Fitness freaks and gadget lovers have long embraced health apps, and more medical facilities and practitioners also are starting to see the clinical usefulness of reliably tracking individual patients’ data. As a recent story by the Associated Press (AP) made clear, medical providers see great potential in the technology, but also limitations in its current form.
What if someone’s device registers data indicating an ailment, but no one at the doctor’s office or hospital notices? Wary of that scenario, one hospital, Hackensack University Medical Center in New Jersey, is experimenting with six patients and three doctors to monitor mainly lifestyle data, such as nutrition. It hopes eventually to monitor blood pressure, heart rate and other vital signs, but will defer that decision to a hospital committee.
This tentative approach might be careful and wise, but we wonder if the hospital is more concerned about being sued than helping to make people more responsible participants in their care.
Doctors say patients increasingly bring health data to their visits, often as printouts that someone in the office must scan into a file. So receiving such information electronically through Apple's HealthKit and similar technologies would enable practitioners to see more charts and the patterns within them. Some hospitals envision establishing a team to review this sort of incoming data.
Many consumer devices such as fitness trackers aren't regulated by the FDA, so how reliable are they as messengers of true and useful information? (See our blog, “FDA Launches First-Ever Probe of Medical App for a Mobile Device.”) The Center for Digital Health Innovation at the University of California, San Francisco, is studying the issue with Samsung. One test involves strapping a consumer device on 100 people and taking measurements as they stand, sit, exercise and sleep. Data 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," Michael Blum, the center's director, told AP.
Data entered into a health-care provider's electronics record system are covered by strict federal privacy laws (such as the Health Insurance Portability and Accountability Act, or HIPAA), which subjects providers to penalties for breaches. But if you've signed waivers as part of insurance claims, your insurer has access to the data as well, and as we’ve written, breaches are seldom punished.
Nicolas Terry, director of the Hall Center for Law and Health at Indiana University, isn't concerned about insurance access to data, noting that the Affordable Care Act (“Obamacare”) includes protections for pre-existing health conditions.
But tech companies that come up with data trackers and apps aren’t subject to these health privacy laws. They might be subject to penalties, according to AP, 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 told AP.
That’s concerning, whether or not your doctor is using your information for your care. Although a step counter might seem innocuous, for example, it also might record the location of your step.
"Now you have a surveillance system," Terry told AP. "If the people you meet also have wearable devices, we could figure out who you meet."
It’s the same concern a lot of people have when their car insurers offer lower rates if they agree to install mileage trackers — why should an underwriter know not only how much you drive, but where?
Traditionally, medicine has been dispensed on a pay-for-service model, but thanks to government carrots and sticks, the overuse of services and their increasing cost, Medicare and private insurers are starting to reward doctors for preventive care. Medicare programs that pay doctors a monthly fee to keep patients healthy could involve reviewing fitness data and checking in with patients regularly by phone to identify problems that otherwise might escalate into 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," Dr. John Schumann, an Oklahoma internist who blogs on health issues, told AP.
Data-dispensing devices and apps give you information, but they can’t ensure that you take the medicine you’re supposed to. Companies are developing sensors to record when you pick up a bottle, but unless you want to keep house with Big Brother, doctors just have to trust that their patients are following through as directed.
Younger people tend to accept technological assistance more readily than older folks, so caregivers would welcome ways to entice their older patients to use data-tracking.
"What we need is data for older people, and they are not doing that right now, with rare, rare exceptions," Dr. David J. Cook told AP. He conducts research at the Mayo Clinic into how trackers and apps can improve care.
Many of the clinic’s hip-replacement patients are older, and because Mayo practitioners want to track their post-surgical progress, it has loaned them Fitbit trackers and Android phones. Instead of keeping a written diary of activity, patients just put it on and turn it on.
If they remember…