Patient Monitoring, Big Data, and the Future of Healthcare
July 22, 2014
I’m pretty sure that when you read the word “patient” in the headline of this article, your first thought was about sick rather than healthy people. A patient in the healthcare sector, however, is like a consumer in the retail sector — both healthy and sick patients purchase goods and services. A healthy patient is the desired goal of doctors. Elizabeth Dwoskin and Joseph Walker report that doctors are studying the use of wearable devices to determine whether monitoring patient activity can help make patients healthier. “Many runners and fitness fanatics have been quick to embrace wearable wireless tracking devices for measuring physical activity and calories burned,” they write. “Now, a growing number of physicians are formally studying whether such ‘wearables’ can improve patients’ health by spurring people to get moving.” [“Can Data From Your Fitbit Transform Medicine?” The Wall Street Journal, 23 June 2014] The first group of people that physicians want to target contains those who are obese. Amy Wheeler, a primary-care doctor at Massachusetts General Hospital, told Dwoskin and Walker that she “hopes wireless tracking devices can help motivate her obese patients do what they haven’t been able to do on their own: lose weight.” The formula used by most people to lose weight is pretty simple: burn more calories than you consume. That’s why every legitimate weight loss plan involves both diet and exercise.
One of things that being overweight can lead to is diabetes. In fact, diabetes is often described as an epidemic in super-sized America. For that reason, Dr. Wheeler and several of her colleagues conducted a study last year of 126 patients with Type 2 diabetes. Each of these patients was provided a FitLinxx pedometer. Dwoskin and Walker report how the study was conducted:
“The pedometers tracked how many steps the patients walked and linked to a software program that calculated whether patients met exercise goals. Based on patients’ progress in meeting their goals, data from their electronic medical records, and whether it was sunny or rainy that day, patients would receive motivational tips via text message. Patients who received the tips did a better job of controlling their blood-sugar levels than those who didn’t, said Joseph Kvedar, director of the Center for Connected Health.”
Dwoskin and Walker report that other physicians are using wearable devices to track the progress of heart patients. Dr. David Cook, an anesthesiologist, along with other colleagues at the Mayo Clinic College of Medicine, “used Fitbit Inc.’s namesake gadget to track activity levels of cardiac-surgery patients. The researchers found that patients who moved more the day after surgery were more likely to be discharged sooner.” All of this sounds great and seems to make a lot of sense. Nevertheless, Dwoskin and Walker report that there are challenges to wide adoption of wearable devices for patient care. They explain:
“Drs. Wheeler and Cook are among a growing group of health-care providers who believe that the wealth of data from these gadgets could transform medical care. But adapting consumer gadgets for clinical use poses challenges, from doubts about the reliability of the data to technical hurdles of collecting and analyzing the information. Privacy and security concerns loom large as well. Privacy advocates worry that as Americans upload potentially intimate health information into gadgets and apps, there aren’t enough protections to prevent the data from being misused. Some physicians question whether patients will remember to wear such devices — or remember they are wearing them. That is what happened when Dr. Cook gave wireless trackers to 30 healthy 80-year-olds. Like most of the participants in that study, Chuck and Velma Steidinger said the tracker didn’t influence their behavior because after a few days they forgot the device was there. ‘It didn’t change anything I did,’ said Dr. Steidinger, himself a retired physician.”
