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Informatics Paper: Biometric Monitoring Devices and Integration

Amelia Boyle, Dana Hamilton, Sarah Jacobs, Christina Koppes, Megan Lind

Department of Nursing, The University of Mary

NUR 242: Nursing Fundamentals

Prof. Susan Weigum

March 21, 2021

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Informatics Paper: Biometric Monitoring Devices and Integration

The informatics portion of the Quality and Safety Education for Nurses (QSEN) is

essential to patient care. One such form of informatics is biometric monitoring devices.

Integration of technology within nursing is crucial to advancing the healthcare field. Biometric

monitoring devices (BMD) are assistive medical devices used to improve patient monitoring and

data collection. These devices are used to transmit, record, and log clients' vital parameters,

status, and other health-related information (Majma & Babamir, 2014). Examples of BMDs

include microcontrollers, transceivers, and wearable smart devices. Though this technology helps

track a client's health, access and use of highly personal health information must be made secure

to prevent harm to patients using this technology. As for the benefits and limitations of BMDs,

there are ongoing technical innovations and ethical issues that arise. Due to these limitations,

BMDs should not be solely relied upon. In-person medical care currently provides more

accuracy, thoroughness, and diagnostic abilities. Biometric devices are used for more efficient

collection of data over long periods, which will advance nursing care and decrease healthcare

errors. This technology promotes a client's ability to be an active part of their care by enabling

them to monitor their health. Nurses are involved in the design, selection, implementation, and

evaluation of information technology to support patient care through interdisciplinary

collaboration and clinical skills to identify issues and improve care.

The Scope and Use of Biometric Monitoring Devices

Biometric monitoring devices are used in a variety of healthcare facilities and beyond.

Hospitals, long-term care facilities, athletic training environments, and home care settings are a

few places where the use of BMDs is well-established. The presence of monitoring devices in
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these environments help caregivers provide competent and patient-centered care to promote

health and prevent the occurrence or worsening of illness (Browne et al., 2021).

At present, biometric monitoring devices have gained a significant interest and presence

in the lower levels of healthcare: preventative, continuing, and restorative care. Studies have

been conducted on the effects of assistive biometric devices that monitor a number of factors that

influence a person’s health status. The general conclusion of these studies shows an improvement

in health status through various markers such as improved quality of sleep, increased activity,

lower body fat percentage, improved heart rate variability, and improved overall health (Browne

et al., 2021). The benefits of these BMDs prompt their use in care settings where patients require

or benefit from constant monitoring. Patients with chronic diseases or elderly patients that wish

to retain their independence are particular populations that are likely to benefit from BMDs.

Over time, biometric monitoring devices have been adapted and improved to

accommodate their many uses. They are manufactured as wireless, portable, real-time,

continuous, intermittent, and wearable to support the unique circumstances of their application.

These adaptations propel BMD use and foster its positive effects on patient-centered care.

Outside of direct medical prescriptions, many of the general public are implementing low-grade

wearable monitoring devices outside of health care to monitor the health effects of their lifestyle.

The Apple Watch and Fitbit are two such devices. Lifestyle factors such as activity levels, heart

rate, and caloric expenditures are a few common factors that low-grade wearable monitoring

devices usually monitor. While there are concerns about the use, accuracy, and collection of

personal health, BMDs have many benefits inside and outside of healthcare facilities.
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Biometric Monitoring Device Supports Care Coordination, Clinic Decision Making, and

