Beyond Self-Help: Using Wearables in a Clinical Setting

June 1, 2016 Howard Luks and Sarah Kunkle

An increasing number of people are buying wearables, e.g., fitness trackers and smartwatches, to keep tabs on their health – in fact, manufacturers shipped more than 78 million units in 2015, up 171.6 percent from 2014. Fitbit sales increased 50 percent last quarter alone.  While market forecasts are generally rosy, sentiments on their healthcare applications are more pessimistic. A recent article highlighted “why doctors and administrators don’t love wearables,” concluding that commercially available wearables like Fitbit and Apple Watch will remain “self-help” technologies. Although there are challenges to address when using these devices in a clinical setting, wearables present a huge opportunity to prevent, manage, and cure disease.  In addition, wearables could dramatically improve the quality of research in healthcare.

Wearable devices are already being used as tools for behavior change and health promotion. Although the devices alone are unlikely to change behavior, they can be an important component of a broader engagement strategy. Recognizing this potential, many insurers and employers are using wearables in their wellness programs to track and incentivize healthy behaviors. Doctors also have a key role to play in the prevention of chronic disease and encouraging the uptake of healthy behaviors using technology.

With less than three percent of Americans maintaining a healthy lifestyle, there are hundreds of millions of people in the US alone that stand to benefit from technologies that promote and encourage a healthier lifestyle.

In addition to disease prevention and modification, wearables and other personalized health technologies can also help individuals (and their doctors) manage chronic diseases. Last month, Apple introduced CareKit, an open-source development platform that aims to empower people to use data to understand the impact of healthy behaviors and lifestyles. CareKit’s initial modules include features like medication reminders, symptom trackers, health insight dashboards, and a Connect feature, which allows users to share data with their doctor.

As sensor technology advances beyond step counting, this data-sharing feature will become particularly useful. Medtech startup AliveCor recently unveiled the Kardia Band, a medical-grade EKG band for Apple Watch, with pending FDA approval. The band works with an accompanying Apple Watch app, which automatically processes the data from the device sensors and allows wearers to also record voice memos that are sent along with the EKG to their doctors.

Finally, wearables are improving the quality of health-related research. Many studies still rely on self-reported data for physical activity, which is subject to significant bias. While research-grade devices provide extremely accurate readings, they are often prohibitively expensive, which is problematic when funding is tight. Seeking a reliable but affordable alternative, researchers are turning to commercially available products as evidence emerges that these devices perform within a reasonable degree of more expensive research-grade products. Fitabase, a web platform for the collection, analysis, and export of data from Fitbit devices, says it has assisted researchers and other healthcare institutions in more than 100 research studies using Fitbit products. Other researchers are using Apple ResearchKit in concert with Apple Watch.

There are of course many ethical, legal, and social challenges to address when using these technologies. Specific to their clinical applications, many doctors and healthcare administrators are particularly concerned about data privacy and security. With the widespread adoption of electronic health records (EHRs), information overload is another concern for doctors. As Dr. Bob Watcher, professor of medicine at the University of California, San Francisco put it, “Most primary care doctors I know, if they get one more piece of information, they’re going to quit.”

Howard Luks, MD an orthopedic surgeon based in New York, believes that with the appropriate dashboards, EMR plugins and buy-in by the MD community, wearables present themselves as a means of helping patients recognize the changes to their health that are brought forth by incorporating healthy behaviors into their daily routines.

A 2014 Nielsen survey found that users of wearable technologies tended to be young and wealthy. This demographic of early adopters has given them a reputation as “self-help” devices for the “healthy wealthy.” However, as the market matures, new value propositions are emerging and wearables are migrating into the clinical realm. This presents new challenges for device manufacturers, including more scrutiny on data accuracy and security. Engaging in dialogue with doctors, the healthcare IT industry and professionals as well as other healthcare workers is essential to ensure that these challenges are addressed so wearable technologies can achieve their potential.

 

This is a blog post by Howard Luks & Sarah Kunkle that was originally posted here.

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