Fitbit in health care: Is more data better?

For scientists and researchers who are developing new treatments for disease, Data is power.  For patients, Data can mean empowerment.  Devices that track health indicators are readily available.  These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature.

In the Wall Street Journal, the medical applications of the Fitbit device are explored.  The Fitbit is a basic pedometer that tracks movement, steps taken, calories consumed and (in certain models) sleep habits.  This device is commercially available for around 100 dollars and was initially embraced by serious athletes in order to improve performance.  Now, according to researchers, these devices may be able to impact health outcomes: both inside and outside of the hospital or health care setting.  These impacts may forever change how physicians and health care systems think about managing chronic disease.

As I have mentioned in previous blogs, I firmly believe that smartphone applications for medicine are going to be a part of mainstream medical practice in the coming years.  Providers will prescribe apps just as they do pharmaceuticals.  In the case of the Fitbit device and others like it, data obtained from physiologic monitoring can be used to assess physical fitness and progress towards obtaining specific health goals.  In several recent studies, researchers at Massachusetts General Hospital in Boston, have found that the Fitbit users who have diabetes are more likely to have better control of their blood sugars and achieve weight loss related goals better than those who do not use the device.  Many patients with type 2 diabetes can better control their blood sugars through reduction in BMI (body mass index) and the data provided from the Fitbit device seems to have a positive correlation with weight loss in this particular patient sample.

In the hospital setting, researchers at the Mayo clinic found that in post-operative cardiac surgery patients, the Fitbit was able to identify patients that needed more physical therapy intervention — by tracking movement in the early post-operative days.  It is likely that by identifying and intervening early in patients who are not progressing after surgery we will be able to prevent many common complications such as deep vein thrombosis (DVT), pneumonia and other morbidities associated with lack of activity after surgery.

At this point, the FDA has no immediate plan for regulation as long as they are not specifically created to treat a particular medical condition or disease process.  However, I do expect regulators to act on all types of biomedical data collection devices within the next 5 years.  According to the WSJ, the health monitoring device industry is projected to exceed 5 billion dollars in 2016 — largely due to our focus on patient engagement and prevention.

Concerns have been raised as to the security of data and as to the reliability of the data generated by these devices.  As with most new medical innovations, there is still much work to be done.  We must create secure servers where patient’s data can be safely deposited (and HIPAA compliant) and easily accessed by their health care providers in order to provide necessary changes to care.

In addition, the patient must be able to access their own data in order to assess progress, adjust goals and optimize their lifestyle changes in order to produce better health outcomes.  Additional concerns have been raised around the legal implications of a large repository of medical and physiologic data: Are physicians responsible for every reading and every piece of data in the repository?  Will there be frivolous lawsuits initiated by ambulance chasers (or Fit BIt chasers) in the future?

I contend that more data is better.  Data provides me with the power to make better decisions for my patients.  Data provides my patients with real, meaningful feedback.  When we are sick, we often feel as though we have lost the ability to determine our own destiny and lose any semblance of control.  Data allows patients with chronic illness to actually regain some sense of control and achieve ownership of their disease with the power to invoke change.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • azmd

    I m a religious Fitbit user and agree that it appears to be a powerful tool for reinforcing healthy behavior. Am I on board with my Fitbit data being uploaded to a healthcare system’s database? Not in a million years. I have absolutely no guarantee about how that information will be used and can easily imagine it being used in ways that would be extremely disadvantageous to me, for example by my health insurer.
    Paranoid? Maybe. But just because you’re paranoid doesn’t mean they’re not out to get you.
    Unfortunately our profession does not have a terribly good record with keeping our medical information confidential, and so I suspect that many share my reservations about the extent to which we want our data memorialized in an EMR.

  • Medicalquack

    Privacy enters in here too and there are other devices that have an easier privacy statement to read plus they give you options on whether or not you want to share with 3rd parties as sure the devices are a help but there’s always a fear of an insurance company “scoring” you with this data and seeing your cost go up, that’s the rub,if you will. Withings has a device that gives you an option to share or not to share and it goes right into the PHR, Healthvault once you set it up. Again the fear is data being used against you here, not with getting healthy by all means, so choose your privacy carefully I say.

  • Eric W Thompson

    I could care less about what someone does with my Fitbit data. I don’t have a lot of concern about my medical records either; outside of identity theft. Looking on FaceBook, I think a large number of people share that feeling. Or they are morons. The Fitbit works.

  • RES

    I am not a user of fitbits or any similar device. I don’t doubt that they can be helpful for self-monitoring in diet, exercise, or wellness goals, or for diabetes etc. as the devices improve. If the need arises I might get one myself.
    My father has a pacemaker/defibrillator which reports automatically to the hospital where it was installed, and they periodically alert him to report to them etc.
    These kinds of alerting/monitoring services can be very helpful, and are, as currently operated.
    However, a few days ago I read (in a technology review) about a new device and its maker’s attempts to build a business. It turns out that the business plan is indeed to market the device to end users as helpful to them, but to collect the data from these devices and to market it to pharmaceutical companies and others with interest & $. The cited example was company X matching data from people using its products and other companies’ products, what combinations of medicines they had and diet, exercise, mobility etc. The exercise and mobility data would come from the GPS data of the device. The rest could only come from other data bases as the device itself wouldn’t have this information.
    In other words, the data would be available to third parties without anonymity. This would be of immense interest to employers, potential employers, life, health and car insurers, potential lenders . . .
    anybody who might care about your life or illness prospects.
    So, by all means use a helpful device, but be very careful about the business plans of the seller and what contractual protections you may have.
    If the data sits in an EMR I would be certain it will be accessed for ‘research’ or ‘audit’ purposes, by insurers and others (e.g. employers who pay for insurance).

  • Carolyn Thomas

    Instead of more hype, I’m waiting for the RCT that compares the Fitbit or any other digital self-tracking app/device with the simple old-fashioned non-digital pedometer like the one I’ve been using since a Mayo Clinic cardiologist gave it to me in 2008 after my heart attack. Haven’t found any comparative studies yet – have you?

    My old low-tech pedometer still works great with not even a new battery in six years. And for every hour of high-intensity exercise, I award myself a sparkly colourful sticker on my bathroom’s little exercise calendar. Works like a hot damn. Highly motivating. And provides me with that “real, meaningful feedback” you mention.

    But a few months ago, another physician gave me a Fitbit as part of a goodie bag presented to conference speakers in Vancouver. It sat untouched on my kitchen counter until last week, when I finally decided to try it out.

    So far, I am decidedly unimpressed.

    The question is not so much about Fitbit data. It’s about whether – despite the relentless hype – the Fitbit is one bit more useful to me than that inexpensive little pedometer has been.

    Will knowing what my Saturday morning walks look like on the Fitbit screen, for example, change at all what I do or how I do it? Will I now start jogging through the farmers market to boost that low intensity stroll to high? Will I stop buying all those heavy veggies that slow me down on my (moderate intensity) 45-minute walk home?

    Self-tracking technology like this is merely an answer looking for a question to address.

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