The digital health and wellness space is growing a mile a minute, with thousands of new sensors, apps, trackers, and websites promising ultimate health and fitness born every day. Data requests to MyFitnessPal’s API alone – from wearable sensors like Jawbone’s UP and Nike’s Fuelband to GPS-enabled tracking apps like Runtastic – roughly doubled from 28 million to almost 55 million in one month, between March and April of 2013.
We have entered a new era when it comes to the way individuals are able to collect, analyze, and share their health information. Yet we are still missing some basic data-driven technologies that I think would be very helpful both for me and for my patients, capabilities that I think could impact the ultimate driver of health – human behavior – for the better.
For example, I am longing for a photo food diary that patients can share directly with me. I have found that when I see photos of even a few days’ worth of what a patient is eating, I get a much deeper level of granularity in understanding how food is impacting their health. Written food diaries, even those penned by the smartest, most capable people, tend to be subject to time-lapse. People don’t – or don’t want to – remember everything they ate; the details get fuzzy.
The world is saturated with food diary apps, to be sure, but what I would like to see is a mobile plugin that would enable direct interaction between a patient and clinician. It would allow my patients to add any smartphone photo they take of a meal to a synched Dropbox-like folder that I can access. In a dream world, it would go right to their file in my EMR. In an even dreamier world (I know – dream big!) an analytics layer would tag each photo – not with subjective, user-generated, and inaccurate terms like “healthy” or “unhealthy” – but with concrete data points like “processed,” “restaurant,” “high sugar,” “contains caffeine,” and “low fiber.” It would then graph that data to give both of us a visualization of their individual eating habits. This way we would learn together.
The second data-driven application I would like to see is what I call a “financial health score” app. Essentially, the technology would track patient purchases the way Mint does, then assign each a score based on category (food, travel, medical, etc.) and a “health-factor” of 1-to-5. (Think Whole Foods vs. fast food, running shoes vs. a new TV, or gas vs. a bicycle.) As people increasingly use credit and debit cards for transactions everywhere, more and more data granularity will be possible. The score’s accuracy would improve with time and use.
My former boss, Mehmet Oz, once said to me, “Don’t let perfect be the enemy of good.” In my experience, the first step in behavior change is self-awareness (if you don’t see the behavior, it’s impossible to fix.); I see this app as a means to drive us toward the good that we’re already doing, rather than the perfect that may feel impossible to reach.
The third data-driven technology I would like to see is a truly collaborative EMR. In my own integrative medical practice, the write-up I draft after my first consultation with a new patient serves as my official history and physical. My patients are asked to read the entire document, including the assessment and plan, before we meet for a follow-up visit. I want them to review the document, let me know if they agree with what it lays forth, answer any questions, and modify the plan to ensure that it is something they feel is immediately doable. My patients’ health is not something I am distantly responsible for; we are 100 percent in it together.
I fully recognize that in an inpatient, critical care setting, not all notes need to be shared. By nature of their medical jargon they can be overwhelming. I also recognize that in the outpatient setting there are sensitive situations – the abuse of an elderly patient by a family member caretaker, for instance – where provider-only notes are appropriate. However, notes that support preventive care and proactive behavior modification have a real role when patients leave the office. At most, these can change the patient-provider relationship and the patient’s sense of responsibility for their care. At minimum, the patient point out errors in communication.
The theme connecting these three tech requests is collaboration and self-awareness, and the optimal outcome is real behavior change. I see a lot of technologies for healthcare that offer either the patient or the doctor a solution, but few that bring them together in pursuit of a common goal. I also see a lot of technologies that ask people to engage in a new behavior rather than meeting them where they are. Fuelband and Up are successful because they don’t require you to do something new or differently to use them, but they result in new perception of self. The change might be incremental, but as we saw with MyFitnessPal, ‘incremental’ in the new era is massive.