Cedars-Sinai's Brennan Spiegel: Digital health no easy feat
Digital health is at its infancy, and even technical solutions that hold great potential to transform health outcomes can be waylaid when applied to everyday humans, Brennan Spiegel, director of health services research at Cedars-Sinai Health System, writes in a blog post.
Patients lose their devices, can't charge them, feel stigmatized by wearing them, or just have no interest at all in using them, he says. What's more, the data can be misleading.
He cites, as an example, a study conducted at Cedars-Sinai to measure activity in patients with rheumatoid arthritis. A 72-year-old woman found relief during the treatment course of the study, and while the data showed a decrease in her pain, the sensors also showed a marked decrease in her activity.
The theory was that feeling better meant less fatigue, joint stiffness and overall better physical function--basically more activity. But the activity data showed she essentially stopped walking.
Only by interviewing the patient did they learn that less pain meant she could return to her passion--writing--and she'd often spend 11 hours a day at the keyboard.
In another well-publicized example, Cedars-Sinai offered about 80,000 patients the ability to sync their health data from Apple HealthKit, Fitbit, and other wearable devices with its electronic health record system. Yet only about 500 people agreed to do so.
"To be fair, not everyone who has an e-portal account uses the portal at all," says Spiegel, who calls the effort a spectacular success. "So that alone could explain much of the drop off. Also, the message we sent was purely informational and short, basically explaining the availability of the new capability with a link to instructions. Also, we don't know how many of our patients own a wearable device or a HealthKit-enabled iPhone in the first place."
Spiegel says that Cedars-Sinai is using that initial rollout as a learning experience.
"We're about to test competing messages to see if we can improve uptake by addressing key knowledge, attitude, and beliefs people have about digital health," he says. "But the bottom line is that we built it, and they didn't come in droves. There was no overwhelming demand to connect. People were not clamoring to beam their data to their doctor.
He adds that even when a digital health intervention has matured, ongoing validation and refinement are necessary to ensure its effectiveness. "Nothing rolls off the assembly line ready to go. And even when it's working, it's still not quite working in some cases. This stuff is hard to do."
Healthcare need meticulous, systematic research to figure out whether, how and when digital health will provide value, Spiegel says.
One common theme in a recent National Quality Forum paper on making better use of data was that the problem isn't a lack of data, but that healthcare organizations lack the ability to use and apply the data toward improvement.
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