The technology industry has been buzzing of late because of the big players entering the wearable sensor market. We are very familiar with Misfit and Nike’s Fitbit for some time. Others investing into the sector include Intel, Microsoft, Apple and Samsung.
There is no doubt that the inertia for fitness trackers is undergoing modulation. This is a result of both a dampening of the initial “wow” factor by consumers and a maturation of the market. Recalls of Nike Fitbits make this officially a mainstream product. As consumer fitness sensors navigate their way in society, one must appreciate the fact that introduction of this kind of technology is paving the way for its future use in mainstream health care enterprises.
However, there exist significant differences between the consumer and health care markets (though I am certainly not denying the fact that a patient is also a consumer). I have previously discussed issues vital to designing and implementing digital health technologies. I will attempt here to touch on five critical differences between the consumer and patient care markets.
1. There needs to be buy-in by the health care provider for patient-facing trackers. There are few physicians these days that roll their eyes when patients tell them they have looked up something related to their complaint or condition on the Internet. Such was not the case 15-20 years ago when online health information was far less reliable. Today there are websites which are routinely suggested to patients to obtain information, and in fact virtually all physicians and other providers utilize the Internet and apps to obtain information. In order to garner support of providers, the technologies need to: improve efficiency, achieve better patient outcome, and deliver data in either stealth or meaningful ways via utilization of quality analytics within new care delivery processes. This contrasts with the direct to consumer model (see also number 4 below).
2. Consumer-facing trackers need not demonstrate efficacy. There is no burden of proof of efficacy for a consumer item. The sale of the technology is the ultimate goal but adherence is not. It should be noted that the recall of the Fitbit Force was ordered by the Federal Product Safety Commission for an unacceptably high incidence of contact dermatitis (skin irritation) from the device, not because it didn’t perform up to standards. Hospitals will be places for the critically ill and a place to have procedures performed. This scenario is already a reality in many developed countries. One way to achieve this is with the utilization of reliable proven and unobtrusive technologies. Technologies will be used to monitor patient at home to decrease hospital readmissions, manage chronic disease states, and help people age at home. These technologies will need to prove their worth with outcomes studies. The targeted outcomes might consist of cost efficiency, clinical benefit, or others. Is this too much for patients and providers alike to request?
3. Patient-facing trackers require more than pure data. Lost or ignored data garnered by a consumer fitness tracker has little consequence. What is done with the data in a patient-facing device is the potential of its success. Does it mean the person needs to walk more? Faster? If it suggests bad sleep pattern (a stretch) is it because of obstructive sleep apnea or a noisy neighbor? Does an increased heart rate require the person to drink more fluids, take less insulin, have their blood count or thyroid checked, or increase their diuretic usage? Therein lays the challenge for companies of these products (or others which process data from different sensors). The product might be the same, but unless analytics and processes for evaluation and management of actionable data (hopefully driven by the user demographics and medical history) are in place, the shift from consumer to patient-focused tech will not be successful.
4. Patient-facing tracking sensors need payer participation. Right now there is no concrete incentive for a consumer to use a heath tracking device. It is already clear that health care providers are becoming payers. In addition, we are also witnessing more payers becoming providers. Some of the more visible politics of this trend have been seen in the Highmark versus UPMC battle waged in public media campaigns. Whatever the level of participation, payers are critical to the adoption of these technologies. The development of new business models is necessary. A wearable sensor has a better chance of being utilized if the patient is incentivized financially vis-a-vis lower health care premiums to wear it in the context of an overall treatment program. The data can be used by wellness or chronic disease management coaches already widely used by payers.
5. Consumers are self-managers and patients often depend upon caregivers. While the walking well constitute the majority of consumers of fitness trackers, family caregivers are becoming increasingly more important to the health care system. These people also need to be connected to the data derived from sensor trackers of their patients. Most directives arising from algorithmically derived data should be targeted to both the patient and a caregiver to facilitate understanding and adherence. Consumer-facing trackers might focus on trendy language associated with the data, stylish design or graphics. Patient sensor platforms need to deliver understandable and timely simple instructions to them and caregivers. Caregivers are necessary intermediaries to patients whereby consumers are independent recipients and managers of the data.
There might be some significant differences among financial analysts and others regarding fitness tracking revenue predictions. These predictions often mix the apples of consumers and patients. I believe these technologies will become an integrated part of health care. However, the shift from consumer to health care markets is not one as simple as some make it sound. It will not be seamless by any means and will require financial, strategic, clinical, and sociological considerations to be incorporated into that transition. I look forward to being both an active participant and observer of this process.
David Lee Scher is a cardiac electrophysiologist and a consultant, DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.
