Back in 2012, Brian Dolan wrote an article on mobihealthnews.com about Fitbit data being uploaded into electronic health records (EHR). Ignoring the irony that the majority of practices cannot fund a feature like this today, three years later, let us explore how wearables like Fitbit could be used to curb the obesity epidemic.
Is it all about the footsteps?
First, consider the weaknesses of the device. You may have heard the statement “abs are made in the kitchen” or “your weight is 80% diet.” While those phrases may not be entirely true, diet certainly seems to impact the average person’s weight as much as -- in my opinion more than -- activity level. The recommended 30-minutes-for-3-times-per-
week exercise regimen could be enough for someone eating a fairly healthy diet. However, if that same person is washing down meals with sugar-filled sodas and desserts, they’ll likely display a completely different build. As obvious as that sounds, measuring footsteps won’t seem to matter in that case.
Failure to log
That moves us on to recording foods, which many apps have already proven to be less than helpful. There exist barcode-scanning features and most apps utilize massive food databases including even the most rare options, yet people still seem to have problems recording meals consistently and accurately. This is understandable. The process is annoying. Most people want to enjoy themselves after a meal, not spend more time on their smart phones recording portions -- and probably feeling guilty. Not to mention, this method is still a form of self-reporting. Not surprisingly, patients tend to underestimate their eating habits and overestimate their activity levels, thus rendering these logs somewhat useless for many patients.
For activity, however, the devices like Fitbit are great. Obviously some activities might burn more calories than other, but require the same amount of movement (sitting and doing biceps curls versus sitting and typing a report). Users do have the option to record workouts, but that requires more thinking and button-pushing. Keeping the idea as simple as possible, generally healthy people take more steps in a day than unhealthy people. Taking the stairs versus taking an elevator (one version of Fitbit actually measures stairs climbed). Enjoying a walk outside versus watching 30 minutes of television. I’m sure you get the point.
Even more of the "big data"
Overall, this data is fantastic. It gives physicians a general, and more importantly, objective estimation of a patient’s activity level. However, the problem doesn’t exist in the data collection. Providers only need a couple of data points to see progress or failure. As a physician, I don’t want to see what a patient has eaten every day since his/her last appointment or details about the patient’s exercise routine like maximum bench -- although that’s always great to brag about. I want to visualize a trend. Pertinent data would include weight, total caloric intake (even if that's only one random day per week), and activity level measured by movement. If time or resources permit, abdominal circumference or other measurements could be added as well. Compare those metrics to the usual statements like, “well I’ve been trying to take walks a few times a week.”
Integration with the EHR (preferably seamless)
Onto the issue of getting those data organized. Fitbit allows people to generate charts. Ideally, those would be uploaded to a primary care practice’s EHR, just like any other lab, radiology report, or consulting physician document. This is where a brick wall exists. Integration of apps with an EHR requires a huge effort on part of the vendors and/or in-house IT staff. Fortunately, there is good news. One physician, who is well ahead of the curve, actually found a way to integrate Fitbit data directly into his proprietary EHR. Josh Umbehr, M.D. of Kansas states, “Basically we send [our patients] an invite, they accept it, and then it syncs the data to us any time they sync their device”. When I asked him how it worked, he replied, “We built an interface for Fitbit directly, but we also work with humanapi.com to connect with tons of devices and apps.”
It must be mentioned that Dr. Umbehr runs a direct primary care practice, in which all of his patients pay him directly, thus allowing him to experiment with this kind of innovation. Not every physician may be as tech-savvy, but this certainly should give other primary care practices some hope for incorporating this kind of technology in the near future.