Medical Futures Lab

Guest posting by Alisa Momin

The wearable technology market has been criticized repeatedly for failing to cater to patients who actually need to monitor their health on a regular basis in order to keep up good health and a decent quality of life. Instead, the industry is producing flashy technology for everyday people without chronic conditions or any real need use to track their sleep cycles or steps for about two minutes, before inevitably tossing them aside after the originality wears off. How many of us have tried tracking the amount of steps we take per day, or logging the amount of calories we digest and burn? How long did these practices last? Probably not long.

How do we fix this problem and make this kind of technology widespread and long lasting in the healthcare industry, where it has so much potential? By proving to people that wearables can actually help people detect chronic conditions, illnesses, or diseases before they have the chance to do much harm, we can overcome the lack of interest in wearables. We can also thereby move toward patients and consumers that actually have a need for this tech—especially aging patients with several chronic conditions. This is exactly what is happening now.

Recent news in healthcare is disproving the apparent uselessness of the current wearable technology market. The Scripps Translational Science Institute has received a grant from the USAID for its program that uses Sotera Wireless’ ViSi Mobile System to continuously monitor the blood pressure, pulse rate, ECG, breathing rate, temperature, etc. of Ebola patients through a wearable sensor. Ultimately, this would help in identifying warning signs of Ebola early on, before the virus has the opportunity to spread. Doctors’ chances to miss changes in health status will be significantly reduced, as they would receive the data collected regularly. This project, called STAMP2, could monitor up to 500 patients, with the potential to grow even further.

Why is this important? I believe this could be a new approach for this industry that opens up the usability of wearables on a global scale. If physicians become more aware of the widespread use of wearables, especially in preventing health concerns even as devastating as an Ebola outbreak, they will become more invested in applying this technology to their own aging patients in order to prevent or detect chronic conditions earlier. Patients tend to trust their doctors—44.2% have said their doctors’ recommendations would be an incentive to use a fitness tracking device. Hopefully, as wearables start to show that they are useful in healthcare, they will have the opportunity to impact more patients in the future.

http://www.wired.com/2014/11/where-fitness-trackers-fail/

http://mobihealthnews.com/40564/scripps-wins-usaid-grant-to-monitor-ebola-patients-with-medical-wearables/

http://technologyadvice.com/medical/blog/study-wearable-technology-preventative-healthcare/

Guest posting by Jesal Shah

Going forward, as identified by many in the first critique session, the most challenging task in our campaign to increase HIV screening by physicians will be the aspect of changing doctor behavior. Most health education efforts are usually patient-centered; moreover, a majority of recent attempts to change doctor and hospital practices have involved top-down, reimbursement and incentive-based mechanisms rooted in economics. This includes remuneration forms, such as salary, capitation, fee-for-service and diagnosis-related groups, as well as reinforcement schemes, like pay-for-performance or financial penalties. However, these strategies are beyond our limited institutional know-how and power.

Increasing physician testing of HIV will be particularly challenging, because screening benefits are not immediate. It’s as Dr. Atul Gawande, a prominent surgeon, health policy expert and author, puts it, “an invisible problem”. In his piece, “Slow Ideas”, Dr. Gawande contrasts the difference between the widespread adoptions of anesthesia, which provided visible benefits and eased doctor’s workflow, and the slow implementation of antiseptic protocols and technologies, which had less immediate returns and required greater doctor effort. Evidence for a certain practice in itself is not enough to build acceptance in the medical community.^1,2 While there are very few high quality studies examining physician behavior change models/strategies, the status quo dissemination through publication, pamphlets or guidelines has been shown to be largely ineffective.^2,3 These methods are extremely passive and distant; efforts, which are active and interactive, have been demonstrated to be more successful. These include in-person educational outreach or academic detailing. There has also been evidence supporting the utility of reminders or audit-then-feedback approaches. Overall, there are other innovative individual piloted techniques, such as Dr. Vivian Lee’s tactic to capitalize on the intrinsic competitive nature of physicians or Dr. Gawande’s mentorship network, which uses persistent human connection to promote behavior change. However, the most important message ingrained in literature is that multifaceted interventions tackling various barriers is better than a single campaign.^2,3 This echoes the suggestions of many at the critique session, including our problem owner. Physician behavior change is an insurmountable barrier when approached narrowly, but in combination, many of the above techniques and others, can hopefully facilitate a change in HIV screening practices.

Sources:

1. Gawande, Atul. “Slow Ideas.” The New Yorker. The New Yorker, 29 July 2013. Web. 14 Feb. 2015.
2. Grimshaw, J. M., M. P. Eccles, A. E. Walker, and R. E. Thomas. “Changing Physicians’ Behavior: What Works and Thoughts on Getting More Things to Work.” Journal of Continued Education of Health Professionals 22.4 (2002): 237-43. PubMed. Web. 14 Feb. 2015.
3. Smith, W. R. “Evidence for the Effectiveness of Techniques to Change Physician Behavior.” Chest 118 (2000): 8-17. PubMed. Web. 14 Feb. 2015.