Wear­ables may look adorable, but they aren’t that us­able

Modern Healthcare - - NEWS - By Rachel Z. Arndt

Peo­ple measure how many steps they take be­cause it makes them feel healthy, like they’re do­ing some­thing proac­tive for the body and mind. But can that mea­sure­ment—the ac­tual num­ber it­self—make peo­ple health­ier? Or is it just an­other life­style met­ric dressed up like a med­i­cally ac­tion­able data point?

Right now, the an­swer is a lit­tle bit of both. While mil­lions of peo­ple are busy strap­ping Fit­bits, Ap­ple Watches and other fit­ness track­ers to their wrists and mov­ing un­til they feel the Pavlo­vian vi­bra­tion of reach­ing 10,000 steps, oth­ers are us­ing ded­i­cated at-home med­i­cal de­vices such as con­nected glu­cose me­ters and weight scales.

Clin­i­cians, mean­while, are busy try­ing to fig­ure out how to turn those steps and blood-sugar read­ings and weights into mean­ing­ful tools to keep their pa­tients healthy. The tools might also al­low doc­tors to make bet­ter de­ci­sions for their pa­tients dur­ing those stretches of time be­tween ap­point­ments, with at-home mon­i­tor­ing serv­ing as a benev­o­lent, health-ori­ented sur­veil­lance sys­tem that sends alerts when cer­tain thresh­olds are crossed.

“You can’t re­ally get sus­tained, ef­fec­tive be­hav­ior change at any level just by do­ing pe­ri­odic, episodic of­fice vis­its,” said Dr. Joe Kvedar, vice pres­i­dent of Part­ners Health­Care’s Con­nected Health. “This is a very im­por­tant part of health­care de­liv­ery, and it’s just start­ing to come into fo­cus.”

The key is culling in­for­ma­tion from raw data, mak­ing sense of a slew of num­bers that, on their own and with­out con­text, are just consumer-ori­ented life­style met­rics. While get­ting the num­bers is easy, mak­ing them worth­while is an­other mat­ter.

“Pa­tient-gen­er­ated data re­ally needs to be pro­cessed and made very user-friendly,” said Dr. Eric Topol, di­rec­tor of the Scripps Trans­la­tional Sci­ence In­sti­tute.

To do that, a few providers, op­ti­mistic about the prom­ise of at-home gad­gets, are turn­ing to soft­ware made by a hand­ful of com­pa­nies hop­ing to trans­form pa­tient-gen­er­ated health data into im­por­tant clin­i­cal in­for­ma­tion that com­ple­ments the med­i­cal-grade mea­sure­ments providers record when their pa­tients are in the hos­pi­tal or doc­tor’s of­fice. The ques­tion is whether re­ly­ing on at-home mea­sure­ments is worth it, or whether providers are bet­ter off not forc­ing new data into their work­flows and spend­ing their time else­where, among the plethora of data points they al­ready have.

Just get­ting go­ing

Wear­ables tap rel­a­tively new tech­nol­ogy, and it’s im­pos­si­ble to talk about the prom­ise of th­ese mea­sure­ment tools with­out first dis­cussing the short­com­ings of th­ese mostly wrist-mounted de­vices

that rely on ac­celerom­e­ters and tiny sen­sors to track move­ment, heart rate and other stats.

The first Fit­bit de­vice was in­tro­duced in 2007. The gad­get and oth­ers like it have come a long way since then: A re­cent Stan­ford study showed that heart rate data from the Ap­ple Watch, Fit­bit Surge, Mi­crosoft Band and oth­ers all had er­ror rates of un­der 5% dur­ing cy­cling.

But wrist­bands are lim­ited—and they’re still, at their core, life­style de­vices.

“There’s no magic to this 10,000-step thing,” Topol said. “That’s com­pletely ar­bi­trary. I don’t con­sider it med­i­cal.”

Where consumer wear­ables—and fit­ness track­ers in par­tic­u­lar—ex­cel is in mar­ket share: About one-fifth of Amer­i­cans have a fit­ness tracker, ac­cord­ing to Gart­ner. That makes it a con­ve­nient means for pay­ers to keep track of their in­sureds’ habits. In­surer Os­car Health, for in­stance, re­wards its mem­bers for track­ing their steps, and Ap­ple and Aetna re­cently dis­cussed get­ting Ap­ple Watches for many Aetna mem­bers.

“It al­lows us to en­gage with not just our sick mem­bers, but also our healthy mem­bers,” said Liz Robau, Os­car Health’s prod­uct and tech com­mu­ni­ca­tions man­ager. “They’re open­ing the app, they’re us­ing step-track­ing, so they have more fa­mil­iar­ity with the other fea­tures in our func­tion­al­ity.” In other words, Os­car’s mem­bers be­come more ac­tive par­tic­i­pants in their health.

That’s all well and good, but what would make en­gage­ment even more worth­while is if the mea­sure­ments them­selves led to ac­tions and in­sights. “The idea be­hind track­ing is that even­tu­ally you want it to lead to some sort of re­sult,” Robau said.

