The digital health revolution is in full swing, and there are an abundance of new mobile and web-based digital health tools that address everything from nutrition and exercise habits to disease-specific conditions and hospitalization. Consumers have embraced the new trend, and are becoming more actively involved in tracking and managing their own health.
This is an incredibly important paradigm shift on the oft-ignored side of the health care equation: the patient. It needs to be embraced by physicians. One hurdle to capitalizing on this new wave of patient engagement is the fact that the market is full of products that are unlikely to produce any long-term health benefits, with more beneficial, substantive tools interspersed in between.
How then can a patient decide which products to invest their time, money and motivation in? This would seem to be an excellent opportunity for physicians to weigh in. However, the lack of physician recommendations regarding these products is extraordinary. If you visit the websites of some of the major medical organizations in the country, the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, among many others, not one of them has a link to “endorsed apps,” “mobile health,” or any other reference to digital health tools. Without providing some guidance as to what works and doesn’t work, physicians miss the opportunity to maximize the benefits of this technology in terms of quality of care, access to care and cost, those things that occupy much of the discussion on health care today.
Products addressing one area in particular caught my attention recently – the obesity epidemic in children. It serves as a good example of the discordance between consumer directed digital health products and physician recommendations. Obesity is so difficult to treat because it is a health issue rooted in behavior, and behavior modification is the most difficult treatment option a physician can recommend. Consider the American Academy of Pediatrics’ recommendation that a child have 15 well-child visits with their pediatrician over the first five years of life. That amounts to approximately 7-8 hours of physician-family interaction time, over the course of five years.
It is impossible to expect that the answer to the childhood obesity epidemic can come solely from these limited interactions. So it would make sense that companies develop digital health tools that target such an important public health issue. Specifically, there are a growing number of platforms that incorporate pedometer-like technology into activity trackers for children. Many of the products include a small device that can be attached to a child’s waistband or shoe. Activity can then be measured and tracked via a web or mobile portal. Children can earn points to buy prizes, earn medals that can be displayed on their user profile, and compete against local and national peers. The idea obviously is to establish a reward system that children would respond to, and therefore increase their activity level. Of course, such products will inevitably increase a child’s “screen time” (the time spent in front of a TV, computer, tablet or mobile device), which is considered to be one of the biggest contributors to the rise in obesity in children. Given that medical organizations recommend limiting screen time as a crucial step in improving the health of children, is this really the best way to fight obesity?
Many of these products purport to help kids form better exercise habits. Some companies go so far as to publish research that supports the hypothesis that their activity tracker leads to increased activity levels. Unfortunately, the research itself is designed, conducted and analyzed by those involved with the company. It also draws conclusions that are in no way supported by the data.
I believe that the widespread implementation of activity tracker platforms for children could have negative long-term consequences. At a time when children are forming lifelong habits, these products teach them that they should be rewarded for taking an active role in their physical health, rather than establishing the critical point that good health in and of itself is a very important reward. More importantly, when children enter their physical activity data on to a digital platform, you turn exercise into equal parts fitness and screen time/sedentary behavior. I also worry that young children will grow up believing that any activity worth doing should involve a computer, phone or tablet.
As digital health tools become ubiquitous in the medical field, it is imperative that physicians take an active role in shaping the use of these technologies to improve population health. For many reasons, it seems physicians struggle to adjust or supplement their traditional care-delivery model when it is clearly not working. I use obesity as an example, but the same could be said of many other conditions – diabetes, heart disease, etc. Pervasive traits among physicians, such as comfort with a certain practice model, regimented training programs and a healthy skepticism for new evidence, seem to be significant barriers to adaptation and innovation. Without creative physician-driven solutions to identified problems, third parties will always fill that void. An important first step might be for professional medical organizations to co-develop apps that are based on good evidence, and can effect change in the target population.
At the very least, a rating system for digital health tools, endorsed by health care providers, could help guide patients to the best solutions in an increasingly crowded marketplace. Ideally, such a system would be free of commercial influence, and based on evidence, when it exists, or on expert opinion, when it does not. The longer physicians wait to weigh in on these important issues, the less their voice will be heard as the industry takes off without them. As that happens, without a doubt, our profession and our patients will suffer.
Thomas Santo is a physician who blogs at Scope of Medicine.