, 2012).

Responses to these devices will certainly range from "Cool! Very James Bond-y" to "this is too much like 'big brother.'" A sampling of these gadgets and their reasons for use will explain why.

* In a test of 76,000 urine screens conducted by Quest Diagnostics, 63% of the patients tested did not take their medications as directed by their physicians. In response to medication nonadherence, the U.S. Food and Drug Administration has approved tiny digestible microchips that can be added to pills, allowing providers to monitor whether they take their medicine. The chips, about the size of a grain of sand, are made of copper, magnesium, and silicon. They react with stomach juices, then send a signal to a skin patch, which then relays it to a smartphone, then on to the doctor's office. Afterward, the chip dissolves and passes through the digestive system normally. The chips are aimed more toward people taking medications for chronic conditions than those on a short round of antibiotics (Hall, 2012).

* Another device-and-app creation approved by the U.S. Food and Drug Administration is iBGStar, a blood glucose meter that attaches to iPhones or iPads for diabetes monitoring. Users like it because the device is small, about one fourth to one sixth of the size of older blood glucose monitors, and, I suspect, has a "cool-factor."

* "Wearables" essentially have embedded health-monitoring gadgets in clothes. They are always on, always accessible, and easily worn on the body; they typically have real-time information access, data-input capabilities, local storage, and some form of collaborative-communications ability (Bird, 2012).

* A plethora of smartphone medical-monitoring devices not yet approved by the U.S. Food and Drug Administration, but in the developmental stages include (USA Today, 2012):

Heart-EKG uses the iPhone's microphone or camera flash to calculate users' average number of heartbeats per minute or take their pulse, by placing the phone over an artery and activating an app.

The iHealth wireless blood pressure wrist monitor measures users' blood pressure directly from their iPhone, iPad, or iPod Touch. Its app records systolic/diastolic numbers, heart rate, and pulse wave and can chart blood pressure readings.

And if bling on your cell phone case is not enough, AliveCor heart monitor developed an electrode-studded cellphone case that turns the iPhone 4 into an electrocardiogram device that users hold in their hands or place on their chests to detect irregular heart rhythms. Combined with the app, the monitor can analyze, transmit, and store an ECG reading for diagnosis.

A cellphone-based E. coli sensor for water and other fluids is under development by a University of California-Los Angeles research team, using a lightweight attachment to the phone's camera; this may be available in 1-to-2 years.

San Francisco-based CellScope's otoscope attaches to the phone's camera lens and will enable parents to photograph their child's eardrum. The images can then be e-mailed to medical professionals to check for an ear infection.

With all these devices, a series of related questions beckon. Their answers will evolve over the coming decade(s).

1. What does this latest technology trend mean for the majority of today's case managers, who are now over 50 years of age (CMSA, 2012)?

2. With retirement nearer than farther, how will the workforce keep up in terms of knowledge acquisition, scope of practice, plus definition of new competencies?

3. Will demand for competent case managers exceed supply?

4. What ethical challenges will emerge from these technologies?

Smartphone applications and medical-monitoring devices are destined to grow as they are used to detect health risks (E. coli, Listeria) or monitor health risks. New legislation impacting mobile devices, plus how regulations sync with practice reality, is addressed in this month's Legal and Regulatory column. This theme will continue as paramount for all licensed professionals, especially case managers. Increased availability and access of apps, plus even smaller and more mobile devices, translates to increased need for case managers to assess and intervene. What a double-edged sword!

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