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Lisa Gualtieri is an assistant professor of public health and community medicine at Tufts University School of Medicine, where she also directs the Digital Health Communication certificate program. She also runs RecycleHealth, a nonprofit that recycles old wearables by providing them to people who need them. She talked with SearchHealthIT about consumers' use of wearables for fitness and wellness and going beyond that to see how physicians and patients can use wearable activity trackers more in healthcare.
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In your research, how do you measure the effectiveness of wearables and wearable technology in producing better medical outcomes?
Lisa Gualtieri: I've worked with a lot of physicians who are very interested in how the use of wearable activity trackers can increase their patients' activity levels. I think that there is an ideal of this data going into an electronic health record and being monitored and reviewed and having even alerts set up, but, at the moment, I think it's more of a dream with a small number of physicians really interested in how this could be used.
For people who would not normally know about or purchase wearables, can the mere fact that they're given one or own one, especially with some initial training, help them in increasing their fitness levels? A lot of people don't know their baseline activity level, and even knowing that might help people to monitor this and succeed. They can say: "Oh, if I walk a little bit more, look at how many more steps I get per day."
Wearable activity trackers seem to work pretty well at the consumer level, but what about using wearables in medical settings?
Gualtieri: Wearable activity trackers are consumer devices ... and that's how people think about them for the most part. What I'm trying to do is to say, given that wearables exist and given that they're out there and given the kind of adoption rate, which has been estimated at 20% of the U.S. adult population, how can they actually be used not only as medical devices, but also as ways of helping people to improve their own health?
Can you talk about the idea of getting more physicians on board with using data produced by wearables in everyday interactions with patients? Let's say in family medicine, for example.
Gualtieri: Part of the problem is it becomes one more thing for the physician to do and also how to determine the type of knowledge that's required in order to do this, to introduce this. One study found that almost 50% of people would be willing to use a wearable or are interested in using a wearable if they're given it for free by their physician.
It seems clear that wearables and sensors are effective in tracking chronic conditions in controlled population health programs involving diabetes, COPD, asthma, congestive heart failure and so on. But is there any real momentum in using wearables in general practice and family medicine?
Lisa Gualtieriassistant professor, Tufts University
Gualtieri: What I'm seeing is a small number of physicians who are interested in or are integrating it into their practices. For the average person, it's really not that different than the discussions that we had years ago about physicians recommending websites to their patients, or physicians recommending apps to their patients. How much does a physician need to know in order to recommend that their patient be using a device, and how does it get integrated into annual visits, more frequent visits, depending on what the health condition is?
A big part of your work, recently, has been your nonprofit project for recycling wearables, but can you talk about the pricing of sensors and the technology and the commodification of wearable health technology and how that will affect adoption and use of wearables?
Gualtieri: That's a great question, especially with the Consumer Electronics Show [it took place Jan. 6-9 in Las Vegas] and a lot of focus on the latest and greatest, to some extent with no regard for the cost of these devices. But I think what's happened because of the cost of the devices is that a lot of the heavier purchasers of these tend to be younger, healthier people or what Tara Montgomery of Consumer Reports calls the "worried well."
My interest is much more in the people who really need to be improving their health, like a hospital patient who is being encouraged to walk up and down the hall five times a day. A lot of people could, in fact, benefit. The other side is technology adoption. The process of even selecting which device you want is really difficult. Whenever I go in a store that sells wearables, I'm always interested to see how they're displayed and how easy or difficult it is if you walk in not knowing specifically if "I want to purchase 'x or y'" how easy it is to figure out which might be the best device for you.
I know that my experience with Withings [Activité Pop smartwatch] has very much influenced me because I love the eight-month battery. When I've shown my Activité Pop to people, and I've said, "One of the reasons that I use this is because I like not having to charge it every week," people get very excited about that. Some of that has to do with the evolution of this technology. What are the right features? Do you want something that you clip on your shoe? Do you want something that you clip on your bra strap? Do you want something that you wear on your wrist? If you're wearing it on your wrist, do you care what it looks like? Do you need the fancy [fashion designer] Tory Burch model?
I think there's still this question of do you need something simple? Do you need something fancy? Do you need something with a small number of capabilities or a large number of capabilities? What's going to work for you? I think there are a lot of questions around that, around how these are designed and that may be something that will change as the technology evolves through market demand.
What's the relationship between social media and wearables and health IT? Is all the data generated by wearables going to be useful for researchers and how?
Gualtieri: In the Wall Street Journal, a couple of months ago, there was a map that used Fitbit data showing some of the regional differences about people's activity. There are a lot of interesting things that can be done. The one I'm particularly interested in has to do with healthy aging and, on the small scale, how you can use wearables to detect differences in individual daily patterns and set up warnings and alerts as a result of that. But, on a larger scale, what can you learn about people's movements, about small changes that make differences? There's a lot of research in how to redesign streets and sidewalks to make areas more walkable.
Where does wearable data fit into this? Can you actually look at changing patterns over time and say, "Oh, look at the impact of this redesign?" In addition, of course, there's seasonality and there's many different factors.
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