New Technology Lets Doctors Watch Patients From Afar

A man uses an UP fitness wristband and its smartphone application in Washington on July 16, 2013. Jawbone, the San Francisco-based company behind 'smart' wireless earpieces and Jambox speakers, late last year released redesigned UP wristbands that combine fashion with smartphone lifestyles to help people along paths to improved fitness. UP wristbands are priced at $129 in the United States. UP applications tailored for Apple or Android mobile devices collect data from the bands to let people get pictures of activity, sleep, eating, and even moods on any given day or over time.
National Journal
Darius Tahir
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Darius Tahir
Oct. 16, 2013, 6:04 a.m.

You may be weary of pun­dits bear­ing buzzwords about “data” and “big data” and pro­claim­ing the geeky good news that the solu­tions to your prob­lems are merely a set of num­bers and a good al­gorithm away. But the pro­pos­i­tion is be­ing taken ser­i­ously by the health care in­dustry. Pro­viders are in­spired by the con­ver­gence of two sep­ar­ate trends: the pro­lif­er­a­tion of ever-cheap­er sensors and the Obama­care-in­spired need to make more-in­formed de­cisions in or­der to de­liv­er good care for less money.

Many people carry or own devices that can act as sensors. Smart­phones have ac­cel­er­o­met­ers that can meas­ure phys­ic­al activ­it­ies and ad­vanced cam­er­as that can provide evid­ence for in­ter­pret­a­tion. These devices are be­com­ing more soph­ist­ic­ated; Mi­crosoft’s Kin­ect cam­era, for in­stance, can es­tim­ate blood pres­sure based on how flushed a user ap­pears.

Con­sumers’ will­ing­ness to carry sensors every­where be­comes im­port­ant as pro­viders are in­centiv­ized by the Af­ford­able Care Act to keep costs down while im­prov­ing out­comes. Act­ing on this newly avail­able wealth of data — per­haps by in­ter­ven­ing earli­er, more cheaply and ef­fect­ively — might be­ne­fit pro­viders that are in­creas­ingly paid for qual­ity, rather than volume, of care.

As con­sumer sensors be­come more soph­ist­ic­ated, pro­fes­sion­al-grade sensors are be­com­ing easi­er to use. Joseph Kvedar dir­ects the Cen­ter of Con­nec­ted Health at Part­ners Health­Care, a Bo­ston-area health sys­tem. A dec­ade ago, the hos­pit­al’s old sensors were “dumb,” Kvedar notes in a re­cent blog post. To ex­tract the data, the sensors had to be tethered to a cent­ral hub, lim­it­ing their use in hos­pit­als and re­motely, as deal­ing with wires and ex­tract­ing the data was an­noy­ing and time-in­tens­ive. But sensors are in­creas­ingly wire­less, and hubs like Qual­comm’s 2net auto­mat­ic­ally sync with a vari­ety of devices and scrape their data, con­vey­ing it dir­ectly to pa­tients’ elec­tron­ic health re­cords.

More con­veni­ent gath­er­ing of data might mean bet­ter dia­gnoses and care. One study, pub­lished last month in the An­nals of Thoracic Sur­gery, used com­mon fit­ness mon­it­ors to as­sess post-sur­gery re­cov­ery in eld­erly pa­tients. “Spe­cific pa­tient mo­bil­ity data are typ­ic­ally found in nurs­ing notes and are not usu­ally part of the workflow of the sur­gic­al team,” the au­thors write. “Such data may not be ob­tained in all pa­tients and are in­ter­mit­tent…. With wire­less tech­no­logy, data are ob­ject­ive, ac­quired, and dis­played nearly con­tinu­ously.” That could help doc­tors bet­ter tar­get their care, bring­ing down costs.

