Doctors and other health care professionals are trying to solve the conundrum of what to do with all the health data from millions of consumer wearables.
Dr. Shoeb Sitafalwalla knows the routine: He walks into the exam room and sees a patient sticking their arm out, a wearable fitness tracker around the wrist. He walks over, taps the tracker’s screen, and sees how many steps the patient has taken so far that day.
After congratulating the patient for trying to be more active, Sitafalwalla, a cardiologist in suburban Chicago, continues with the exam. The data on the tracker? Most of the time, it’s forgotten after that tap on the screen.
“In my day-to-day practice, about 60 percent of my patients have some sort of wearable,” says Sitafalwalla, who also has a background in bioengineering and sits on the digital strategy council for Advocate Health Care. “There’s so much innovating going on now, and that’s great. At the same time, we’re still trying to figure out how to incorporate the data from the innovation into practice. Instead of us having the device first – after FDA approval – and dispensing it to the patient, it’s the patient coming to us and saying, ‘Why aren’t you looking at that?’”
He is not alone. Doctors and other health care professionals have been trying to solve the conundrum of what to do with the data from wearables since the first generation of Bluetooth-enabled versions hit the market a decade ago and sales took off. An estimated 125.5 million wearables shipped in 2017, up 20 percent from 2016, according to International Data Corp.’s Worldwide Quarterly Wearable Device Tracker. That number is expected to double by 2021.
As the devices have grown more sophisticated, so has the type of data at consumers’ disposal. Simple step trackers have evolved into smartwatches that connect with some of the more than 300,000 mobile health-related applications now available. Users can monitor their heart rate, see the length and quality of their sleep and record their water and calorie intake, among many other capabilities. In January, Apple updated its Health app so users can upload health records to their phones and have them accessible on both the iPhone and Apple Watch.
It’s the patient coming to us and saying, ‘Why aren’t you looking at that?’
Sitafalwalla stresses that he supports patients using a wearable fitness device if it gets them off the couch and walking. The benefits of healthier patients far outweigh any issues with the devices. But they can become an issue when consumers panic over data and come see him, convinced they have a heart condition when it could just be a regular variation in heartbeats. Those visits may, in turn, lead to unnecessary and expensive medical tests.
Apple and Stanford University School of Medicine recently launched a clinical study using the Apple Watch’s heart rate sensor to identify irregular heart rhythms. If any abnormalities are detected, the participant is alerted through the app and connected with one of the study’s telehealth providers for further evaluation. It’s considered one of the first attempts to derive clinical value from data collected by consumer wearables.
“When wearable heart monitors came out, they were not meant to diagnose arrhythmia or cardiac issues. They were to inform patients where they fall on the spectrum,” Sitfalwalla says. “With that in mind, there are clearly limits to the technology. Have I seen patients who come to me for a full workup because they simply had a dropped heartbeat? Yes, I have. Does that have the unintended consequences of driving up health care costs? It could.”
Perhaps no group is as tuned into data as new parents. From the day their baby is born, they are continually monitoring how long the baby sleeps, how much and how often the baby eats, how many diapers are changed, what the baby weighs … the list goes on and on. If the baby is sick, add in more data points to worry about, like temperature, medication and fluids.
It’s not surprising that the latest wave of consumer data products targets worried new parents trying to get some peace of mind. Recently, a national baby goods superstore sent a sales email promoting ways to build a “smart nursery.” The advertised products included a Bluetooth-enabled changing pad that’s also a scale. It connects to an app where parents can record the baby’s weight, feeding times and amounts, diaper changes, sleep and more.
That data can then be shared with doctors and caregivers. Another product advertised is a baby sock with a built-in pulse oximeter. It tracks the baby’s heart rate and oxygen levels, and sends a signal to the parent’s phone if something appears to be wrong. Those are just a few of the many high-tech products aimed at helping worried new parents.
While products like these carry the standard disclaimer that they aren’t meant to diagnose or treat disease, the data is more than likely to send parents to the pediatrician if they detect the slightest variation from the norm. But what concerns health care providers more is when these gadgets give parents a false sense of security. They may not watch for other symptoms and signs that something could be wrong and need attention.
“There are so many kits and tools available that say you can diagnose a baby’s condition at home,” says Dr. Prashant Deshpande, a pediatrician in suburban Chicago. “But my prevailing advice is that the parents are the best monitor for any child. It’s OK to get these tools if it makes you feel more comfortable, but remember that most of these apps have not gone through any rigorous regulatory reviews about the authenticity of their findings. There is a large amount of data being generated, but it may not be necessary in everyday life. Likewise, having a lot of information does not equate to knowledge about the particular medical condition.”
Deshpande also notes that when patients first had access to medical websites, he thought his patient visits would decrease because they were getting most of the answers online. In fact, the opposite was true. He estimates that physician offices are busier than before because of what he calls the “syndrome of the worried well” – parents of relatively healthy kids who read about certain symptoms online or measured some parameters with an app and became convinced their child has a problem.
“The first thing I tell them is I always go by how the child is behaving and the gut feeling of the parents,” he says. “Minute to minute, second by second monitoring of a child is needed in very few settings, and not at the home of a healthy child.” Once he takes a thorough history and does an exam, he finds most parents are less worried about the data that brought them in to his office.
No matter what he says, though, he knows parents are going to gravitate toward anything that can ease those middle-of-the-night worries. To that end, Deshpande tries to encourage them to use websites and apps from reputable, established medical organizations, and keep away from monitors unless he recommends them. Ultimately, he hopes these apps will come under regulatory scrutiny and regulations, like any other medical device.
“Health care apps are the Wild Wild West right now,” he says. “Things will get settled eventually, and a few standardized, well-tested and regulated apps will sustain to serve the patients and their parents well.”
Not long ago, Jennifer Brazen, an ACE-certified personal trainer, had a client who would look at his wearable device after every weight repetition to see what his heart rate was. If it was too high or too low, he would point it out to her. In Brazen’s view – and in her own experience – that is not the intent of a wearable fitness device or any other health tracker.
“A few years ago, I was training for a marathon and I wore a heart rate monitor and a GPS and I tracked everything,” she says. “I had so much data coming at me that I forgot to enjoy running.”
She encourages her clients to use wearables for motivation, particularly being able to join challenges with friends. She also likes the features that buzz when someone hasn’t moved enough in an hour. Getting people moving, she says, should be the ultimate goal of a wearable.
“People are so focused on the data – the heart rate, the calories – that they lose the bigger picture. A workout is supposed to be about enjoying yourself, not about calories in and calories out.”
Once that focus is lost, it’s only a matter of time before the wearable ends up in a drawer or becomes just a watch. As much as he sees patients who want him to tap their wearable, Sitafalwalla sees plenty who used to be in that group and now their wearable sits in a drawer. To him, that’s worse than any false alarm.
“What pleases me most is if my patients are using the device and demonstrate engagement in their own health and wellness routine,” he says. “Unfortunately, we see the opposite. The new challenge for providers and technology developers is to find ways to encourage patients to stay engaged in their overall health, rather than simply track metrics that make up components of it.”