Dr Levine is Practice Director, CCRM New York, and Attending Physician, Lenox Hill Hopsital, New York. He has no conflicts of interest to report in respect to the content of this article.
Typing the word “wearable” into Amazon returns information on more than 600,000 products, ranging from activity trackers, to fitness trackers, to smart clips, to arm- and wristbands, to smart watches. FitBit, Jawbone, Misfit, Garmin, and Apple Watch are just a few of the names associated with these devices. Regardless of the manufacturer or the form, all of these devices have the same general idea; they passively monitor daily activity and the data aggregated are streamed via a hardwire connection or Bluetooth and accessed through a mobile application or web-based portal. Since the advent of wearable devices, the products have gotten significantly smaller and lighter and are jam-packed with (sometimes) highly accurate sensors.
The missing capability
As these devices have increased in popularity, discussions about prescribing exercise have become much easier. But one capability is still missing: collection, compilation, and streaming of data in a meaningful way directly into a patient’s electronic health record (EHR). While I love seeing a device on my patient’s wrist, I am often at a loss when she is unable to tell me about her data. I have found that patients like knowing that they have walked 10,000 steps in a day, but they rarely can tell me (or show me) their daily step count or their daily weight. Did their weight go down when they increased their steps the preceding month? Some patients use dietary tracking apps such as MyFitnessPal, and I often ask patients about the effects of dietary modifications on their wellness (weight, sleep, energy level, etc). Few can answer. While patients can often show me that they are consuming only 1750 kcals a day, they often can’t show me how that affects their wellbeing. But is it the patient’s job to do that, or mine as her doctor?
Apple took a huge step forward by creating the Health app, which is an easy-to-read dashboard of health and fitness data. It can integrate data from multiple sources (ie, wearables and nutrition tracking apps), and display the information concisely in one place. As a physician, though, I think there is something awkward about asking a patient to send me a screenshot of her data. In 2016, it’s realistic to expect that the data should not just flow into a patient’s Health app but also into her own EHR. Unfortunately, that is still not the case.
NEXT: What's the holdup?
What’s the holdup?
Third-party vendors have made great strides in helping data “flow” from a patient’s device to her permanent record, but big-box EHR manufacturers have not made that a priority because the data are hard to map. Until all health data are standardized on phones and sent the same way from each device, it is almost impossible for an EHR to use that information because the system has no idea where to put the data.
Furthermore, as more EHRs offer portals that allow patients the ability to view their records, it seems almost archaic that the data cannot just flow back to the patient’s phone so that it can all be consolidated into one place. Patients are going online to look at their most recent cholesterol levels but logging their daily exercise and nutrition in an app that cannot integrate that data.
And, as more providers and patients look to consolidate this information, and attempt to “log” this data, either in the EHR or on a phone, we are going to have more data entry errors because we are all manually entering disconnected information. For example, if a patient types in a cholesterol level of 33 instead of 330, she may falsely believe that she has a low average serum cholesterol and not watch her food intake.
The NHS initiative
The National Health Service (NHS), the publicly funded healthcare system in England, has launched an initiative to link devices and apps with improvements in certain public health disorders (ie, diabetes, heart disease, asthma, sleep disorders, chronic health conditions, obesity, etc). One software manufacturer, Medelinked, is providing their service free to NHS patients, doctors, and healthcare professionals in the hope of closing the aforementioned gap.
For example, patients and providers can share data on blood glucose and cholesterol levels, calorie intake, weight, waist size, exercise level, blood pressure, as well as comments on symptoms and wellness. The bidirectional tool allows patients to send data to their health providers and caretakers to send data to their patients. It is one of the first such tools to allow patients access to and ownership of their health data.
Moving beyond a fashion statement
As someone who embraces technology, and at times, even tries to force its use in healthcare, the inability to stream and flow patient-derived data is my big healthcare disappointment of 2016.
Everyone is collecting data. In fact, most people don’t know that the iPhone has a built-in pedometer; so even when you are just walking with your phone, it is tracking you. However, at the halfway point of 2016, I am still unable to access these data, and as such, I feel that wearables are as much fashion statements for the nondominant hand as they are quasi-healthcare tools.