When our wearables talk with our doctors

When our wearables talk with our doctors

Summary: Soon, our wearables could change health care – but perhaps not in the way you expect.

iHealth's Wireless Blood Pressure Wrist Monitor

John Francis’s family has a history of high blood pressure, so when the 53-year-old Minnesotan saw that Apple’s online store offered a blood pressure monitor by iHealth that could upload data to a smartphone or tablet app, he bought it and began tracking his blood pressure.

Surprisingly, the readings showed not only that his blood pressure was low but also that it was getting lower and lower. A month later, when the monitor, which also checked his pulse, measured it at a frightening 30-35 beats per minute (a normal rate is 60-100), he went to the ER, where he was told waiting a few more days could have meant death. Now fitted with a pacemaker, he continues to monitor his blood pressure.

“My blood pressure monitor is literally a life saver,” he told iHealth last month.

Francis’s use of the blood pressure monitor gives a glimpse of the upcoming digital revolution in health. Fitness trackers such as Fitbit, Jawbone and Nike Fuelband have surged in the last few years, with sales of such devices and smart watches projected to exceed $1 billion this year according to the Consumer Electronics Association. That’s 25 times the sales five years ago, when the term fitness trackers largely meant analog pedometers.

But even today’s 2.0 devices have a fairly limited application. While they do collect data over time and communicate with smartphones, their impact won’t truly be known until this fall. That’s when Apple, Google and Samsung will launch platforms (HealthKit, Google Fit and SAMI, respectively) enabling consumers to aggregate health data from a number of devices, and relay the information to other parties including health care providers and electronic health records. Apple and EHR company Epic Systems have already announced a partnership, and Allscripts is reportedly in talks with the Cupertino-based company. 

Apple, Google and Epic declined to comment for this article, and Allscripts and Samsung did not respond to requests for comment.

The link to medical providers, some analysts and doctors say, has the potential to transform health care and medical research by boosting the number of patients doctors can treat, shifting treatment to more preventative measures and lowering the costs of care and insurance.

“It’s a straightforward way of connecting the data end to end from the consumer’s home straight to the physician’s office,” says Jim Taschetta, iHealth chief marketing officer. Taschetta continues:

The first half of the digital equation is powerful in and of itself — [it’s] empowered consumers to take charge of their own health.... The second half of the equation is about how do we seamlessly and efficiently bring the medical community into that. That’s what you’re starting to see with Google and Apple and Samsung creating these switches in the middle that will allow data to flow seamlessly.

Less hype for the healthy

While the platforms will open up a new level of access to patient health data for doctors, none of that will occur without an individual’s consent. “If you don’t want to give your information to somebody, you don’t have to do it. This is a self-subscribed thing. Either you want to be part of it or you don’t,” says Patrick Moorhead, principal analyst at Moor Insight & Strategy.

Each of the tech players mentioned above is designing its platform so that all health data transmission occurs within Health Insurance Portability and Accountability Act (HIPAA) guidelines. Each consumer/patient decides which health organization — doctor, insurer, lab or another institution — gets to see what data.

Each consumer/patient decides which health organization — doctor, insurer, lab or another institution — gets to see what data.

For those who opt in, the initial changes may seem mundane. Dr. John Wald, a neuro-radiologist and medical director for public affairs and marketing at the Mayo Clinic, says that the current Mayo Clinic Patient iOS app allows patients to access their appointments, securely message physicians and obtain lab and imaging results, but that between now and September, Mayo, through its work with Apple, is revamping the app to allow patients to send HealthKit data to their medical record.

In a second-phase rollout by year’s end, “consumers will be able to take the information they have in HealthKit and use the Mayo Clinic app to access information about glucose, diabetes or asthma or other things that could potentially be monitored and contained in HealthKit," says Dr. Wald. They could also make appointments at Mayo Clinic and access medical information on Mayo Clinic's websites and other digital platforms.

“So that’s the next generation for us — to not only treat our current patients, but educate consumers,” he says.

That may sound unremarkable, but what’s more exciting is that your doctor will be able to see how many steps you take daily, right? Actually, unless you have a particular condition, he or she isn’t likely to be that interested. While your physician won’t be likely to dismiss the data if you do bring it to an exam or give her or him permission to view it beforehand through one of the above platforms, doctors probably won’t see great use in such information for a healthy patient for the same reason that a recent study showed that half of all fitness tracker owners abandon their devices.

“I’ve tried these things and I’m relatively healthy and active and I look at these things and I have no use for them. They’re not changing me in any meaningful way, but if you have serious heart disease and have to check your blood pressure every three hours because it dramatically affects your health, those are the unique solutions where we’ll see this traction take off and pay off,” says Ben Bajarin, principal analyst at technology research firm Creative Strategies.