Error Prevention

BMDs have numerous advantages to health care. Biometric devices have improved care

coordination by creating a more effective way to obtain data. BMDs have allowed individuals to

take their health into their own hands by monitoring their health through wearable devices such

as wristbands that can connect to an individual's phone. This is especially beneficial in the day

and age of Coronavirus disease (COVID-19) when visiting the doctor is not always most

accessible. Resources, hospital space, and health care workers are exhausted during COVID-19

times. According to Manta et al. (2020), “remote monitoring can be used to deliver routine

healthcare for patients who were unable to come in for their scheduled clinic visits for chronic

conditions, diseases, and illnesses” (p. 1040). Monitoring patients from home can also detect

early signs of disease or sickness. BMDs benefit clinical decision-making. It allows for regular

collection of objective data which further allows health care workers to easily track and assess

the plan of care. Systematic collection of vital signs using biometric devices also allows health

care workers to understand the patient's baseline and act quickly if their vital signs vary from the

acceptable range (Manta et al., 2020). BMDs allow health care workers to monitor patients from

their home and take initiative when a patient's condition wanes (Edlund, 2016).

One of the most common problems in healthcare is medication errors due to patient

misidentification. BMDs help to prevent these errors and promote the safety of the patient. With

BMDs, healthcare workers use more successful identification such as fingerprint scans rather

than Social Security and birthdate to identify patients. Something as simple as this is vital to

promote the patient's security, safety, and well-being. However, it is important to note that
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computerized systems are not 100% reliable, therefore, nurses still need to ensure that they

identify the right patient (Sohn et al., 2020).

Considerations for the Security of Confidential Protected Health Information

Due to the extremely individualistic identifying nature of BMDs, there are some concerns

regarding the confidentiality of protected health information. To successfully integrate BMDs

without compromising a patient’s privacy, concerns such as data usage, disclosure, storage,

profit, security, and more must be managed (McMahon, 2021). A few states have already

initiated legislation that addresses many concerns regarding BMDs that should be considered for

nationwide implementation. As technology has advanced within medicine, it has become

increasingly necessary for specific regulations on the use of protected health information to

advance as well.

Besides using physical security measures, the legal responsibility of private companies

for keeping biometric data (BD) secure has also been addressed in a few states. However, due to

companies potentially having customers from any state, the most strict measures will likely be

used by all states. California currently has BD covered by the California Consumer Privacy Act,

and this will be strengthened by a new law passed by state proposition in 2020. Consumers can

verify which information is being kept by companies, opt-out of sharing it for marketing

purposes, and request to delete it. Illinois was first with a detailed law concerning BD in the

Illinois Biometric Information Protection Act (BIPA). Most importantly, the Illinois BIPA

requires that the individual whose data is to be stored must be given notice that BD will be

collected, stored, how it will be used, and time of storage. The individual must give written

consent to this collection and storage. This will prevent companies from secretly collecting such

data. It also requires notification of a public policy letting consumers know when their stored BD
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will be destroyed, which should be as soon as the use for which it was collected ends, or three

years after the last use of the data, whichever comes first. This is very helpful to the public,

especially to those suffering from poor health, as the burden of removing the data lies with the

company and does not require the possibly forgetful consumer to be responsible for its removal

(McMahon, 2021).

To avoid any conflict of interest or profit motives regarding the maintenance of BD,

BIPA bans private companies from profiting in any way including selling, leasing, or trading this

information. To strengthen this, it bans disclosure of BD without the individual’s consent, unless

it is needed for a financial transaction that has been authorized by the individual. This will go a

long way toward keeping BD from falling into the wrong hands, as this data would be very

valuable to companies to target individuals for advertising (McMahon, 2021).

Finally, BIPA addresses the security of BD. It requires that companies use reasonable

industry standards for storing, transmitting, and securing this data. Companies already store

private or confidential information, and the methods used for securing BD should be at least the

same or better than those. With companies legally and financially responsible for securing an

individual’s unique and valuable BD, this should prompt them to do their best to prevent a

person’s sensitive information from being reduced to profitable consumer marketing information

or used to deny an individual something necessary (McMahon, 2021).

