Patients who self track their data: Curb your enthusiasm

Patients who self track their data: Curb your enthusiasm

Happy New Year!  It’s 2013!  Time for us to embark on ambitious health and fitness resolutions we have no intention of keeping past March!

Here to assist us with our resolutions are a collection of fitness devices and apps that will help track our heart rate, sleep cycles, calories burned, steps walked, mood and much more.  Data from these devices can be stored, displayed graphically, shared with friends, and if we were really determined, shared with our physicians.

As a primary care physician, I am very excited about the self-tracking movement.  I love the idea of people being enthusiastic about their health and using technology (or just a pen and paper) to gain insight into their behaviors and habits.  You can’t change what hasn’t been measured, right?

However, now there’s talk of bringing that self-tracking data into the exam room and having it stored in our electronic medical record.  Self-tracking evangelists see the movement as integral to the future of personalized medicine and patient engagement.  They tell us we’re on the cusp of a revolution in patient empowerment, allowing physicians to use data about our bodies to help us liver healthier and happier lives.

Whoa. Let’s slow down.  I can see how people in the self-tracking movement would be enthusiastic about “medicalizing” their data, but I see a few reasons to temper expectations:

1. There’s not strong data to support self-tracking.  We can make some inferences about how self-tracking would work in a clinical setting by looking at the studies done on telemonitoring, which also generates a large volume of attribute-rich data.  Some studies have shown benefit in outcomes, especially for diseases like diabetesCOPD, and hypertension.  However, hard measures like mortality have not been improved by telemonitoring devices.  Data on hospitalization and ED visits, especially in the elderly, have been mixed.  People (especially the engineers who created these wonderful devices and apps) love to think that more data points are better. But to date, we just don’t have a robust set of well controlled studies telling us what self-tracking is useful for, what devices or apps to use, how to interpret the data, or how to integrate it into medical care.

2. Physicians may not want the data.  Imagine that a 45-year old man who had just started exercising after years of inactivity gives their doctor all of their heart rate measurements from the past month.  All 5000 measurements.  There’s no way their physician is going to want to touch that data.  Buried inside those data points will be erroneous and clinically meaningless measurements which, without review and context, will be fodder for trial lawyers when something bad happens.  It’s data overload to the Nth degree, because let’s face it … anything can be tracked.  Once data gets put into the medical record, it’s assumed the physician has reviewed the data and acted on it accordingly.  No one wants something in the patient’s chart that not only has limited medical use but carries substantial legal risk.

Finally, we need to pay physicians to analyze and counsel about the data, similar to how we pay for EKG interpretation or reading an x-ray.   Fee-for-service still rules the roost, and nothing gets done unless someone pays for it.   Any thoughts on why so few physicians use email, even though it’s been around for decades?  Wanna guess how much Medicare or any other major insurance provider pays for email use?

My New Year’s resolution is that I’m going to keep my self-tracking data to myself.  No posting on Facebook.  No sharing with my doctor.  Self-tracking has the potential to increase mindfulness of our body and our reactions to the environment.  And what’s great is that this can be done in a very private and nonjudgmental way.  At some point in the future, self-tracking in medical practice will be ready for prime time.  But until then, let’s not medicalize this incredibly reflective process just yet.

Keegan Duchicela is a family physician who blogs at Primary Care Next.

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  • http://strangelydiabetic.com Scott Strange

    Really… I assume you are leaving diabetics out of this scenario, especially the type 1 diabetics whose very lives rely on that curbed tracking

  • http://www.thehappymd.com/ Dike Drummond MD

    Wow … throw patient centric out the window. Patients track data for THEM … not their doctor. Here’s an example.

    There is an exercise tracking device called FitBit … it is essentially a digital pedometer. I know a personal trainer who has a group of clients who wear these devices which automatically post their activity to the group page webpage, where their competitive juices are stoked by seeing everyone’s steps for the day.

    I have never seen such a tiny device make such a huge difference in people’s activity levels and their weight. People are walking up and down the stairs as they brush their teeth before going to bed just to get the extra steps.

    And research be damned. Each patient is an “N” of one. Tracking works to influence their behavior or it does not. I encourage people to try a tracker … THEN ask “How did that work for YOU?” You get to advise them on whether or not that device is reaching your mutual definition of improved health goals. You are a trusted advisor .. they are the ones taking action. And these trackers can be powerful for some people.

    Let your patients help you with whatever technology works for them and step down off your pedestal of “doctor knows best”. You are working too hard trying to balance up there. Whatever works for the patient is best for the patient.

    My two cents,

    Dike

    Dike Drummond MD
    http://www.thehappymd.com

    • southerndoc1

      Another bad headline. Reading the OP’s last paragraph, I think the two of you pretty much agree.

    • http://primarycarenext.blogspot.com/ Keegan Duchicela, MD

      Dr. Drummond, thank you for your comment.

      In my practice, if a patient’s excited about their tracking, they find it fun, and they seem to be more aware of their health, I say “Great! Keep at it”, and leave it at that. I don’t discount any success in reaching their health goals, no matter how they achieve them.

      However, I have a hard time suggesting people buy a $100-150+ device when we have no good idea of who should be buying the device (and there’s often a selection bias in terms of people’s success with the devices), how often they should use it, or what the data collected actually means in terms of health. I have a much easier time suggesting self-tracking using pen and paper (like a food log, headache diary or sleep diary)… because it’s cheap.

      I think these are very powerful devices, but so is their marketing. We need more research to prove their worth. Especially if we ever want to ever incorporate the attribute rich data into our EMRs (which is what was suggested by, I believe, the allscripts CEO recently).

      • http://www.thehappymd.com/ Dike Drummond MD

        Hey Keegan … I would submit we don’t need ANY research here. Every patient is a “N” of 1. If the device works for them … it works for them. No matter what “response rate” research might show … it either works for this patient or it does not.

        And since the patient pays out of pocket for things like FitBit – it goes even farther. THEY get to decide if it is working for them and YOU get to give your professional second opinion.

        In my experience if a device like this does not work – the patient knows it quickly and stops using it just as fast. But don’t discourage them from trying because there is insufficient research to make a doctor happy. What ever works … what ever works.

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

  • http://www.facebook.com/karen.b.laing Karen Burhans Laing

    Health Literacy includes how your daily actions impact your health. Self tracking is a proven aspect of successful weight loss programs and is rapidly being adopted by fitness buffs.

    EMRs are a bonus to the health care system allowing all providers to see and review your health records.

    But self tracking results do not belong in EMRs. The technology is not always accurate. Doctors don’t have the time to review all the data, and there is no control data to help evaluate the results.
    So track away! Get healthy! Ask your doctor about results that seem unusual or when your data suddenly changes. But don’t expect your doctor to enter it into your EMR. It doesn’t belong there.

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