The continuous physical

That doesn’t mean that current fitness trackers won’t have a role in the big data revolution in health. For chronic diseases like diabetes, educators who counsel people with the condition on proper diet and fitness could use such trackers to help coach patients. Trackers could also be useful for orthopedic surgeons who want to make sure their post-operative patients are hitting a certain number of steps each day.

Already, companies like Fitbit are experimenting with selling their devices at a discount to whole organizations, that, in turn, have teams of employees compete to see who can log the most steps. Data shows an active workforce could someday lower group prices. HealthPartners, part of the Cigna Network, offers some corporate plan participants a tracker and $200 after a year of meeting wellness goals, earned through a combination of diet, fitness and participating in challenges.

However, Moorhead points out that in order for these kinds of incentive programs to be effective, they need to be designed so they can’t be gamed by fraud. “What’s to keep me from giving my Fitbit to my son who does 20,000 steps a day and is super active and let him wear it versus me who might only get 5,000? There’s no means yet to deal with fraud protection,” says Moorhead.

Other health trackers could be used for monitoring babies and the elderly. Mimo has created one for parents that logs an infant’s respiration, skin temperature, body position and activity level. In the future, wearables could also allow for remote monitoring of the elderly, to see how much a person moved and whether he or she ate or showered, potentially lowering the cost of home health care.

And someday, your fitness data could combine with other data sets from your life to generate personalized recommendations. For instance, Shawn DuBravac, chief economist at the Consumer Electronics Association, says,

If I have my scale, calendar, travel schedule and all these other things digital now, I can start to [see] really interesting recommendations. Maybe every Tuesday I get wings with the guys and every Wednesday I weigh a pound heavier, so I end up working out hard to lose that extra weight for the next day or two, and this is a weekly cycle. I may not notice but a bunch of devices might this pick up this, and Tuesday morning I go to my fridge to grab breakfast, but my fridge says, ‘You’ll eat more tonight, so instead of X, do Y.’

The mini M.D.

Beyond fitness, the more significant use for wearables lies in specialized devices — and blood pressure monitors and glucometers are just the beginning. Medical devices have been evolving to become more consumer-facing. “Things that were once just in the purview of medical professionals have slowly bled into consumer or individual use or ownership of it. … The miniaturization of technology is making a lot of things possible,” says DuBravac.

In the future, health institutions will be monitored for (and their reimbursements will be based upon) the number of times they have to readmit a patient within 30 days after a hospital stay. Dr. Wald says:

If we can define the right parameters to measure during that 30-day period, we can hopefully decrease those readmission rates. One of those things could be weight. If the patient has heart disease and their heart starts to fail, they accumulate fluid in their body. So measuring a person’s weight is one easy way to track how well they’re doing.

Other parameters that could be useful to monitor after cardiac surgery include blood pressure, pulse rate, the amount of oxygen in the blood, and even remote EKG monitoring which will measure the electrical rhythm of the heart unobtrusively. That last example isn’t possible now, but probably will be within five years, Dr. Wald says. Other future devices could help with asthma, mental illness, pulmonary conditions and more.

Medical wearables could also be used for research. Earlier this year The Michael J. Fox Foundation and Intel Corporation launched a study to evaluate three wearable devices for their ability to detect certain characteristics of Parkinson’s disease. Intel engineers are now comparing the devices’ data with clinical examinations to determine their accuracy, and also to develop algorithms for analyzing the data, which consists of up to 300 observations per second.

Data doctors

Not only do new and better technologies, sensors and devices need to be created, but also hospitals and health care providers must form processes for parsing new data. “What needs to happen to drive value is the right piece of data needs to get to the right person at the right time,” says Dr. William Morris, an internist and associate chief information officer at the Cleveland Clinic. Health care providers must develop algorithms or processes to find the signal amidst the noise of many different types of data and many different ailments — for everything from post-operative knee surgery patients not recuperating quickly enough to diabetic patients with high blood sugar.

But once in place, those processes should transform care, because traditionally, Dr. Morris says, “we only knew what was going on that day you showed up in the office but not the other 364 days.” Daily readings would help doctors gain a clearer picture. The additional information could be used to maintain wellness among healthy patients. Or it could be used to keep those with chronic diseases stable, preventing emergencies that are not only expensive but also result in worse patient outcomes. 

“We’re kind of going back in time to when physicians would make house calls. It's the 21st century version of a house call."

