As Wearables Improve, They Can Boost Patient Engagement and Lower Risks

Summary

More and more patients are tracking their biometrics through a wearable device. Practitioners who embrace and direct this interest can reap rewards in patient engagement and safety.

Roughly one-third of Americans own a smartwatch, and the market for smart rings and other biometric-tracking gadgets is growing, though some metrics are more reliable than others. It’s not surprising that many of our patients seek to improve their health by sharing data from their devices with their practitioners.

Technology skeptics are asking: Remember when EHRs were going to lighten our burdens, not add to them? Remember when patients first got smartwatches, and our inboxes flooded with unusable, clinically irrelevant, low-quality data? Some got fed up and swore off looking at patients’ wearables, but it’s time to take a breath and try again.

As the data quality of consumer wearables improves, we can combine new capabilities with patient education to boost engagement and lower risks for patients and practitioners.

It’s Not About Tech Perfection—It’s About Patient Engagement

Often, data from wearables is less than optimal: A smartwatch can easily mistake a downhill run for tachycardia or commit other errors, because optical sensors worn at the wrist can be tricked by motion. Moreover, optical sensors’ accuracy degrades for patients with darker skin tones—obviously, that’s a problem we must pressure developers to fix.

Still, wearables present us with opportunities. If we educate our patients about which metrics are relevant to their health concerns, and if we give instructions for how to tell us about those metrics, then we can reap immediate rewards in patient safety while kicking off longer-term positive feedback loops through patient engagement.

Here are some considerations when incorporating wearables into clinical practice:

It’s not an EKG—but it is a rhythm strip. As a cardiologist, it’s not ideal for me if a patient comes in and says, “My watch told me I had AFib last week,” and I say, “Well, let me see the strips,” and they don’t have them. Fortunately, I can teach the patient how to store this data on their iPhone, and then I can actually look at the tracings, which can be very high quality.

A wearable, even one with imperfect data, still gives me a general sense of a patient’s heart rate variability, which is a measure of how well they adapt to scenarios such as workout, stress, activity, or sleep. People with poorer prognoses don’t move much off of their baselines. Someone with significant heart rate variability is healthier. And rhythm strips can let us know if the patient’s heart rate is fast or slow and regular or irregular, which moves us toward diagnosing life-threatening conditions like atrial fibrillation (AFib) or making recommendations for improving overall health. A wearable doesn’t have to provide a full-on EKG for me to start getting a sense of a patient’s baseline, or for me to start using their wearable’s data to explain some of these concepts to them.

It’s not a sleep study—but it’s a start. Smart rings help evaluate sleep patterns, though they vary in their degree of accuracy. For instance, some commercially available rings have trouble distinguishing waking up from being an active sleeper. That said, they’re still a place to start when we suspect a patient has sleep apnea. One reason we don’t test enough for sleep apnea in this country—although we know that sleep apnea raises patients’ risks for high blood pressure, AFib, and all sorts of other medical issues—is that it’s difficult to get approval from insurance companies. Depending on the details of your patient and your institution, a smartwatch or smart ring reporting hypoxia or bradycardia can be a place to start.

Speaking of wearables and testing, for patients who require further sleep investigation, many sleep labs now get more accurate results by sending clinical-grade devices home with patients, rather than having patients come in for a sleep study.

But commercial wearables are helpful, even when dealing with patients who simply benefit from social accountability in maintaining healthy sleep habits.

Patient engagement doesn’t eliminate risks—but it reduces them. Engagement is tied to both patient adherence to care plans and to practitioners’ professional satisfaction. We can recruit patients’ involvement in their own care and take advantage of any actionable data.

Some physicians caution against leaning in to wearables, worried that patients may counterproductively fixate on one metric at the expense of their overall health. Others worry that patients will become low-grade hypochondriacs, driven to seek care over routine ebbs and flows in biorhythms. True, some patients do need a reminder to not obsess (and to not call my office every day). But for most patients, the more data they’re armed with that’s actionable, the better for both of us. Higher patient engagement contributes to higher patient adherence, which can mitigate patient risks. In a recent study of patients with type 2 diabetes, patients using wearable devices showed stronger adherence to the exercise plan.

It’s not the Olympics—we don’t need perfect data for some things. Patients mean different things when they say, “Yes, doctor, I’m exercising three times per week.” A smartwatch can help quantify things enough to get us on the same page for goal-setting purposes.

It’s not the data Wild West—patients can send data through your EHR portal. In the early days of wearables, clinicians worried about the deluge of patient data, about security, and about HIPAA compliance. These days, we can lean in to interoperability improvements—some wearables can transmit data directly into the EHR—or we can educate patients (or ask staff members to educate patients) regarding how to send data through our EHR’s patient portal.

It’s not a data firehose—it’s a drip system that you design with your patient. I don’t see data saturation as a problem anymore, provided that we have office processes in place to sift, sort, and prioritize messages, as well as the ability to discuss expectations with patients. When a patient sends me eight rhythm strips a day, it’s time for a conversation. Plus, members of my team can manage these information flows so they don’t clutter my inbox.

It’s not solo practice—it’s top-of-license practice on a team. I’m not dealing personally with all my patients’ wearables data, and neither is my nurse, my nurse practitioner, or my physician assistant. Questions about how our practice should handle patients’ wearables data are answered in part through clear role definitions, a culture of safety, and a team-based model of care.

Wearables Aren’t Going Away, So Let’s Use Them Wisely

Researchers and developers are finding novel ways to apply metrics from commercial wearables, such as a recent study in the detection and prediction of inflammatory bowel disease flare-ups. In mental health, researchers are investigating how the motivational aspects of incorporating wearables into care could engage patients with depression.

Clinicians can capitalize on patients’ interest in wearables and biometrics to elevate patients’ engagement. Wearables can, at a minimum, remind patients of the conversations they’ve had with us: As one physician observed, “What wearables do is encourage good habits”—with a reminder of the good advice that we’ve been giving all along.

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