Gadgets Like Fitbit Are Remaking How Doctors Treat You.


Dr. Eric Topol, a cardiologist at the Scripps Clinic in San Diego, knows when his patients’ hearts are racing or their blood pressure is on the rise, even if they’re sitting at home.

With high-risk patients hooked up to “personal data trackers” — a portable electrocardiogram built into a smartphone case, for instance — he and his researchers can track the ups and downs of patients’ conditions as they go about their lives. “It’s the real deal of what’s going on in their world from a medical standpoint,” says Topol, whose work is part of a clinical trial. “The integration of that with the classical medical record is vital.”

Similar efforts are underway around the country, as physicians and other providers seek to monitor patients remotely through new technologies, aiming to identify problems early and cut costs and inefficiencies in the healthcare system. The approach is a key focus of the nation’s Affordable Care Act, and the influx of data from internet-connected devices could be a valuable tool for health systems, helping them to maximize resources and target interventions toward patients who will benefit most. It’s also a huge potential boon for companies that manufacture these technologies and have the know-how to store and wring value from the data they generate.

Similar efforts are underway around the country, as physicians and other providers seek to monitor patients remotely through new technologies, aiming to identify problems early and cut costs and inefficiencies in the healthcare system.

Already, mobile apps, scales, and activity trackers that beam data they collect to the cloud are helping some doctors and hospitals keep tabs on their patients and inform treatments. Insurance and electronic medical records companies are investing in and partnering with tech outfits like RedBrick Health and Audax Health, which encourage consumers to use activity and health tracking tools and upload the data to their platforms.

Apple, Adidas, Samsung, GPS maker Garmin, audio tech company Jawbone, and gaming hardware manufacturer Razer are developing products that measure biological functions at ever faster clips. Startups across the country are creating gadgets such as pill boxes that can monitor whether patients are taking their meds and under-the-mattress sensors that measure heart rate, breathing and movement. Microsoft HealthVault — Microsoft’s web-based electronic health records platform — lets doctors access data from fitness trackers like Fitbit or Nike+ Fuel Band and glucose and heart monitors that patients have uploaded themselves. It’s an attempt to create a one-stop shop for health information.

Many medical professionals have been slow to embrace the concept of patient-generated data — partly because many are skeptical of information they don’t collect themselves and because many consumer-grade apps and gadgets aren’t approved by the U.S. Food and Drug Administration, the agency that regulates medical devices. In addition, some doctors and other patient advocates are concerned that internet-based systems aren’t secure and that patient privacy might be breached, intentionally or not. But there are signs that resistance to patient-generated data systems is eroding as the healthcare system shifts to focusing on outcomes, and institutions look to web-based solutions to expand their reach and save money.

Thinking Outside the Silo

Last week, Practice Fusion — the fourth largest vendor of electronic medical records in the country, according to Bloomberg Businessweek — announced a partnership with AliveCor, Inc., maker of a smartphone heart monitor, and Diasend, an online diabetes management system. When patients approve sharing data from these FDA-approved services, their information will start flowing into their Practice Fusion medical records. The company plans to integrate more devices that help consumers track their health, according to Matt Douglass, the company’s co-founder and vice president of platform.

Scripps’ Topol called the announcement an important but “baby” step toward making data-powered medicine a reality. “It’s the future,” he said. “But we’ve got a long way for this to become routine.” Integrating data into medical records can be clunky. Topol’s patients, after all, must still email him screenshots of their information before it can be put into their records.

Companies like AliveCor and Diasend require FDA clearance for medical use because they provide diagnostic services. But others — like Nike+ FuelBand and Fitbit, which work essentially like pedometers, or Wellframe, an app that guides patients through a cardiac rehabilitation program — are meant to foster healthful habits. For now, that distinction saves companies from the drawn-out and expensive process of applying for FDA approval.

Integrating data into medical records can be clunky. Topol’s patients, after all, must still email him screenshots of their information before it can be put into their records.