Current and future developments will transform health care routines, promoting more remote contact between doctors and patients. “We’re kind of going back in time to when physicians would make house calls,” Mayo Clinic’s Dr. Wald says. “It’s the 21st century version of a house call.” While he agrees face-to-face communication is preferable, the downsides of a lack of human touch would be offset by more frequent contact and less travel for patients. For example, the Mayo Clinic currently has 30-some partner hospitals across the United States, Puerto Rico and Canada. Doctors in Rochester, Minn., could use electronic data to consult remotely with patients through physicians at those partner institutions.

At the moment, some obvious hurdles remain to seeing all these predictions come to fruition — starting with the need for ever-increasing accuracy in the various sensors. But one of the biggest obstacles is the fact that health insurance, at the moment, does not typically reimburse for monitoring patients remotely.

One new reimbursement model, called population health, which was spurred by the Affordable Care Act, pays health care providers a flat fee for managing, say, 100,000 or a million diabetic patients in an area. Dr. Wald says:

Whether those patients see you 100 times or two times or whether they have 100 tests or two tests, you’ll be reimbursed the same amount based on a risk analysis for those patients. If you can effectively treat those patients at home and decrease their in-hospital stay duration, then the reimbursement model will be favorable for you.

Slow adoption of payment models like this could delay the digital health revolution.

So, will wearables improve our health care? “I think that has yet to be determined,” says Dr. Morris. “The hypothesis is there but with anything in medicine, you have to prove it with data.”

Topics: Innovation, Emerging Tech, Health, Mobility

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  • wearables already exist!

    Wearable medical monitoring is not new! Not even close! Doctors can already send patients home on overnight heart monitors, home BP devices are affordable and diabetics can print out records! If anything, worrisome that your health data may go via an iPhone, rather than a secure monitoring device! I'd at least ask your doctor if they have a BlackBerry (and your accountant and lawyer for work!) as I sure don't want 1000's of patient results on an iPhone with its much maligned attempts and failures @ security.

    Home monitoring is nothing new! Using an unsecured iPhone is not a great idea. I think all business and health care professionals should be using BlackBerry. There is a reason the Defense Department and Obama use BlackBerry. Obama was told to get a new BlackBerry over iPhone, as iPhone security just cannot be relied upon! (He also likely benefits from better BlackBerry build quality and battery life)
    • I somewhat agree

      I would add Windows Phone to the BlackBerry, since it has government certifications also. However, most people don't care enough about protecting there personal information until it has been used against them, then they don't feel responsible in any way at all.
    • I didn't say wearables were new

      I said that the ability for your smartphone to transmit the data from wearables to your health care providers would be new this fall. In fact, in the article I imply that all these gadgets exist in the one sentence where I state that remote EKG monitoring is the only one that doesn't yet exist.
    • Ummm...

      The president was told to get a Blackberry (what 6 years ago now) because it had been vetted and approved by the government, not because it is necessarily any more secure than an Android or iDevice. Blackberry's can of course be hacked, just like any other device. I ran a Blackberry Enterprise server for years, and while it is certainly used to be easier to remotely administer a Blackberry, they are not the be all in security.

      The reason the president was told he had to have a Blackberry is because the government is always behind the curve on technology, and not because an Android or iOS based device is inherently any less secure.

      Additionally, there are government certified (hardened) versions of Android OS and I am certain iOS as well. Finally, I think most people care about securing their personal information, but

      1. Aren't aware of all the dangers
      2. Don't feel all their personal information requires the same level of security
      3. Place their faith in a third party (Government, Corporation, friend...) to keep them informed and safe.
  • Opening story bad example!

    This is just a home BP monitor. No different than any that patients have had access to for years! Likely more expensive! Not like it alerted the hospital. Patient monitored, saw ABN result and went to ER. No different than many other automated home BP systems patients have used for over a decade! And had results been automatically sent to doctor's iPhone (which would be different than the last decade of devices) I'd worry about security and insurance repercussions!

    Apple benefits hugely from most consumers not knowing that most of the current "advances" are existing products, like an automated home BP cuff that patients can buy cheaply from ANY medical supply store and lost drug stores! Kind of like Apple current commercials, with features like GPS/maps, photos, email, restaurant booking etc that my boring BlackBerry does better.
    • RE: Opening story bad example!

      Absolutely. And by the way...when had Mr. Francis seen his doctor last? Did the author bother to find that out?

      If his family has a history of high blood pressure, was he seeing his doctor on a regular basis to monitor this issue? Seems like he wasn't, if he indeed had LOW blood pressure, and a very low heart rate.

      Yes he was lucky...but also apparently quite lax in regards to his own health, what with the admitted family history of BAD health.

