Digital Health advancement: From initial screening, in-patient care to prevention of re-admission in hospital management (Part II)

Digital Health advancement: From initial screening, in-patient care to prevention of re-admission in hospital management (Part II)

Digital Health advancement: From initial screening, in-patient care to prevention of re-admission in hospital management (Part II)

Digital health has accelerated the advancement of the healthcare system during the COVID-19 pandemic and beyond the use of infectious outbreaks. In this article, we further discuss how these innovative wearables have facilitated the management from initial diagnostic screening, and in-patient monitoring to reducing re-admission rates in hospital settings. 

Hospital Screening (eg. Diagnostic screening of obstructive Sleep Apnoea and insomnia)

FDA-cleared wearables for home sleep test has significantly revolutionized the screening of obstructive sleep apnea (OSA), which was previously expensive, labour- intensive and required hospitalization using polysomnography (1–3). Recently, wearables for home sleep tests have also expanded their diagnostic applications in providing new clinical and research insights into mental wellness and psychiatric disorders. Several commercial sleep trackers have been utilized to assist the diagnosis of insomnia apart from reported symptom-based diagnosis (4) which is subjective, labour-intensive and highly dependent on the clinician’s experience. 

Belun Sleep Platform (BSP), using an FDA-cleared wearable Ring, offers an automated home sleep test for patients with OSA and insomnia. Belun Sleep Platform (BSP) has the capability of monitoring and analyzing Oxygen saturation (SpO2), heart rate variability (HRV), photoplethysmography (PPG) waveform, and accelerometer-derived actigraphy data. It can calculate an estimated apnea-hyponea index (bAHI). It can also differentiate wakefulness from sleep, perform sleep stage analysis and give REM and NREM sleep duration using its artificial intelligence platform. Furthermore, it also shows autonomic nervous system (ANS) activities, including sympathetic and parasympathetic activities, throughout the monitoring period. 

In-patient monitoring

Continuous vital signs monitoring by wearable devices may allow timely detection of clinical deterioration for in-patients, especially in general ward settings. Some of the examples include the use of wearables on the wrist, upper arm, and chest to measure heart rate, respiratory rate, blood pressure, SpO2, axillary and skin temperature. These alarm management systems may facilitate the detection of respiratory event for ICU transfer and, rapid response calls for better management, especially after surgery in surgical wards (5–7). Besides these technologies can significantly minimize the length of hospital stay, improvement of patient outcomes and also reduce strain on hospital resources especially on early postoperative monitoring for surgeries from cardiology, urology, oncology and even paediatrics (8). They may also facilitate earlier discharge, triaging of patients and reduction reducing healthcare expenses to both patients and the hospital. Moreover, vulnerable subjects, elderly, children or speech-impaired patients are particularly suited to wearable device monitoring to ensure better patient safety during their hospital stay with timely care (8). Another potential area of application using wearable devices is to provide objective pre-operative assessment for recovery rate in patients considering surgical treatment options. For example, accelerometer data collected by consumer wearable data prior to baseline can be used to evaluate one’s functional recovery, especially in orthopaedic surgeries (9). However, healthcare professionals may need to be aware of the limitations of these current digital gadgets, such as short battery life, poor signals connection and unexpectedly high frequency of alerts at default settings.  Substantial room for improvement or adjustment may be required during actual implementation. 

Post-operative monitoring to prevent readmission

Besides early post-operative monitoring in ward after surgery, post-operative monitoring after discharge is another key area of interest for hospital management. Wearable sensors which allow monitoring of vital physiological parameters (e.g. resting heart rate, heart rate variability, respiratory frequency, arterial oxygen saturation, thoracic fluid content, and even blood pressure) are particularly useful in this aspect. Moreover, the adhesive chest sensor allows the detection of cardiac arrhythmia and is expected to allow long-term monitoring at home instead of conventional 24 h- Holter recording (7). Phone case or a watch bracelet containing an electrode to record a single lead ECG is possible to detect intermittent atrial fibrillation or supraventricular tachycardia, and it can be shared with specialists for timely consultation (10). The use of consumer wearable technology for post-operative monitoring by comparing the preoperative baseline activity level on the day prior to discharge after major colorectal surgery is another promising predictor for the risk of 30-day hospital readmission (11). Studies also showed that wearable technology has the ability to assess the associated post-operative complications in patients undergoing elective colorectal surgery by analysing their baseline pre-operative activity levels (12). Other wearables such as disposable multisensory patches placed on the chest also showed promising results in early detection of impending rehospitalization (e.g. non-trauma hospitalization events, worsening heart failure events) with a predictive accuracy comparable to an implanted device (13). 