“Right now, there’s a void in the industry in terms of what do you do with this information,” says Tapan Mehta, the chief of global healthcare marketing for networking giant Cisco. “How do you take this data and synthesize it and make it into knowledge, which can then be used at the point of care?”

Another roadblock to making all this patient-generated information medically relevant is that it’s in silos controlled by the companies that collect it. Plus, analyzing it can be pricey. What’s needed, some experts say, is a system that aggregates and distills data into easily digestible nuggets of information for both patients and their doctors. For consumers to buy in, the interface needs to be as simple as signing into services with your Facebook account, says Guido Jouret, Cisco’s Internet of Things general manager.

Google Health was an early attempt at integration that failed because uploading the data was a hassle, he says. Now Practice Fusion is making a go of it. The company already brands itself as a “physician-patient community,” allowing patients to directly manage their health and find providers. Integrating consumer-grade health products was a logical next step. For now, patients must come into their doctors offices to upload data to the platform wirelessly through the cloud, but there are plans to let patients upload their own data from home in the future. The idea is to leverage the power of the internet to increase social interactions and productivity and provide users seamless, on demand data access from any device.

“If you look to 2020, there’s no way electronic medical records are not running primarily in the cloud,” Douglass recalls Ryan Howard, his co-founder, saying when he approached him in 2005 and sold him on the idea of starting a web-based electronic health records company. “All medical information had to be instantly accessible.”

The Privacy Problem

In the long-term, Douglass says, the company could develop “fairly complex algorithms that are looking at trends across patient populations — who’s healthy or who can be healthier and whether recommendations are actually making them better.” Like Google and Facebook, the San Francisco-based startup acts as a marketplace for information. Its services are free to the more than 100,000 medical professionals who use its product. The company makes money by partnering with diagnostic labs, imaging centers and drug companies and through targeted advertising.

Photo: Jon Snyder/WIRED

Practice Fusion has to play by federal rules governing patient privacy under the Health Insurance Portability and Accountability Act. It says all its data is aggregated and stripped of anything that would identify patients. Privacy advocates are concerned, however, the federal privacy law doesn’t apply to the growing volume of data produced by many health consumer apps and devices. Even outside a medical context, web titans like Google, Microsoft, Amazon and Facebook have faced criticism when using their customers’ activities to target them with ads for products and services. Using health data to target patients makes the stakes even higher, some privacy advocates argue.

Privacy advocates are concerned, however, the federal privacy law doesn’t apply to the growing volume of data produced by many health consumer apps and devices.

“The big concern with services that collect or aggregate health data from multiple sources is that many of them will not be covered by health privacy laws,” says Deven McGraw, the director of the Center for Democracy and Technology’s Health Privacy Project. “Consequently, how they collect and use health data is going to be governed by the companies’ internal privacy policies, which they write.”

Bob Kocher, a partner at venture capital firm Venrock and a former special assistant to the President for healthcare on the National Economic Council, says medical data today is more secure than ever. “We lost paper charts all the time,” he says. “Now we actually know which servers they’re on, and we can even document if there was a breach.”

Plus, he says, health data hasn’t yet proven all that valuable for hucksters. The bad guys don’t care about your health: They want your identity, and they can piece that together from your birthday, social security, e-mail and address — information they can get from variety of sources including bank statements, he says.

For physicians, on the other hand, the information can be invaluable. “We’re getting data that we’ve never had before,” Topol says. “It’s quite extraordinary.”

New tools automatically match patients with clinical trials.


The majority of Americans—72%—say they would take part in a clinical trial recommended by their doctor, according to a survey released last month by the Alexandria, Virginia-based science advocacy group Research!America. Despite that enthusiasm, though, there’s a shortage of enrollment. According to US government estimates, only about 3% of patients with advanced cancer enroll in phase 1 trials. Part of the problem, experts believe, comes down to a lack of awareness: the general public doesn’t know about investigational trials, and few physicians discuss the option with their patients.

