Smart and smarter. The battle for the "smartest" watch

Following on from a blog post I wrote at the beginning of January the media attention around smart watches seems to have reached fever pitch. Thanks to @Paul_Sonnier's Digital Health Group on LinkedIn I came across this article about how Samsung are already launching their second generation smart watch. From what I can gather it does pretty much what the original Samsung Gear did, but has been redesigned to be more ergonomically sound.

As the article appears on a site called 9 to 5 Mac it's hardly surprising that the majority of the discussion is around when Apple are going to launch their smart watch. This article from a few days ago is quite fascinating, suggesting that Apple's new smart watch (note no-one is saying that Apple won't go down this route) is going to have way more health data functionality that just movement sensing.

As mentioned previously, although valuable, there has to be more to wearable devices that purely movement tracking to make them truly useful health management adjuncts for the masses. Jawbone, Nike and Fitbit have all done great jobs of taking the humble pedometer and transforming it into a piece of tech that can be integrated seamlessly into daily life (albeit with a slight bump in the road for the Fitbit Force), but this surely is just a first step.

For most of us our wristwatch is the only item we wear every day. It therefore makes sense to use it as the conduit to capture health related data. It doesn't seem beyond the realms of possibility to have a wristwatch continuously monitor heart rate, body temperature and movement throughout the day. Add to this an inference on how much sleep one is getting at night time (I say "inference" as all of the sleep monitoring apps and devices rely on interpreting movement, or lack of movement, at night time to crudely quantify sleep duration and quality) and you have a data stream that would be extremely useful in monitoring individuals with a number of chronic diseases.

Take for example someone with COPD (chronic obstructive pulmonary disease), a condition affecting 6.8% of US adults. Individuals with COPD are prone to "exacerbations" where a simple viral respiratory infection can lead to severe shortness of breath, copious mucus production and sometimes a super-imposed bacterial infection. If left unchecked an exacerbation can be life threatening and invariably requires hospital admission, however, if caught early and treated with antibiotics and steroids hospitalization can often be avoided. Now imagine someone with COPD wearing a smartwatch continuously transmitting data back to their provider. Their heart rate will increase a day or two before they start to feel unwell, their temperature may also increase. In addition, as the infection starts to take hold they'll probably feel more breathless and so won't be moving around as much as they normally do. The combination of these three data streams should be enough to identify an exacerbation at an early stage. With this early identification comes the ability to treat and the real possibility of avoiding a hospital admission. Now that to anyone's mind has to be a victory for health tech!

Prevalence of COPD in the United States. Image from CDC website: http://www.cdc.gov/features/copdadults/copdadults_a600px.jpg

 

    

Electronic patient portals – panacea or passé?

Sitting on an 11 hour flight from London to Los Angeles I finally got round to reading this paper which was published at the tail end of 2013 in the Annals of Internal Medicine; Electronic patient portals; evidence on health outcomes, satisfaction, efficiency and attitudes. If you remember the publication was met with quite a few news stories stating we need to move on as patient portals don’t work and have no impact on satisfaction or outcomes. However, when you actually delve into the meat of the paper (something I think few commentators are inclined to do) this is actually not what was found. The researchers from the VA and UCLA trawled through a vast number of published research articles from the last twenty-three years and found quite a mixed bag of outcomes. Certainly utilization of some patient portals did appear to generate improved outcomes, both in terms of better disease management and a need for fewer face-to-face visits, although some didn’t. One of the main issues the researchers’ encountered was the fact that there was usually a paucity of information around the context of how the portals were implemented and publicized. The conclusion from the study was not that patient portals don’t work, rather we need to better understand what elements are needed in terms of functionality and how best to implement them. Only then can we better understand how to use them and ultimately quantify what impact they can have on patient care.

With so many areas of our lives digitized these days I am frequently amazed at how slow we have been in healthcare to adopt similar strategies to streamlining medical practice. After all, these days you can sit at your computer and shop for groceries, access your bank accounts to transfer money or send checks, and even purchase an exotic foreign vacation. But the chances are you won’t be able to access your medical record, communicate with your provider or book an office visit. This will change; I am convinced of that fact. Already EHR vendors are including patient portal functionality in their solutions. In many cases these are quite rudimentary and only allow for a limited scope of interactivity, but it’ a start. Undoubtedly the new patient portals need to be “tethered” to the EHR, however I don’t think they necessarily need to be part of the same software suite. My reasoning is simple, EHRs are designed with a very specific task in mind; they are optimized so that data from individual patients can be written, stored and retrieved when necessary. This is very different functionality to what a patient portal needs and to this end this is why I think innovation and practical usability will happen quicker if separate organizations create this functionality and then plug this in to the broader EHR ecosystem.

The next area is what to include in the patient portal. Research has shown that giving patients access to their medical records improves engagement and self-efficacy. Indeed, the BlueButton movement is a great example of how opening up the data stream can result in some very innovative and valuable applications. My personal feeling is that the patient portal needs to be centered around specific task, in a similar fashion to doing online banking or booking a flight on Expedia. You go to the portal to perform a specific transaction (unless of course you’re my wife who will spend hours browsing vacation spots she will never visit!). In the case of the patient portal this may well be completing a health assessment as a prelude to an annual wellness visit, the creating an advance care directive or simply requesting a prescription refill or an office appointment. Whatever the task it needs to be simple and intuitive to complete and ideally accessibly from mobile devices as well as standard “home based” computers.

Without a doubt the digital age is finally creeping up behind us in healthcare. Some will try and ignore it for as long as practicably possible, although I believe that those of us who embrace it will see real improvements in their relationships with their patients, and importantly their outcomes too.

Example of provider's dashbard of their patient's health assessments results just prior to co-creating an annual wellness plan with them.