That phone app keeping track of your exercise and meals might keep you out of the hospital one day.
Why give your doctors permission to incorporate data from fitness trackers and health apps into electronic patient records? Well, they may spot signs of an ailment sooner and suggest behavioral changes or medication before you land in the emergency room. They also may be able to monitor how you’re healing from surgery or whether you’re following a treatment regimen.
“Right now, we only see our patients for about a 15-minute visit in the office, and it’s a very constricted view,” said Dr. Lauren Koniaris, a specialist in pulmonary critical care at Hackensack University Medical Center in New Jersey. “This really globalizes the view of their health status, so that we’re really in contact with them on a much more daily, if not hour-to-hour, basis. It’s almost like a virtual house call.”
At Hackensack, a handful of patients at risk for heart failure are asked to use a fitness tracker to count steps walked and flights climbed. They are also asked to record what they eat – by photographing the product’s bar code, for instance – using a phone app that has a database containing nutrition information on thousands of food items. Using Apple’s new HealthKit technology, data from the various trackers and apps gets automatically transferred to the Epic MyChart app on the iPhone. From there, the information goes to the hospital’s records system, which also comes from Epic.
Hackensack wants to expand to more patients and start tracking blood pressure and sleep quality, too. But the hospital first needs to ensure that teams are in place to review the glut of data coming in. More broadly, there are consumer privacy and security issues to address, along with questions about whether these trackers and apps really improve patient care. The University of California, San Francisco is studying which gadgets are reliable and whether that reliability extends to patients with extreme conditions. Then they have to figure out what information is really meaningful – not just noise.
Many doctors and hospitals see potential. The Mayo Clinic in Rochester, Minnesota, uses Fitbit trackers to monitor hip-replacement patients for a month after surgery. Health workers get data on daily steps and can tell when patients have trouble walking – a hundred or more miles away. The Ochsner Health System in New Orleans is turning to wireless scales and blood-pressure devices to help reduce readmissions for chronic diseases such as heart failure. Noticing a small weight gain, for instance, might reveal fluid buildup resulting from the heart failing to pump normally. Not only can doctors intervene sooner, they can use the data to show how exercise can help lower blood pressure.
“If we’re going to succeed in improving health, we have to get patients more engaged in their care,” said Dr. Richard Milani, a cardiologist at Ochsner.
Heart-attack patients have long been asked to weigh themselves, while those with diabetes have had to check glucose levels. Smartphone technology makes all that easier and gets measurements to doctors more regularly and reliably. There’s no forgetting to record a number or transposing digits.
With Apple’s HealthKit tools, disparate gadgets and records systems can work together more easily. Think of HealthKit as a common language, eliminating the need for translators. Beyond sleep and exercise data coming from fitness trackers, doctors can eventually incorporate devices that measure glucose, blood pressure, respiratory rates and blood-oxygen levels. The devices communicate with the iPhone wirelessly or through the headphone or charging port. Google, Samsung and Microsoft have similar ambitions that will expand monitoring to users of Android and Windows phones, though they aren’t as far along. For now, developers must write separate code for each Android or Windows app to integrate.
Gary Wilhelm, 51, who works at Hackensack on payroll and finance technology, joined the hospital’s app test after he suffered a heart attack in October. He appeared animated during a check-up this month as he showed Dr. Sarah Timmapuri, his cardiologist, various charts on flights climbed and cholesterol intake. Timmapuri instructed Wilhelm to monitor his pulse on his new Fitbit Surge. If it gets to about 155 beats per minute, he’s to end his workout.
“Even if I did not do a single thing with the information, just the patient knowing that I’m reviewing it will already have a positive effect,” Timmapuri said.
Mayo patient Randy Smothers, 62, of Chisago City, Minnesota, agrees. He said he was in pain after getting his right hip replaced and would have stayed on his couch without the knowledge that someone was checking on him.
“This pedometer they gave me made me walk every day and move on and get going,” he said.
Apps and trackers could ultimately reduce patient visits, though there’s a risk patients would practice self-care.
