Wrong approach to wearables? – For sure.

Originally posed on Linked In Pulse

Recent comments in several digital health forums escalated the dialogue around the value of wearables in healthcare.  Dr. Robert Pearl of Kaiser Permanente stated that if you asked most physicians about the value of wearables their answer would be “December” implying that they are useful Christmas gifts but not much else.  Dr. Ezekiel Emanuel, Vice-Provost of the University of Pennsylvania didn’t even like the gift idea saying “Forget wearables for the masses.”  Med City News stepped into the fray with the headline “Is healthcare looking at wearables the wrong way?”  The answer: “For sure!”

Wearables are going to be, arguably already are, a key part of changing the way we execute healthcare.  Disbelievers must reconsider three views of wearables to see this conclusion.

Wearables are sensors that can sense different properties -- The fact is wearables as we know them today, primarily consumer fitness accessories, are not about clinically valid measurements for diagnosis or the streaming of critical body function data.  But wearables are sensors -- sensors of us humans.  As sensors they can be designed to measure two types of properties: physical and physiological.  In our healthcare experience we are most familiar and comfortable with physiological measures because these indicate the state of the patient’s body.  Physiological measures are appropriately clinically validated, scrutinized, and regulated because they are often part of a diagnosis that will then determine the care provided to help or save the patient.  But wearables do not have to be physiological to have value in healthcare. Measuring patient activity, both purposeful and general, provide insight into the patient’s health and life style.

Patient activity is a measure of patient behavior-- Although some wearables do measure physiological properties like heart rate and blood oxygenation; the vast majority makes simple physical measurements of activities. Those activities – steps, running, sleeping, etc. – are measures of our behavior and so as such they measure our life style. The CDC says that roughly 50% of healthcare dollars spent on chronic care are attributable, read “wasted”, on patient lifestyle, i.e. patient behavior.  Patient behavior determines outcomes in any chronic illness therapy – diabetes, COPD, hypertension, joint repair or replacement.  If a patient does not follow the therapy the physician or care giver prescribes, the desired outcome will not be achieved.  A first step in improving something is to measure it.

Patient Generated Health Data (PGHD) has value -- Not everyone in healthcare shares the “wearables have no value” view.  Cleveland Clinic identifies wearables as one of the top ten most disruptive technologies in healthcare.  Partners Healthcare’s Dr. Kdevar sees wearables as the key to getting “frictionless data from the patient.”  Kdevar’s comment is important because it addresses a root cause of the medical community’s resistance to wearables – Patient Generated Health Data.  The healthcare ecosystem, primarily the tort and insurers who financially penalize and reward the caregivers respectively, have defined the rules such that only certain data from very tightly controlled and tested sources can be used in care.  Since these ecosystem partners interface with the provider’s at a system level most of the views of wearables are system-centric as opposed to patient centric.  The irony is that clinical data, taken only when the patient is in contact with the healthcare system, represents an incredibly small part of the patient’s life.  How much more effective are caregivers when they have data from patients more often than every six months? 

Some healthcare systems are already changing their view of PGHD and thus wearables.  I attended a conference on Big Data in healthcare recently and the CIO of a major healthcare provider, recognized for being a healthcare innovation leader, showed their approach to the data-to-information pyramid in their organization. The bottom layer had the data sources that they were capturing, structuring and analyzing to help their organization better understand and improve outcomes.  I noticed that PGHD was not in the data layer and asked him why.  “That is a gross oversight” he said.  He continued with how data from patients, properly vetted, tagged, and structured, was going to be an increasingly important part of their Big Data efforts.  Much of that data would come from wearables.

What is the right view of wearables in healthcare?  The right view is to figure out how to use them to sense and change patient behavior; how to create healthier lifestyles.  When we take that view and accept the data from the patient that view allows, then we can use wearables to manage the single biggest effect on the outcome – the patient.