The Benefits and Limitations of the Biometric Monitoring Devices and the Impact on

Safety and Quality

Although BMDs are useful, there are ethical and safety considerations to note, as well as

benefits and limitations. Technology is not a complete substitute for hands-on care. Also,

technological advancements are still occurring. The Coronavirus pandemic has caused an
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increase in the use of BMDs and with it, increasing ethical and safety considerations. BMDs are

beneficial because they allow for the collection and relay of massive amounts of digital health

data. A recent increase in user downloaded smartphone applications have facilitated more

efficient data relay to clinicians through the manufacturer servers (Cohen et al., 2020). This

constant monitoring with BMDs allows a patient to live a more normal life with easier

management of symptoms and peace of mind. BMDs have enormously impacted cardiovascular

health management as well (Baldasarre, 2020). Cardiac devices including pacemakers and

implantable cardioverter-defibrillators (ICDs) have “dramatically expanded their diagnostic

capabilities,” and there are recent advancements in storage and sensors, increasing battery life

and wire performance (Cohen et al., 2020, p. 1258). This digital revolution, including safe

bluetooth connectivity directly to the health care team, is transforming patient care (Cohen et al.,

2020). According to a study during the COVID-19 pandemic, BMDs have been tested and

proven to be accurate and valid before they were placed on the market. Devices can be

categorized as low risk, medium risk, and high risk, all of which require different levels of

clearance (Manta et al., 2020).

There is an increasing demand for consumers to monitor their own health, decreasing

financial expenses from hospital stays and improving health promotion and prevention of further

illness (Baldassare, 2020). Fearing infection and crowded clinics during COVID-19, people

have increasingly used BMDs, including pulse oximeters and Bluetooth COVID-19 tests. BMDs

can aid in preliminary patient physical assessments, assessing COVID-19 symptoms, and

monitoring patients after hospital discharge to prevent readmission (Manta et al., 2020).

There are limitations to BMDs, especially in safety and quality. A recent review of the

health privacy laws indicates that many U.S. citizens are unable to access or can access very little
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of their own digital health data, especially in “raw, granulated form” under Health Insurance

Portability and Accountability Act (HIPAA), but the data protection laws of California and

countries in the EU, including the EU General Protection Regulation (GDPR) allow for more

access to this biometric device collecting system (Cohen et al., 2020, p. 1257). This is a major

implication that BMDs do not always honor patients’ rights to view their own information and

understand their diagnosis. BMDs unearth ethical questions, including the source of the data, the

owner of the data, and the level of accessibility of health information. Also, remote connectivity

is only built to send information to the clinicians and not the other way around. In emergency

situations, clinicians cannot therapeutically intervene since they cannot control the diagnostic

and therapeutic functions of the device. Healthcare providers often question how accurate BMD

measurements are taken at home without supervision. Nurses must also understand data values

and possible biases in data collection from BMDs in order to make appropriate inferences and

use the data for clinical decision-making (Manta et al., 2020). If BMDs completely replace

in-person care, one should consider situations in which a BMD breaks, such as the internet

becoming hacked or the electricity going out. The use of BMDs should be considered as aimed

towards the monitoring of physiological parameters, and not a diagnosis of any clinical

condition, the responsibility of a medical specialist. Although BMDs are helpful, it has become

clear through scientific literature that the application of these devices in the medical field and

safety within the workplace is still limited, partly due to an absence of focused scientific research

(Baldassare, 2020).

Biometric Monitoring Devices and Integration and Nurses’ Involvement in Design,

Selection, Implementation, and Evaluation of Information Technologies

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Nurses are responsible for the implementation and use of BMDs as well as the evaluation

of information presented by alarms on BMDs. Clinical alarms are one of the most popular forms

of BMDs used in acute care, however, an overload of alarms can create issues for nursing staff.

Research by the American Journal of Clinical Care shows too many alarms at once can cause

nurses to feel overwhelmed, become desensitized to alarms, and may interrupt or delay patient

care (Honan et al., 2015).

Concerning implementation, noise pollution due to alarms was one of the main barriers to

patient satisfaction. Patients and families become concerned when alarms are constantly blaring

from monitoring devices. This leads to panic and anxiety. This fear can lead to complications in

already unstable patients and dissatisfaction with care from family members. Many alarms

require no nurse action and thus, cause unnecessary concern from nurses and patients. These

interruptions may delay necessary interventions (Honan et al., 2015).

