The Pros and Cons of Wearables

Wearable health-tracking devices such as Fitbits and smartwatches can be both beneficial and detrimental.

Posted in Physician Connection on Wednesday, August 25, 2021

The Pros

Many people find it empowering to track their own health data. As such, wearables are associated with:

• Stronger social support. Wearable devices provide access to people with similar conditions and support networks, which has been shown to correlate with greater adherence to home-based therapies. Various health care scenarios have shown improvement in self-efficacy and self-motivation in the areas of weight loss, quitting smoking, managing diabetes and exercise.
• Changed behavior. The small choices we make about our health each day add up, and by monitoring movement, diet and sleep, it’s easier for people to understand how their choices impact their health. 
• Better management of chronic conditions. Consistent self-reporting from patients about their health can be a challenge for physicians monitoring chronic conditions. Wearables can allow for the gathering of reliable at-home data related to the individual patient’s condition so providers and patients can work together to set goals and tailor solutions.
• Moving from curative care to prevention. Diet, exercise and socioeconomic factors are great predictors of outcomes but tend to be underutilized. As patients provide their primary care doctor with wearable tech data, conversations can start over ways to prevent future illness.

The Cons

The ability to collect patient data from a wearable device offers the potential for improved outcomes. Yet how we use and act on this data is imperative. On the large scale, these data discrepancies impact clinical research. On the smaller scale, data concerns impact the individual physician in practice, specifically:

• The data isn’t always helpful. Just because you can collect data doesn’t mean you should. Know what data to collect based on the individual patient. When speaking with a patient, make decisions together about what makes sense based on their individual health conditions and concerns. This gives you an opportunity to help patients understand what the different data points mean and how they might be helpful in supporting better health.
• The data isn’t always accurate. Heart rate measurements tend to be accurate on most trackers, but measurements like energy expended and calories burned have been found to be inconsistent. Keep in mind, wearable devices are not reviewed for accuracy by the FDA.
• The data may not be private. Simply put, there are a lot of different state and federal laws to consider when working with protected health information. It’s important to note that the onus is on the practice for keeping this data safe — and patients in general lack awareness about security issues and privacy risks.
• The data may not be secure. In 2018, a security breach in the app MyFitnessPal impacted 150 million people. When physicians are involved in handling this data, it’s possible a practice could be held responsible for consumer notification. Any device connected to the internet is vulnerable to cyberattacks, so it’s important for providers to understand this risk. Patients are also concerned. A survey conducted by Healthline in June revealed that more than 45% of wearable and mobile app users are worried that hackers may try to steal their personal health information.
• The data is siloed. Currently, device makers have data and physicians have patient outcome data, but there’s a lack of infrastructure between the two that supports quality research.

How Physicians and Patients Can Work Together to Find Meaning in Data

For the office-based physician, conversations with patients surrounding the use of wearables can help improve outcomes. However, it’s important for everyone to be on the same page.

While it’s a fictional example, imagine this: A patient you haven’t seen in six months suffers an adverse health event. A review of the medical record indicates that your practice gathered data, through the patient’s wearable, that might have impacted the patient’s trajectory had the data been reviewed and acted upon in a timely manner. There’s no documentation in the record of patient or provider responsibilities as it relates to the wearable device, and now everyone’s asking the question: could this event have been prevented?

Questions for Practices to Consider

It’s important for physicians and practices to understand the role wearables will play in their physician-patient relationships. Here are questions practices need to consider in order to protect patients and reduce liability risks:

1. Does the data being collected create a physician-patient relationship that requires a duty of care? It’s important to determine how frequently the information will be reviewed and when follow up responses are required.
2. Is your EHR and team ready? When your practice receives information from a wearable, it’s important to understand how the data will be stored, accessed, and monitored. Data may be received at any point in the day—will patient-specific alerts be set up so a provider can follow up?
3. Do your patients understand what to expect? Document in the patient’s chart the expectations, roles and responsibilities regarding wearables. Ensure the patient understands that if a medical emergency is occurring, the first step is calling 911.
4. Can the data be tested? If making real-time health care decisions based on wearable data, it’s important to test its reliability. MGMA suggests having patients transmit data, such as weight or blood sugar, before appointments so medical staff can verify their own findings with the data transmitted.
5. How is patient data being protected? Taking steps to ensure network security, including the installation and updating of anti-virus programs and firewalls, is imperative. Also consider implementing password policies that require complexity and frequent changes.
6. How might wearable data monitoring impact provider workload? Providers already spend a significant amount of time outside of clinical care updating electronic health records. It’s important to consider how workloads might be impacted by additional monitoring of wearable health data.
7. When do practices need to disclose use of health information? Physicians should understand the applicable laws and address them, including privacy laws and practices to protect the data stream from the patient’s device. It’s also important to ensure the safety of the physician’s network. Patients will need to give informed consent, so it’s important to explain to patients what data is collected and how it’s used.
8. How will device recalls and software updates be monitored? Be certain that everyone involved knows who is responsible, and the patient has provided consent based on this duty.

Wearable 3-Part Series

Risk management activities, if applicable, must be completed 90 days before your renewal.