How Belun® remoVital facilitate in healthcare management of COVID-19

Belun® remoVital monitoring system is a real-time monitoring system composed of an FDA 510(k)- cleared Belun Ring, a body temperature sensor and a communication hub. The system measures vital signs, including blood oxygen saturation, pulse rate and body temperature. The installation is simple and user-friendly, and no pairing for Bluetooth or WiFi is required. The automatic connection with the cellular networks enables the system to run once it is turned on. It allows easy access to patients’ real-time measurements via the web portal. Besides, this real-time alarm customisation alerts healthcare professionals if any measured vital sign exceeds the pre-set thresholds.

During the 5th wave of COVID-19 in Hong Kong, Belun® remoVital was widely implemented in quarantine centres, including the Asia World Expo; Belun® remoVital played a safe-guarding role, especially for elderly and vulnerable subjects during the COVID-19 infection. With the implementation of our system, Belun facilitated clinicians to manage 400 elderly patients with mild COVID-19 symptoms at the Asia World Expo. Our system not only significantly reduced manpower shortages during the COVID-19 pandemic but also reduced the risk of infection in our healthcare professionals.

Up to now, over 32 organizations, including HK hospital authority, medical groups, clinic groups, dentists, and elderly centers selected to use the Belun Sleep Platform, Belun Ring and Sleep App, and Belun remoVital monitoring system. Many doctors read our medical journal papers, including 1) “Belun Ring Platform: a novel home sleep apnea testing system for assessment of obstructive sleep apnea” ( and 2) “Detection of obstructive sleep apnea using Belun Sleep Platform wearable with neural network based algorithm and its combined use with STOP-Bang questionnaire” ( If you would like to know more about how to adopt Belun’s solution in your organization or home use, pls feel free to contact us to schedule a meeting by filling out the form below:



1. Gu W, Leung L, Kwok KC, Wu IC, Folz RJ, Chiang AA. Belun Ring Platform: a novel home sleep apnea testing system for assessment of obstructive sleep apnea. Journal of Clinical Sleep Medicine. 2020 Sep 15;16(9):1611–7. 


3. Yeh E, Wong E, Tsai CW, Gu W, Chen PL, Leung L, et al. Detection of obstructive sleep apnea using Belun Sleep Platform wearable with neural network-based algorithm and its combined use with STOP-Bang questionnaire. PLoS ONE. 2022;16(10):e0258040. 

4. Kang SG, Kang JM, Ko KP, Park SC, Mariani S, Weng J. Validity of a commercial wearable sleep tracker in adult insomnia disorder patients and good sleepers. Journal of Psychosomatic Research. 2017 Jun;97:38–44. 

5. Paul JE, Chong MA, Buckley N, Harsha P, Shanthanna H, Tidy A, et al. Vital sign monitoring with continuous pulse oximetry and wireless clinical notification after surgery (the VIGILANCE pilot study)—a randomized controlled pilot trial. Pilot Feasibility Stud. 2019 Dec;5(1):36. 

6. Leenen JPL, Leerentveld C, van Dijk JD, van Westreenen HL, Schoonhoven L, Patijn GA. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J Med Internet Res. 2020 Jun 17;22(6):e18636. 

7. Michard F. A sneak peek into digital innovations and wearable sensors for cardiac monitoring. J Clin Monit Comput. 2017 Apr;31(2):253–9. 

8. Amin T, Mobbs RJ, Mostafa N, Sy LW, Choy WJ. Wearable devices for patient monitoring in the early postoperative period: a literature review. mHealth. 2021 Jul;7:50–50. 

9. Karas M, Marinsek N, Goldhahn J, Foschini L, Ramirez E, Clay I. Predicting Subjective Recovery from Lower Limb Surgery Using Consumer Wearables. Digit Biomark. 2020 Nov 26;4(Suppl. 1):73–86. 

10. Tarakji KG, Wazni OM, Callahan T, Kanj M, Hakim AH, Wolski K, et al. Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: The iTransmit study. Heart Rhythm. 2015 Mar;12(3):554–9. 

11. Kane WJ, Hassinger TE, Myers EL, Chu DL, Charles AN, Hoang SC, et al. Wearable technology and the association of perioperative activity level with 30-day readmission among patients undergoing major colorectal surgery. Surg Endosc. 2022 Feb;36(2):1584–92. 

12. Hedrick TL, Hassinger TE, Myers E, Krebs ED, Chu D, Charles AN, et al. Wearable Technology in the Perioperative Period: Predicting Risk of Postoperative Complications in Patients Undergoing Elective Colorectal Surgery. Diseases of the Colon & Rectum. 2020 Apr;63(4):538–44. 

13. Stehlik J, Schmalfuss C, Bozkurt B, Nativi-Nicolau J, Wohlfahrt P, Wegerich S, et al. Continuous Wearable Monitoring Analytics Predict Heart Failure Hospitalization: The LINK-HF Multicenter Study. Circ: Heart Failure. 2020 Mar;13(3):e006513.