Nurses as well as other healthcare professionals such as monitor technicians are

responsible for the evaluation of BMDs. Some facilities utilize monitor technicians to help

nurses monitor alarms. Monitor technicians were reported, based on this study, to cause

additional issues. Technicians’ calls to nurses when intervention was not necessary resulted in

many interruptions. Inadequately trained technicians also disarmed alarms without notifying

nurses when reporting was necessary (Honan et al., 2015).

Nurses decided what they felt were appropriate remedies to these issues. The main

remedy addressed was increased staffing, which would allow nurses the time they need to

evaluate alarms and quickly disarm them, reducing patient and family anxiety. Proper training

for alarm technicians will also help address this concern. Improvement of alarm technology, such

as recognizing appropriate parameters on a case by case basis would also improve both patients'
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and nurses’ experiences. This would also improve the issue of noise pollution and patient and

family satisfaction. This identification has led to improved monitoring devices and ultimately

better care outcomes for patients (Honan et al., 2015).

When designing new BMDs, and improving the ones currently a part of healthcare

systems today, the nurses who will be observing and evaluating their data are an important

consideration. According to the American Journal of Nursing, nurses are a key part of healthcare

innovations. They often collaborate with engineers to create BMDs. Nurses' clinical knowledge,

when combined with engineers' abilities to code, build, and create nurses' visions makes them a

great team. Engineers help nurses design BMDs and nurses can advise the engineers on the best

design for the device. Together nurses and engineers can test the devices and put them into

action. The most successful innovations in healthcare have come from interdisciplinary solutions

to problems (Giuliano & Landsman, 2022).

Many nurses believe they cannot power innovation, however, engineers' specialty is

creating solutions to problems. Nurses and engineers engage in critical thinking and problem

solving together they are able to support one another and use each other's strengths in clinical

knowledge. Nurses often do not consider that their problems in clinical practice can be solved by

new BMDs. Nurses are very good at identifying problems but often do not have the resources to

create solutions (Giuliano & Landsman, 2022).

Nurses assess the competency of devices and select the most cost-effective and accurate

devices. When engineers create a new device, nurses will be the ones using them in their clinical

trials. Nurses can select components of devices that are productive and realistic in practice. The

engineers make adjustments based upon the opinions of those who will use them in practice.

Nurse educators and engineers together work to ensure BMDs support nursing practice and abide
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by nurse practice laws. Using products that promote accurate documentation is important to

patient safety and satisfaction (Giuliano & Landsman, 2022). According to Potter et al. (2021),

“Through the use of nursing informatics, technology is put to practical use to enhance bedside

care and education” (p. 379).

In the current healthcare climate, BMDs are heavily relied on within a wide variety of

health care environments and are undergoing different design adaptations to accommodate their

expanding uses. Biometric monitoring devices are an effective tool for nurses to closely monitor

patients while allowing the patient to be actively involved in understanding and monitoring their

health. When technology is successfully integrated within healthcare, data collection will be

more efficient, patients may gain more independence, and medical errors may decrease. Though

biometric monitoring devices can be extremely helpful, it is vital to consider the ramifications of

exposing protected patient health information to various companies. To safely and successfully

use this technology, strict regulations on data use must first be implemented. A few states within

the United States have already addressed issues that should be considered upon nationwide

implementation. Also, due to the unreliability of technology, it is crucial not to be too reliant on

it. Additionally, the security details of BMDs have not yet been perfected, so this may lead to

ethical issues regarding the protection and rights of patients. Nurses influence the evaluation and

creation of new BMDs by giving their input on monitor functionality and collaborating with

engineers to create new and innovative BMDs to solve clinical issues. Further research is

required, but BMDs can be used safely in addition to in-person medical care.
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