Recap: Scaling the Self-Tracking Movement
Now that more than a third of American adults own a wearable device, it's important to consider how this technology will evolve. How can we use self-generated data to improve health outcomes for ourselves, but also for our communities? In August, MHA@GW hosted a live Google Hangout about the future of wearable technology as it pertains to health.
There were a number of topics discussed - including how consumers are using wearable devices, what types of socioeconomic barriers may be inhibiting access to them and what needs to change in order to transform the individual self-tracking movement into one in which population health outcomes are improved.
Pierre Vigilance, M.D., MPH, moderated the discussion. He is the associate dean for public health practice and associate professor of global health at the Milken Institute School of Public Health at The George Washington University. A leader in public health practice, management, and education, he has more than 20 years of experience in health and wellness.
The following four panelists joined Dr. Vigilance:
- Blair Palmer. The lab lead for UNICEF Innovation in San Francisco, she is a graduate of Vanderbilt University. Palmer earned a master's degree in public health from Yale University, and was recently included in Dell's #Inspire100 list of world changers in entrepreneurship, philanthropy, education and media who use technology to empower and inspire others.
- Jacqueline Fellows. An award-winning journalist and senior editor at HealthLeaders Media, her weekly column on physician leadership focuses on the unique issues physicians face at hospitals, from health systems and in group practices. She also contributes a monthly business feature about hospital service lines to the magazine.
- Autumn Saxton-Ross, Ph.D. The program director for place-based initiatives for the National Collaborative for Health Equity (NCHE), she holds degrees in sociology, health education and exercise science. Her research, academic, and professional interests are on the social and physical environment and their influences on health behaviors.
- Teresa Wang. The research and strategy manager at Rock Health - a full-service seed fund that supports digital health care startups - she graduated from the University of Pennsylvania in the Vagelos life science and management program with a Bachelor of Arts in biology and a Bachelor of Science in economics, with a concentration in health care management and policy.
Meaningful use is key. This doesn't refer to the typical "meaningful use" of the electronic health record (EHR), but rather, what makes the data useful to the individual or provider who's tapping into it.
Just gathering the data isn't enough, both consumers and health care providers need the analytics that help make sense of what's been gathered. This includes the ability to take disparate data from a variety of sources and integrate it to affect outcomes. Palmer emphasized this fact.
"It's looking beyond a quantified self...and really looking at how you then qualify that data," she said. "What data is meaningful, and how do you make it meaningful in order to really show improved health outcomes?"
A solid infrastructure is needed. It's about much more than the wearable devices and the ability to capture the data within them - analysis and the creation of value are needed as well.
As an example, Fellows cited the current environment, in which health care providers are adjusting to changes in payment models, as one place where this data could make a difference.
"I talk to C-Suite leaders of health care organizations, and hospitals, and physician groups and specialty groups. And what they're struggling to do is move from a volume-based to a value-based world," she said. "Population health is a big part of that. There are some organizations that are doing some great work. But by and large, the infrastructure is not really there to support it dynamically like it needs to be."
Both patients and providers need to be engaged. Fellows also said that in addition to creating deeper connections with patients through the use of technology to improve health, we need to include physicians, too.
"While these technologies are coming along, physicians have to be able to also engage with them and use them in a meaningful way with their patients," she said. "You've got to make it easy for patients, but I think you have to make it easy for doctors, too."
Technology must be accessible in order to address health disparities. This includes affordability, education and reliable telecommunications systems within diverse socioeconomic populations and rural areas. Saxton-Ross highlighted the challenge that may exist in communities that haven't been traditionally geared toward supporting health-promoting and prevention behaviors.
"How do we ensure that these things are happening at the same time so we don't, once again, see this divide of everyone having the technology but not everyone having these behaviors?" she said. "Or, recognizing that these behaviors haven't really been a part of culture or haven't been supported for individuals to take advantage of these opportunities?"
Wearables can make a big difference in the developing world. This will occur most effectively by making the most of easily accessible technologies - such as smartphones. By integrating them into existing services and the existing infrastructure, life-enhancing and life-saving services can be delivered.
Palmer said UNICEF is working toward such solutions through its Wearables for Good Challenge, which includes a casebook for those interested in developing wearables for social good.
"It goes through the various focus areas of how you would do exactly that, and looking at the design constraints that would be needed in these last-mile settings So how do you reach that mother that needs to have prenatal care before she has her baby?" she said. "We're looking at those types of solutions where you're not just thinking about the user - you're talking about the user, but you're also looking at the local context."
Multiple and consistent touch points are needed. In order to promote healthy behaviors across communities, the entire system - including socioeconomic and cultural factors - needs to be considered. Saxton-Ross said that creating the best results means including more than a single point of influence.
"If we think about all the systems that people engage with, those are all possibilities to help with engagement," she said. "So, as technology grows...how can we use these different systems...as opportunities to promote these health-benefiting behaviors?"
There is more than one path to create change. There are many avenues in which the collection of data can make a difference, such as social media, online communities and smart cities in which digital technologies are used to better connect with citizens, enhance efficiency and improve quality. In addition, community-based alert and response systems can be used to address disease outbreaks, disasters and other emergencies.
When asked if she knew of any particularly innovative or interesting ways that people have been incentivized either by the device itself or by other methods, Saxton-Ross talked about how the amount of money that's generated by private device companies could be re-invested to benefit population health in a variety of ways.
"If we think about that money and how it can then come back to communities through philanthropy and really help out, this is a tremendous opportunity that can help communities get to the roots of these issues...we can all pick up that bag," she said.
Generation gaps exist. The fact that wearables aren't tied to traditional health care is a plus for reaching the younger crowd. Wang noted that making use of a consumer electronics angle increases access to better health for individuals and creates momentum for making it happen. However, wearable technology also displays the gap across generations in terms of how data is used.
"Because wearables are consumer electronics, you see a generational divide," she said. "Young people or younger generations are much more comfortable sharing their data and are a lot less worried about what their data is being used for."
History matters. Those who have had negative experiences with either technology, the use of their data - or both - may be resistant to creating deeper connections through its use. It's therefore essential that accurate education be provided to users - including consumers, patients and providers. They want to know about things like data ownership, privacy and security - especially in an era in which security breaches and the sale of data to third parties is increasingly prevalent. Providing transparency about how such things are addressed and avoided will go a long way toward building trusting relationships.
Consider the Future
Improvements in technology are creating new opportunities to move wearables beyond fitness tracking to affect health care in new ways. However, in order to improve outcomes, an increase in access, engagement, trust and meaningful use of the data will need to be achieved. The purpose here wasn't to arrive at conclusions about the future of wearables, but to provoke a deeper discussion about the issues related to the merger of technology, data and health as it lives beyond the individual and within the broader population.
How about you? What's your take on the evolution of wearable health? How are you making use of wearable technology to improve your own health or the health of your community? What barriers to progress exist in the use of wearable technologies in health care? What ingredients do we need to create lasting solutions?