“It may be an aid or a tool to help me deliver better care, but it is just a tool,” said Dr. Robert Wergin, President of the American Academy of Family Physicians. “It shouldn’t substitute for a face-to-face visit.”
Challenges for Doctors Using Fitness Trackers and Apps
Though more hospitals and doctors are starting to use data from fitness trackers and health apps to help treat patients, they are moving cautiously. The technology has a lot of potential, but there are key challenges to work out:
What if a patient’s data shows signs of an ailment, but no one notices? That’s the chief reason Hackensack University Medical Center in New Jersey is starting with only six patients and three doctors and is monitoring mainly lifestyle data, such as nutrition. It wants to add blood pressure, heart rate and other vital signs to its monitoring, but a hospital committee needs to sign off first.
Doctors say that many patients already bring health data to visits, often as printouts that an office must then scan in. Getting data electronically through Apple’s HealthKit and similar technologies would give doctors and nurses more options to see charts and look for patterns. Ultimately, Hackensack and other hospitals envision setting up a specific person or team to review incoming data. Software alerts could be triggered when a measure falls outside the ideal range, and a nurse or technician would check for accuracy and refer unusual cases to doctors.
IS DATA RELIABLE?
Many consumer devices, such as fitness trackers, aren’t regulated by the Food and Drug Administration. So how much should doctors rely on them? The Center for Digital Health Innovation at the University of California, San Francisco is studying this in a partnership with Samsung. One way to test involves strapping a device on 100 individuals and measuring them as they stand, sit, exercise and sleep. Readings would be compared with those from devices known to be reliable.
“Just because it works in a lab on a couple of individuals doesn’t necessarily means it works on a broad variety of individuals in real life,” said Michael Blum, the center’s director.
PRIVACY AND SECURITY CONCERNS
Data entered into a health-care provider’s electronic-records system is covered by strict federal privacy laws, which subject providers to penalties for breaches. But if you’ve signed waivers as part of insurance claims, your insurer can get the data, too. Nicolas P. Terry, Director of the Hall Center for Law and Health at Indiana University, isn’t too concerned about that, though. He said President Barack Obama’s health-care law includes protections for pre-existing health conditions.
Health-privacy laws don’t extend to technology companies that make trackers and apps, however. The companies might be subject to penalties if they fail to abide by their own privacy policies. But if they never promise to safeguard the information, they are free to share and sell it, Terry said.
The concerns exist regardless of whether a doctor is using the information for patient care. Although a step counter might seem innocuous, it also might record the location of your step.
“Now you have a surveillance system,” Terry said. “If the people you meet also have wearable devices, we could figure out who you meet.” He says data companies might also build health scores that potential employers and life-insurance companies would love to have.
DO I GET PAID FOR THIS TIME?
Historically, doctors are paid for office visits and procedures. But Medicare and private insurers are starting to reward doctors for preventative care. With the Medicare program, for instance, doctors are given a set monthly fee to keep patients healthy. That could involve reviewing fitness data and checking on patients regularly by phone to identify problems that might otherwise result in more costly treatments or visits.
“It is slowly changing … but it’s still challenging to get paid for analysis and for email and phone call time,” said Dr. John Schumann, a Tulsa, Oklahoma, internist who blogs on health issues at GlassHospital.
These devices and apps do little to ensure that patients take the medicines they’re supposed to. There are companies developing sensors to record when you pick up a bottle, but for now, doctors have to trust their patients.
Doctors also need to ensure that they aren’t getting data only from younger patients who are already highly motivated and aware about their health.
“What we need is data for older people, and they are not doing that right now, with rare, rare exceptions,” said Dr. David J. Cook, who is leading research at the Mayo Clinic into how trackers and apps can improve care. Because hip-replacement patients that Mayo wants to track tend to be older, Mayo has had to loan them Fitbit trackers and $60 Android phones.
Neither Fitbit nor Android works with Apple’s HealthKit, so programmers at Mayo had to write code to integrate those devices. HealthKit should make future integrations easier at Mayo and elsewhere, but there will always be some devices and apps excluded.