Engaging patients in their own health management is a perennial problem for healthcare providers — and for society as a whole. Preventable chronic illnesses like obesity and heart disease cost our country
a trillion dollars per year in medical costs and lost productivity.
Study after study demonstrates that even modest lifestyle changes can slash the mortality and morbidity associated with these conditions — and curb the crippling costs of caring for these patients. However, providers can only do so much when an estimated
50 percent of patients don't adhere to their recommendations.
Healthcare reform has only added to the urgency providers feel when it comes to modifying patients' behaviors. We are moving quickly toward a future in which reimbursement for hospitals, health systems and physician groups will hinge on their ability to effectively manage population health. But it seems as though once patients leave the office, providers have neither knowledge about nor control over what happens next.
Now a consumer trend has come along that could change everything. The surging popularity of portable fitness trackers is inspiring people to take charge of their health by making health measures concrete, immediate and above all fun and social. Could providers harness mobile fitness tracking technologies — and consumers' enthusiasm around them — to manage population health?
Health Tracking Is in Fashion
It may come as a shock to providers, but under the right circumstances, people actually seem to enjoy tracking their health metrics. According to the market research group NPD, holiday sales of wearable fitness trackers increased 300 percent between 2012 and 2013. And retailers are responding with devices for every taste and budget. (Witness the arrival of
Fitbit-compatible fine jewelry by designer Tory Burch.)
Mobile health tracking comes in many forms, but data collection generally starts with wearable tracking devices like Fitbit and Jawbone Up that measure heart rate, calories burned, steps taken, sleep time and other health metrics. Consumers also have access to a growing number of wireless measuring devices like scales, blood pressure cuffs, heart rate monitors and pulse oximeters. Device data is transmitted to the cloud, where users can view, analyze and share it via mobile health apps like RunKeeper (for athletes), LoseIt! (for dieters), Gluco-Share (for diabetics) and the forthcoming
Apple Healthbook (for just about everyone).
Of course, Fitbits were never intended to diagnose conditions or inform treatment. However, the number of FDA-approved mobile medical devices on the market is also growing. For example, the Practice Fusion EHR now integrates with AliveCor's FDA-approved mobile electrocardiogram (ECG), allowing providers to upload patients readings, reports and consultation notes.
Patient-Generated Health Data: the Benefits to Providers
Mobile fitness tracking has many potential benefits for providers who are actively managing their patient's health:
Promoting good habits. Providers who are counseling patients on disease prevention and management can capitalize on the fun, engagement and immediate feedback fitness tracking provides. The Pew Research Center found that people who formally track health measures (either with a device or by writing them down) are far more likely to
use the information when making health decisions or talking with their with providers.
Explore cause and effect. Health tracking puts a great deal of data at patients' and providers' fingertips, which can lead to some surprising insights. It's now easy to pull up a graph of a patient's activity level or blood sugar readings since the last visit and discuss the highs and lows. What kept her from walking this week? What happened the day his blood sugar spiked? By connecting health behaviors to other events in their lives, patients gain new insights that can lead to better decisions.
Wellness programs. A recent
survey by HealthLeaders Media found that 57 percent of healthcare providers plan to incorporate a wellness program into their population health management strategy, and mobile fitness tracking could play a key role. Companies that have already incorporated trackers into their wellness programs have reported some positive results, especially when programs promote sharing and healthy competition. (“What we’re seeing is people getting up in the middle of the day and going for a walk," one software executive told The Dallas Morning News.”) By the same token, population health managers can use tracker data to manage "Fitbit clubs," award digital badges, update online leader boards and track progress toward group goals.
Business intelligence. As the adage goes, you can't manage what you can't measure, and that's certainly true when it comes to managing population health. Wellness platforms like Redbrick Health and CafeWell provide benefits like personalized health coaching to members of a defined group (e.g., diabetic patients) who voluntarily share their health data. (Companies have achieved similar results with incentives like insurance discounts.) This data is then transformed into business intelligence that population health managers can mine for insights and use to support decision-making.
While there are many advantages mobile health tracking, there are also disadvantages:
- Clinical accuracy. Very few mobile health devices are FDA approved, so providers may be understandably hesitant to put too much stock in individual readings or intelligence derived from group data. Even at the consumer level, studies suggest that trackers tend to underestimate the effects of light aerobic and strength-based activity.
- Privacy. Data generated by a Fitbit or shared through an app is considered to be "consumer-generated." It therefore doesn't carry the same HIPAA protections as information disclosed during a physician consultation. To date, the FTC and FDA have not provided clear guidance on how providers should safeguard health-tracking data or what protections consumers who share it should expect.
- Access. Unless it's FDA-approved (and it rarely is), mobile health-tracking equipment usually can't be prescribed or covered by insurance. The cost of personal tracking devices, smartphones and tablets can price some of the most vulnerable patients out of the market.
- Long-term compliance. While mobile fitness tracking is popular at present, the challenge will be to keep patients motivated long-term. To date, no rigorous, long-term studies have demonstrated a link between fitness trackers and better health. What's more, surveys suggest that at least 50 percent of people who use mobile health tracking quit within a year. Further research, innovation and incentives will be needed to motivate patients toward long-term goals — even as the trend inevitably falls out of fashion.
[Image credit:
"Fitbit Ultra - teal" by
AshStar01 licensed under
CC BY-SA 3.0]