For wear­ables to be use­ful, it’s not enough for pa­tients to wear them con­sis­tently. The data has to be able to move off the de­vice and into EHRs and other sys­tems. “A lot of this consumer-driven data isn’t be­ing in­gested into the EHR,” said Vaughn Kauff­man, a part­ner in Price­wa­ter­house­Coop­ers’ Health In­dus­tries Ad­vi­sory prac­tice. Data must be turned into the equiv­a­lent of a nar­ra­tive by soft­ware. Flow man­age­ment

Some providers are turn­ing to out­side com­pa­nies to help them man­age all that data so they can eas­ily ac­cess it, make sense of it, and use it to keep their pa­tients health­ier dur­ing all the time out­side of of­fice and hos­pi­tal vis­its. In part, providers are re­spond­ing to pa­tient de­mand.

“Pa­tients are go­ing to have wear­able de­vices,” said Rita Bowen, vice pres­i­dent of pri­vacy, com­pli­ance and health in­for­ma­tion man­age­ment pol­icy for soft­ware and ser­vices firm MRO, “and they’re go­ing to present that data.” She then echoed Kauff­man’s sen­ti­ment: “The prob­lem comes from flow­ing that data into an EHR.”

While Fit­bit of­fers an ap­pli­ca­tion pro­gram­ming in­ter­face to bring data into care man­age­ment dash­boards, other com­pa­nies are pulling data from de­vices that cap­ture more tra­di­tional health-re­lated mea­sure­ments, such as blood glu­cose, weight and blood pres­sure.

“Some­thing that could be a driver of a fast growth rate around wear­ables is that there’s a clear re­im­burse­ment model” for providers, Kauff­man said. But right now, pa­tients are still pay­ing out of pocket for a lot of th­ese de­vices, he said.

Nev­er­the­less, some providers are ac­tu­ally pre­scrib­ing th­ese de­vices to their pa­tients. Ac­tiv­ity track­ers, for in­stance, can be used in di­a­betes and obe­sity treat­ment, Kvedar said.

Once the in­for­ma­tion is cap­tured, though, it has to be­come use­ful.

“We con­trol the flow of the data,” said Eric Rock, CEO of Viv­ify Health, a com­pany that pulls data from con­nected de­vices, pro­cesses the in­for­ma­tion and in­te­grates it into work­flows in EHR sys­tems, with the goal of mak­ing the data ef­fi­cient to use.

“This is im­por­tant to re­duce the over­all work­load, while in­creas­ing pa­tient vol­ume and im­prov­ing out­comes and sat­is­fac­tion,” Rock said. On some EHR sys­tems, for in­stance, providers can get alerts. When a provider clicks on an alert, he or she sees risk in­di­ca­tors cre­ated by al­go­rith­mic anal­y­sis. “We man­age the ef­fi­cacy of the data, be­cause th­ese clin­i­cal pro­grams are gath­er­ing the right in­for­ma­tion at the right time from th­ese de­vices,” Rock said. Hos­pi­tal sys­tems like Sut­ter Health are us­ing pa­tient-col­lected data to try to im­prove care for Type 2 di­a­bet­ics as part of an Ac­cen­ture-led pi­lot pro­gram for the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy ex­plor­ing how pa­tient-gen­er­ated data can be used. The hos­pi­tal has been tap­ping tech­nol­ogy from dig­i­tal health com­pany Va­lidic to bring pa­tient-gen­er­ated health data from a Sut­ter pa­tient app into its ex­ist­ing EHR sys­tem.

“Clin­i­cians and care man­agers could look every day at not just how an in­di­vid­ual pa­tient was do­ing, but also at a risk-strat­i­fied pa­tient list,” said Va­lidic CEO Drew Schiller. Pa­tients, too, got feed­back.

Ac­cen­ture Fed­eral Ser­vices will re­spond to the pi­lot with a fi­nal white pa­per to guide fed­eral pol­icy on the use of pa­tient-gen­er­ated health data af­ter the pi­lot, which ended in Septem­ber.

Some EHR ven­dors, mean­while, are giv­ing clin­i­cians an in-EHR view of wear­ables data by pro­cess­ing the data them­selves. EClin­i­calWorks, for in­stance, in­cor­po­rates data from consumer de­vices, such as weight scales and blood-pres­sure cuffs. In the fu­ture, the plat­form will in­clude a clin­i­cal rules en­gine that helps physi­cians man­age the in­flux of data. “That al­lows physi­cians to make bet­ter de­ci­sions dur­ing the ap­point­ment it­self,” said eClin­i­calWorks Vice Pres­i­dent Sam Bhat.

In­deed, suc­cess­ful use of pa­tient-gen­er­ated data won’t sup­plant of­fice vis­its; in­stead, it will com­ple­ment them, Kvedar said.

“There are ways for us in the near-term fu­ture to build th­ese pro­grams in a way that doesn’t in­ter­fere with those 10 min­utes you get with your doc­tor, but ex­tends it into your life as a con­tin­u­ous func­tion,” he said. “This is a very im­por­tant part of health­care de­liv­ery, and we’ll get there be­cause of the pop­u­lar­ity of wear­ables.”

“A lot of this consumer-driven data isn’t be­ing in­gested into the EHR.” Vaughn Kauff­man Part­ner, Health In­dus­tries Ad­vi­sory prac­tice, Price­wa­ter­house­Coop­ers


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