Wearables Can Enhance Practice, But Questions Remain

Marcia Frellick

April 22, 2018

NEW ORLEANS — Wearable technology — such as fitness trackers, sensors, and monitors — can build patient engagement, save time on office visits, and add real-time data points, according to physicians speaking here at the American College of Physicians Internal Medicine Meeting 2018.

And starting this year, the Centers for Medicare and Medicaid will reimburse physicians for time spent analyzing data the devices collect, as part of improvements to the Merit-Based Incentive Payment System.

"This is an area where there is a lot of focus from health systems so that they can actually bill for care coordination," said Priya Radhakrishnan, MD, from the HonorHealth Medical Group in Scottsdale, Arizona. "The caveat is that 20% has to be borne by the patient" under the Medicare rules of reimbursement.

But "I think it's worth the investment of time and money when you see how we can engage patients," she added.

A Patient's Improvement Got Physician on Board

When Radhakrishnan saw how a wearable heart monitor helped one of her patients with atrial fibrillation, she became a fan.

The patient had seen a cardiologist and was on appropriate medication, but an adverse effect was severe fatigue, she told Medscape Medical News. By reviewing data from the monitor, Radhakrishnan could see that the woman was experiencing two to four episodes of atrial fibrillation a month.

After consultation with the cardiologist, a pill-in-the-pocket approach was decided upon, and the woman was able to take the medication when the device indicated she needed it, leading to fundamental improvements in her life.

"That is the power of wearables," Radhakrishnan said. "Patients own the data and understand what's happening in their lives."

Devices are also useful for patients with diabetes. Many of them email results from their glucose monitors to Radhakrishnan so she can keep an eye on their highs and lows, and have them come for an office visit only when necessary.

However, there is little quality research on the devices and their accuracy, and legal questions remain, Radhakrishnan and others warn.

Legal Questions Linger

It is important to set policies and regulations around the use of wearables, and to make sure that patients understand them, said Radhakrishnan.

Legal issues could arise, for example, if a physician fails to see warning signs in the data before a patient has a stroke.

The glaring lack of research on the devices is a further complication, said Alisa Niksch, MD, director of pediatric electrophysiology and the stress testing lab at Tufts Medical Center in Boston.

In a recent analysis of 4348 studies conducted on wearable biosensors, only 64 were randomized controlled trials, and only 16 of those were sufficiently powered and considered high-quality (npj Digital Medicine. 2018;1:2), she reported.

Before physicians embrace the technology, rigorous comparisons between wearables and standard-of-care devices will have to be conducted. Results so far have been mixed.

Patients aren't reliable for putting their own data into the system.

Contextual data are needed so that providers can tell what the patient is doing when a reading is taken.

Passive data capture would also be an improvement. "Patients aren't reliable for putting their own data into the system," said Niksch. And the data need to flow directly into the electronic health record.

The capacity to filter data and an alert system that notifies the physician when a wearable signals trouble would also be helpful.

And the devices should meet the standards for HIPAA compliance. "We want these devices to have a secure platform for our patients," she said.

The next 5 to 7 years will be turbulent for us as practicing physicians. We are going to be inundated with data.

The market for wearables is growing and will reach $50 billion by 2022, according to estimates from Gartner, a market research company.

"The next 5 to 7 years will be turbulent for us as practicing physicians," Radhakrishnan said. "We are going to be inundated with data. Our patients want us to see these data. We need to be very clear in our expectations with patients, and we must make sure they are partners."

Training assistants — who can take information from a patient's wearable, digest it, and present it to the physician before the 15-minute office visit — will ease time constraints and become increasingly important, she added.

Radhakrishnan is a physician adviser for the Practice Innovation Institute, a Transforming Clinical Practice Initiative supported by a CMS grant. Niksch is chief medical officer at Genetesis, a medical device and software company that provides cardiac diagnostics, and was a member of the advisory board at AliveCor from 2014 to 2016.

American College of Physicians Internal Medicine (IM) Meeting 2018. Presented April 20, 2018.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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