Despite such challenges and concerns, Dr. Eric Topol, a cardiologist at the Scripps Clinic in San Diego, is among those who believe that patient monitoring can transform medical care. He attaches his high-risk patients to a “personal data tracker” — “a portable electrocardiogram built into a smartphone case.” [“Big data healthcare: The pros and cons of remote patient monitoring,” by Daniela Hernandez, MedCity News, 10 March 2014] The personal data tracker is used by Topol and his colleagues to “track the ups and downs of patients’ conditions as they go about their lives. ‘It’s the real deal of what’s going on in their world from a medical standpoint,’ says Topol, whose work is part of a clinical trial.” Topol added, “The integration of that with the classical medical record is vital.” Hernandez reports, “Similar efforts are underway around the country, as physicians and other providers seek to monitor patients remotely through new technologies, aiming to identify problems early and cut costs and inefficiencies in the healthcare system.” The United States isn’t the only country experimenting with patient monitoring. Wayne Parslow reports that Britain’s National Health Service (NHS) is also considering the use of such devices. [“How big data could be used to predict a patient’s future,” The Guardian, 17 January 2014] He writes:
“Healthcare was once about trying to heal the sick patient. But organisations around the world, including the NHS, now have an opportunity to shift this focus to one of keeping the public healthy and anticipating health issues before they become a problem. The ability to create and capture data is exploding and offers huge potential for the NHS to save both lives and scarce resources. Healthcare and life sciences are the fastest growing and biggest impact industries today when it comes to big data. In the UK, huge anonymised datasets are being developed for areas such as pharmaceutical research, with the aim of vastly improving the efficacy of drugs. Disease research is also being supported by big data to help tackle conditions such as diabetes and cancer. But the UK has an opportunity to go much further in unleashing the real power of big data – the potential to personalise healthcare for every NHS patient. Identifying people at risk of becoming ill or developing a serious condition and providing the foresight to prescribe preventive measures is a very real possibility.”
Parslow admits that using big data analytics to predict future health problems is likely to run into stiff opposition; but, the potential of such a program is enormous. He continues:
“Predictive intelligence has huge potential for the NHS. Imagine if a doctor could tell a patient that they could add six years to their life expectancy if they altered a behaviour or changed a medication in order to reduce their high risk of developing a particular condition – a risk identified through big data. Although currently shielded by privacy rules, the personal data that can risk score every NHS patient already exists. And it is already far more centralised and normalised than in countries such as the US, giving the UK the opportunity to become the world leader.”
Parslow finds it interesting that people are willing to share so much information with retailers, but are reluctant to be as forthcoming with healthcare professionals. He is even more confused as to why they hesitate to share data with healthcare providers when they provide it freely to others. He explains:
“The public are already generating and sharing huge amounts of personal health data through consumer devices such as smart watches and wristbands that monitor sleeping patterns, exercise, heart rate, calorie consumption and more. However, in many instances the likes of Google has this data but the NHS doesn’t.”
It is more understandable why people would be reluctant to share personal health information in countries like the U.S. where it could be used to justify significant increases in health insurance costs. This reluctance also highlights the suspicion that a lot of people have about government programs regardless of where they live. Despite such reluctance, the bottom line is that patient monitoring could dramatically improve healthcare and decrease costs. Parslow claims, “We will see hugely improved financial, operational and clinical outcomes and better performance in a healthcare environment where medical professionals do not need to rely on gut feelings.” Hernandez reports that reluctance among healthcare providers and patients may be softening.
“Many medical professionals have been slow to embrace the concept of patient-generated data — partly because many are skeptical of information they don’t collect themselves and because many consumer-grade apps and gadgets aren’t approved by the U.S. Food and Drug Administration, the agency that regulates medical devices. In addition, some doctors and other patient advocates are concerned that internet-based systems aren’t secure and that patient privacy might be breached, intentionally or not. But there are signs that resistance to patient-generated data systems is eroding as the healthcare system shifts to focusing on outcomes, and institutions look to web-based solutions to expand their reach and save money.”
There is also a movement afoot to increase virtual house calls (i.e., telemonitoring). Leigh Ann Ruggles, director for strategy and business development at Verizon Mobile Health Solutions, believes there are “three different markets where Virtual Visits could add value. Health plans, self-insured employers — it could reduce workflow interruptions and absent employees since they can log on to the service 24/7. Health systems are another potential market because they could present it as an alternative to clinics at national drug store chains. Ruggles points out that having this service would allow the health systems’ physicians to concentrate on other, more serious cases.” [“Verizon rolls out telemedicine tool for non emergencies, Virual Visits,” by Stephanie Baum, MedCity News, 25 June 2014] Another benefit of virtual visits is that patients are not exposed to pathogens that may be found in waiting rooms and doctors’ offices.
IBM recently announced that its Watson system was going to focus on the healthcare field (i.e., supporting diagnosis and treatment). If such efforts prove effective, the collection, analysis, and use of big data will likely gain increasing support. If the proper protections can be put in place, the potential upside of patient monitoring far outweighs the potential downside.