‘Wearables' warrant wary expectations

New medical potential for wearables is coming despite the current uncertainties, as recreational fitness devices evolve toward medical-grade technology capable of diagnosing and managing disease.

When using data from personal fitness tracking devices in health care, it's important to be creative, excited, and prudent, a mood that panel moderator Avital Y. O’Glasser, MD, FACP, described as “dampened enthusiasm” at a discussion on Friday.

Dr. O’Glasser surveyed the audience and found that half of the physicians wore personal fitness trackers. She uses one and offered her own reasons for adopting it. She's a busy physician, with not only a career but a family, who wanted more exercise. Using her wearable, she told the audience, it's 3,000 steps from her hotel to the conference center, so she had already accomplished that much by the start of her early-morning session.

Many of her patients see the same benefits, noted Dr. O’Glasser, assistant medical director of the pre-operative medicine clinic at Oregon Health & Science University in Portland. Patients feel energized and engaged when using fitness trackers, even if there is no evidence that they improve clinical outcomes.

For perioperative assessments with patients who look frail on paper, asking about wearable use can be “a great 30-second conversation that adds a data point.”

(In the video above, Dr. O’Glasser discusses the challenges of integrating the data from wearable devices into medical practice.)

Another panelist in the session, Alisa L. Niksch, MD, said she has been dealing with the issues surrounding wearable technology since she began her medical training. Dr. Niksch, who is the director of pediatric electrophysiology and the Exercise Stress Lab at Tufts Medical Center in Boston, cautioned that there isn't a significant amount of evidence supporting the use of recreational wearable technology in health care.

One study looked at 4,328 articles in the literature on wearable biosensors. There were only 64 randomized controlled trials, and only 16 articles had sufficient power to be deemed high quality. The largest cohort was 1,437 patients. Much of the literature is Grade C quality.

“The data is not there” to support using wearables as a reliable aspect of the patient record, added panelist Priya Radhakrishnan, MD, FACP, chief academic officer of Honor Health in Phoenix. But this represents an opportunity for research, she said.

Despite the current uncertainties, there's medical potential for wearables, the experts said. Medical-grade wearable technology will be a $24 billion market by 2022, Dr. Niksch said. It's shifting from recreational wearables toward medical-grade technology capable of diagnosing and managing disease. FDA oversight and HIPAA compliance efforts are underway.

In support of the potential of wearables, Dr. O’Glasser cited a March 21 JAMA Cardiology editorial, “Moving From Big Data to Deep Learning—The Case of Atrial Fibrillation.” From that article, she quoted, “As sensor technologies have miniaturized in size and cost, their penetration into the consumer wellness and retail space has intensified. Although most of these devices have not been integrated into routine clinical use for various reasons, they remain attractive targets for health care because of their potential to more easily access large populations for disease screening and management.”

Dr. Niksch cited several broadly agreed-upon attributes of a wearable that might accomplish those goals:

  • accurate data that are comparable to standard-of-care devices,
  • continuous data vs. episodic data (“We want what's trending,” she said.),
  • contextual data that let physicians know what patients are doing throughout the day and the correlation between, for example, activity and heart rate, and
  • filtered data (“Physicians don't like loads of data,” she said. But they do want to be notified when patients take a turn for the worse.)

She also cited the importance of passive transmission of data from wearable devices. “Patients are not reliable in generating their own data and putting it into the system,” Dr. Niksch said. “The more passive you make these systems, the better it is for accurate information.”

Finally, Dr. Niksch added that regulations need to be created, because to date, it's been the “Wild West.” Wearable devices need to be integrated into the rest of the electronic health record, secured against hacking, and have associated reimbursement, she said.

Other challenges including getting the devices to the patient populations who could most benefit. “It's really the healthy patients, the worried well that tend to use wearables a lot more than patients who are chronically ill with complex medical problems,” said Dr. Radhakrishnan, who sits on ACP's Medical Informatics Committee. “That's something that we really want to make sure that we take into account as we are operationalizing the data that wearables can get.”

Dr. Radhakrishnan said she looks at data for the overall results, not the granular aspects. She looks at the range, the highs and lows, and only then goes into detail if needed.

“The next five to seven years are going to be turbulent for us as practicing clinicians,” Dr. Radhakrishnan said. “We are going to be inundated with data. And patients want us to see this data. We really have to be clear in our expectations by making sure that they are partners as we go down this track.”