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New tools unveiled this year that automatically prescreen patients for trials based on their electronic medical records and email matches to doctors could help solve the problem. “We’ve needed these kinds of tools for a long time,” says Eric Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, California. “Physicians are really busy, and there are so many clinical trials that no human could track them all.”

The US federal registry, ClinicalTrials.gov, currently lists more than 145,000 trials in all 50 states, as well as 184 foreign countries. Wading through those listings is a daunting task for individuals interested in signing up for a study, assuming that they know of the resource to begin with. Ultimately, problems with patient recruitment delay clinical trials by 4.6 months, on average, according to the Center for Information and Study on Clinical Trial Research Participation, a nonprofit organization in Boston. That holdup means it takes longer for treatments to reach the market.

To increase enrollment, some patient-advocacy groups have started playing matchmaker. A year ago, the Michael J. Fox Foundation for Parkinson’s Research launched the Fox Trial Finder, a web portal designed to help pair people with Parkinson’s with clinical studies (see Nat. Med. 18, 837,2012). The Alzheimer’s Association’s TrialMatch, meanwhile, has been up and running since 2010. Anyone can register online or by phone and see if he or she—or a patient or loved one—is a good fit for any of the 153 trials in 621 locations. To date, there have been 11,166 referrals, says Heather Snyder, the Chicago-based association’s director of medical and scientific operations.

In addition to the Fox Trial Finder and TrialMatch, for-profit companies have unveiled web portals to link people with studies. New York’s EmergingMed helps connect individuals with cancer trials, and in late May, Michigan-based CureLauncher unveiled a clinical-trial-matching service for a range of disorders. But tools such as these rely on the gumption of patients and doctors to wade through web listings. A new wave is emerging of automated tools that do away with the need for patients or physicians to manually enter information.

On alerts

Earlier this year, the Virginia Commonwealth University’s Massey Cancer Center in Richmond unveiled two new tools that work with its Clinical Trials Eligibility Database, which stores information about patients and clinical trials at the center. Since February, its MD Alert Notification System has automatically prescreened the list of scheduled patients each morning and emailed physicians when it finds that one of those individuals is eligible for one or more of 75 open trials at the center.

“If the patient is interested, one click by the physician refers them to the research nurse associated with that trial,” says Lynne Penberthy, director of the Massey Cancer Center’s informatics core who oversees the tracking and matching tools. Another new computer application there, the Automated Matching Tool, has been available since January. It screens all patients in the system on a scheduled basis, not just those coming in for a visit.

An algorithm known as Trial Prospector offers even greater automation for clinical trial enrollment. In a pilot study presented at last month’s American Society of Clinical Oncology meeting in Chicago, the program reached into the medical records of 60 people with gastrointestinal cancer who had scheduled appointments at the University Hospitals Seidman Cancer Center of the Case Comprehensive Cancer Center in Cleveland, Ohio. It pulled out 15 pieces of information—including age, diagnosis and blood count—that it compared to eligibility criteria of the 300-plus trials in Cases’s database. It then emailed doctors lists of any matches, and it also shows the studies for which the patient didn’t qualify and explains why; for example, some factors, such as low red blood cell count, might be easily fixed with a transfusion. The algorithm was 100% accurate, and 11% of the patients ended up enrolling in a trial suggested to the doctor by the algorithm.

“In theory this could be readily adapted anywhere, but we’ve still got a long way to go,” says Neal Meropol, associate director for clinical research at the Case Comprehensive Cancer Center. His team plans to refine Trial Prospector over the next 6 to 12 months, expand it to other cancers, and test it in a community-practice setting, where physicians aren’t highly specialized and may not have as much knowledge of open trials.

Penberthy similarly sees automated trial matching tools as a way to reach a more diverse set of participants. “We’re hoping that this is going help increase the equity,” she says. “It may help to increase minority patients enrolled in clinical trials,” an underrepresented population.

Topol, who isn’t involved with the programs, says that although automated matching programs are in their infancy, “eventually they could build something that’s extraordinary.”

Source: Nature