Challenges in the Clinical Adoption of Fitness Trackers and Health Applications

An increasing number of hospitals and physicians are beginning to use fitness trackers and apps to treat patients, but they remain highly cautious. While these technologies hold immense potential, they also face certain challenges. Writer Anick Jesdanun recently discussed this issue. VCBeat has compiled this article to explore the obstacles that fitness trackers and apps must overcome before they can be widely adopted for medical purposes.

Who bears the responsibility?
What if patient data shows signs of disease, but no one notices? To address this issue, Hackensack University Medical Center in New Jersey, USA, conducted a study in which three physicians were assigned to monitor six patients, focusing primarily on lifestyle factors such as nutritional status. The team also aimed to expand monitoring to include vital signs such as blood pressure and cardiac function, but this would first require approval from the hospital’s institutional review board.

Physicians note that many patients now bring their own health data to consultations, but they often need to scan printed copies for review. If electronic data could be accessed through platforms such as Apple’s HealthKit and similar technologies, doctors and nurses would have more options for interpreting charts and determining treatment plans. Hackensack and other hospitals envision assigning an individual or establishing a team to review entered data. When measurements fall outside the ideal range, software alerts would be triggered; nurses or technicians would then verify the accuracy of the data and report any unusual findings to physicians.

Are the data reliable?
Many consumer electronic devices, such as fitness trackers, are not regulated by the U.S. Food and Drug Administration (FDA). How medically reliable are they? The Center for Digital Health Innovation at the University of California, San Francisco, is collaborating with Samsung to investigate this question. The study involves equipping 100 participants with consumer electronic devices to measure and record data while they are standing, sitting, exercising, and sleeping. The measurements will be compared against readings from known reliable sources.

“Of course, even if the results show that it is effective for this group of participants in the trial, it does not mean that it will be effective for everyone,” said Michael Blum, director of the center.

Privacy and Security Issues
Entering data into healthcare institutions’ electronic record systems is strictly governed by federal privacy laws, and violations by these institutions are subject to penalties. However, if users sign insurance clauses waiving their right to claims, the corresponding insurers may also access this portion of user data. Nicolas P. Terry, Director of the Center for Law and Health at Indiana University, is not concerned about this, as pre-existing medical conditions are protected under the Affordable Care Act.

“However, the Health Care Act does not regulate companies that develop fitness trackers and apps. If these companies violate their own privacy policies, they may face penalties; but if they have never committed to safeguarding user information, they are free to share and sell it,” said Terry.

Whether or not physicians leverage this information for therapeutic purposes, the focus remains justified. Although data from pedometers may appear trivial, it at least offers locational capabilities.

“If you wear a monitorable device,” Terry explained, “when you encounter someone else wearing the same device, we can calculate who you have met.” He noted that the health databases created by many data companies are highly sought after by various potential buyers and life insurance companies.

Can doctors receive compensation?
Historically, physicians have been compensated based on consultations and treatments. However, Medicare and private insurers are now beginning to reward doctors for participating in preventive care programs. With the introduction of these insurance plans, physicians can receive a fixed monthly fee that covers activities such as reviewing health data and conducting regular telephone check-ins with patients, thereby helping to avoid more costly treatments or consultation fees for subsequent medical issues.

John Schumann, an internist in Tulsa, Oklahoma, published a blog post on GlassHospital discussing healthcare issues, noting that “things are slowly changing... but data analytics, email, and telephone visits remain challenging.”

What other challenges remain?
These devices and applications play a minimal role in ensuring patients take their medications on time and at the correct dosage. Some companies are developing sensors to record the action of users picking up their water glasses, enabling physicians to clearly determine whether patients have taken their medication.

Currently, the bulk of data available to physicians comes from young patients who are highly proactive about their health.

“We also need health data from older adults, but with very few exceptions, most seniors have not taken action in this regard,” said Dr. David J. Cook of the Mayo Clinic. He is conducting research to explore how trackers and apps can improve the quality of medical care. Because the patients undergoing hip replacement surgery whom Mayo wishes to track are often older adults who are not tech-savvy, the clinic has had to lend them Fitbit trackers and Android smartphones worth $60 to enable data tracking.

Neither Fitbit devices nor the Android system are compatible with Apple’s HealthKit, so Mayo Clinic’s programmers had to develop a separate codebase to integrate data from these devices. While HealthKit should be upgraded to enable Mayo Clinic and similar institutions to access data more easily, some devices and applications will remain incompatible. (For the latest insights on digital health startups, please follow VCBeat’s WeChat official account: vcbeat. We also welcome your engagement on topics of interest, contact us via WeChat, and share your startup projects or research findings.)