Most people associate healthcare with the care you receive when you’re inside the four walls of a physician practice or hospital. But according to Jay Nagy, associate principal of corporate strategy for The Advisory Board Company, headquartered in Washington D.C., the 5,000 hours between periodic encounters with patients provides an additional enormous opportunity to collect data without a face-to-face visit. “This amount of time refers to when sickness and health happen, which is outside the clinical setting, for the most part,” says Nagy. “If you’re able to quantify that somehow, it will lead to not only better treatment and diagnosis, but ultimately better outcomes,” he says.
Thus, we have now entered the world of patient-generated health data (PGHD), an emerging concept that was covered in last year’s Top Ten Tech Trends, but has since evolved as an increase in chronic diseases (according to a Pew Foundation survey, 45 percent of U.S. adults are dealing with at least one chronic condition) and the high cost of managing such diseases has led many to turn to a technological solution to ease the burden on healthcare professionals, and provide useful tools to the elderly and chronically ill.
Analysts predict that the wearables market will grow tenfold to $50 billion over the next three to five years. So undoubtedly, putting personal devices in the hands of patients has begun to change the way patients and physicians communicate with each other. But while much of the focus has been on the Fitbits, Jawbones and Apples—the last of which recently introduced its HealthKit, serving as an iPhone dashboard for consumer health and medical apps—Nick Reddy, senior vice president of information system investments at the Dallas-based Baylor Scott & White Health, says that the prevention side is where the clinically-relevant things are happening, compared to just the 10 steps that are tracked by a wearable device. “We want to spin business intelligence and analytics on it,” Reddy says. “If you’re a diabetic and you haven’t been walking your steps or taking your [metmorfin], let’s flag you so your case manager can intervene. That’s where our roadmap is taking us,” he says, referring to the Baylor Scott & White Quality Alliance (BSWQA), a 3,700 physician-strong network that is one of the largest accountable care organizations (ACOs) in the country.
Nick Reddy
Joy Ku, Ph.D., research technical manager, labs and programs at the Stanford University School of Medicine in Palo Alto, Calif., agrees with Reddy, noting that there is a disconnect between what wearables are being used for and what they could be used for. Right now, if someone with a cerebral palsy, for example, comes into the Stanford lab, there is a motion capture system that puts reflective markers on his or her body as the patient performs different quantitative movements that are captured and fed into a computer program, Ku explains. This process in a lab can be very expensive and it only provides a one-time snapshot rather than getting the patient in his or her natural environment.
Thanks to a grant from the National Institutes of Health (NIH), Stanford University has a new lab designed to pull measurable and meaningful data from wearable devices. “A wearable sensor could change the way these diagnostics are done,” says Ku. “It’s inexpensive and people won’t find it to be much of a hassle. A lab-grade type of a wearable sensor would let you bring the patient in and see what kind of data there is. Is a patient more at risk for developing osteoarthritis, for example? And you can do this across populations,” Ku says.
Joy Ku, Ph.D.
According to Ku, the traditional way to study the impact of wearable devices would be to try out your idea with a healthy population, and if that’s successful, conduct the clinical trial, and then recruit the targeted patient population. But with Stanford’s mobilized center, researchers are flipping that idea around. “We’re saying, okay, there is all of this data out there being collected already from the Fitbits [and others]. The question is, if we gather all of that together, and do studies with low-fidelity type data from the wearables combined with the high-fidelity data from the lab and understand that relationship, can you say anything clinically from that data? And that’s certainly possible,” says Ku.
Beyond The Technology
For wearables to take the next leap forward, Reddy says that those who will be successful in this space will not focus on the “nerdiness” of the devices, but instead, the outcomes. “Americans aren’t healthy because we have all these toys. It makes us conscious, but consciousness doesn’t improve outcomes. And healthcare costs aren’t going down because we can track calories on our iPhones,” Reddy says.
Reddy uses a diabetic patient as an example of applying the technology to change behavior and outcomes rather than focusing on glorifying the device, noting that if the patient’s blood glucose levels were above 100 mg/dl for 10 consecutive days, it would be time for a doctor’s visit. “I want to push towards interventions rather than just look at the sexy glucometer and say, ‘We’re connected.’ This is what I call our ubiquitous transparency initiative, under our digital patient experience,” he says.
To this end, Matthew Diamond, M.D., Ph.D., medical lead at Misfit, a Burlingame, Calif.-based wearables manufacturer, says that there are different ways to determine the value of these devices, but a key step in the process is to learn about the user. Speaking at the New York eHealth Collaborative's (NYeC) 2014 Digital Health Conference on Nov. 17, Diamond said that personal interventions that support the user must be put in place. “If you get a message Monday night that says your calendar is full tomorrow and you won’t have time to exercise, the device—knowing you have a bike—will tell you to bike to work,” he says. Going a step further, Diamond even suggested that it could tell you to lay your clothes out the night before so you will have time to cycle.
“Right now, wearable devices aren’t passing the ‘turnaround test,’ which is, ‘If I leave home without this thing, will I turn around to get it?’” Diamond continued. “Cell phones pass this test, and we want that to be the standard for wearables as well. In an ideal world, wearables will become invisible—you shouldn't have to work to use them. It’s not just a device; it’s a system of support that comes with it.”