      His condition was taken care of...but you just can't cure stupid. Not even Apple can do that.
      • Medical stories are hard due to privacy issues

        I'm the author. Due to privacy issues around health, it took considerable effort to get the information I was able to include.
        • Real life digital medicine story

          In this blogpost from last year, I describe 2 real-life stories of digital medicine in action. I am an Anesthesiologist; a 17 year old came to my house with a heart rate of 300 and I treated him while using an AliveCor EKG in my living room. Two weeks later he had an ablation and cured a rhythm problem that sometimes goes years without diagnosis since it is so intermittent.
    • I said that none of this will be possible until this fall

      I didn't say the current gadgets like the one that John Francis used could talk to doctors now. I said they will be able to after Apple, Google and Samsung launch their platforms this fall. And I never said that when they do communicate, it will send your data straight to the doctor's iPhone. I also never said that these gadgets were new. I very clearly state that he had bought the gadget, which implies it's already been on the market for a while, and of all the gadgets I describe I mention that the only one that doesn't yet exist is the remote EKG monitor.
  • Not much use here in the UK

    Thanks to NHS cutbacks, our wearables would only be allowed to talk to the receptionist! They would need a virtual appointment to talk to an actual doctor - for which they would have to wait six weeks!

    By which time, with any luck, the patient would be dead anyway! :-)
  • In the future it should be mandatory

    ...for health data to be streamed to a person's health care provider. The savings in preventative health care will be huge.
    • Not necessarily...

      It would also keep people alive longer - possibly with illnesses that are much more expensive to treat - which would cost even more money.

      And here in Old Blighty, the NHS would most likely assign any collected data to the wrong patient anyway.
    • Eric Blair

      It's bad enough that people want to willingly opt into Orwell's nightmare vision of the future, but you want to replicate it exactly. Don't worry, you are not alone and health control has been the goal of control freaks for many decades. You have a problem though, since millions, hopefully billions, of people prefer freedom and are willing to fight tooth and nail for it.

      @mrgoose, that's what happens under socialist healthcare and it is what us Americans have to look forward to under ObamanationCare.
    • Not Really

      Wearable devices are not accurate. Especially if they are lost or stolen. (Who knows who's medical information would be sent). By the way, we have something in the U.S. called HIPAA so if any of the data would not go DIRECTLY to the doctors (such as another service with employees who are not background checked) there could be big issues there. With most providers not being certified under the law and lack of encryption, I wouldn't let a surgeon come near me with any device that isn't certified.
  • analog pedometers?

    "...five years ago, when the term fitness trackers largely meant analog pedometers."

    Pedometers count steps.

    Basically they count reversals of swing.

    So weren't they all, always, digital?
    Henry 3 Dogg
  • No one cares until there's a profit motive

    No one cares about my "health data" until someone figures out how to aggregate and sell it, to someone else who then uses it for targeted marketing or to directly discriminate against me. Meanwhile, my doctor is too busy to care what my heart rate looked like over the last 24 hours. I can't wait until congress passes a law requiring this crap.
    • Exactly right

      Nice to see another sane person, although I see someone has already tried censoring your free speech by flagging your post. Typical.
  • Am I in trouble right now?

    I feel flushed and uncomfortable, do I need to see a Doctor right now or is this not serious? Maybe medical devices will eventually make such decisions based partly on your own medical history and various readings. In any case, I see the outcome of these devices' decisions as either calming or total panic right out of the blue, so good luck to us all.
  • IT Pounding Data Down a Rathole

    The thrust of this article is about the wonders of data creation, collection, and transmission, but almost nothing on reception and utilization of the data, except IT's vision of the possibilities. Medical personnel are ill-equipped to utilize even the comparatively small amount of data collected now and stored on electronic media -- usually placed in rigid cell architecture and accessible only with rigid, preformatted report forms that do little to help in creative application of the raw data.

    Go a step further and realize that medical care -- by even the best specialists in their fields -- is based on essentially a collection of diagnosis and treatment formats drawn from norms found in large populations, not on specific symptoms and data of the lone patient in front of them. IT is racing along to further this trend to generalization of diagnoses and treatments, which -- for outliers whose symptoms don't fit the general norms -- means abandonment, suffering, pain, and premature disability and death.
  • Trust me. Nobody will...

    With both the Industry track record about privacy, and the even worse track record of individuals protecting same, I can't wait for the next Internet-of-Health-things scandal.

    That something can technically be done doesn't mean it *can* be made secure, and even less that it *will* be made secure.

    Anyway, better this fad than an implanted Internet-connected pacemaker.