Pro­peller Health, a Wis­con­sin-based start-up, uses pa­tient smart­phones and a sensor at­tached to an in­haler to track the loc­a­tion and time of its use for its pa­tients with asthma and chron­ic ob­struct­ive pul­mon­ary dis­ease. Pa­tients had pre­vi­ously used journ­als to re­cord in­haler use, sub­ject­ing their re­cords to the un­cer­tain­ties of memory. With the new data, they and their care team can bet­ter de­term­ine what trig­gers at­tacks and how to pre­vent them, avoid­ing po­ten­tial emer­gency-room vis­its. The start-up has partnered with in­surers and hos­pit­al sys­tems hop­ing to re­duce costs by provid­ing bet­ter care.

It’s also pos­sible that ob­ject­ive data can provide a bet­ter dia­gnos­is. Many pa­tients, prob­ably due to nerves, are af­flic­ted by “white-coat hy­per­ten­sion,” only demon­strat­ing symp­toms of the con­di­tion when their blood pres­sure is meas­ured in the clin­ic. Mon­it­or­ing devices can make the dis­tinc­tion between white-coat hy­per­tens­ive pa­tients and full-time suf­fer­ers. And sci­ent­ists were sur­prised at the level of vari­ation in gluc­ose levels when con­tinu­ous mon­it­or­ing of dia­bet­ic pa­tients was in­tro­duced, says Wendy Nilsen, a health sci­ent­ist ad­min­is­trat­or in the Na­tion­al In­sti­tute of Health’s Of­fice of Be­ha­vi­or­al and So­cial Sci­ences Re­search di­vi­sion. Health is more com­plex than old tools were able to cap­ture.

Doc­tors are still learn­ing how much and what kind of data to col­lect. Listen­ing to a sea of data rolling in may in­tro­duce too much noise. A meta-ana­lys­is, or study of stud­ies, pub­lished by the Journ­al of Med­ic­al In­form­at­ics this sum­mer shows the level of tweak­ing ne­ces­sary to de­term­ine which are the right sensors and the right data to mon­it­or, and then to trans­late the find­ings in­to ac­tion. The study ex­am­ines dif­fer­ent sensors that as­sess eld­erly pa­tients’ risk of fall­ing and hurt­ing them­selves. Per­form­ance test­ing proved that wear­able sensors gen­er­ally per­formed bet­ter than their non-wear­able coun­ter­parts.

Des­pite evid­ence of the sensors’ ef­fic­acy, the study con­sist­ently found res­ist­ance from nurses and doc­tors to in­cor­por­at­ing them in­to their daily work. A pos­sible reas­on: Hos­pit­als are ca­co­phon­ous places and “alarm fa­tigue” is real. One of the stud­ies in the meta-ana­lys­is found a false-alarm rate of 16 per­cent; after 10 per­cent, the au­thors say, health care pro­viders are de­sens­it­ized. Sensors risk cry­ing wolf and both­er­ing pa­tients and pro­viders alike.

“You don’t want to dis­rupt people,” Nilsen says. “If [a pa­tient’s] blood pres­sure spikes, it might be for something pleas­ur­able — you don’t ne­ces­sar­ily want to call them up on a Sat­urday night and say, ‘By the way, your blood pres­sure spiked.’ We might want them to do those activ­it­ies.”

Pa­tients might not love the sense of be­ing in the pan­op­ticon. Penn State re­cently ended its well­ness pro­gram, which sought sens­it­ive life­style data from em­ploy­ees (ask­ing men, for ex­ample, wheth­er they con­duc­ted reg­u­lar testic­u­lar self-ex­ams) and im­posed a $100 monthly pen­alty for non­com­pli­ance. Em­ploy­ees or­gan­ized and pro­tested what were per­ceived as in­trus­ive ques­tions, caus­ing the pro­gram to end.

The health care sys­tem, then, needs to com­mit to us­ing data re­spons­ibly — to be sens­it­ive to pa­tient pref­er­ences and to make sure the in­form­a­tion is be­ing put to good use. Oth­er­wise, pa­tients might stop mon­it­or­ing be­fore it ever really be­gins.

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