A decade ago, patients with a suspected sleep problem had to spend a night in a sleep lab, then wait to visit their physician to review a readout of their sleep stages, night awakenings, and snoring patterns. Today, patients can wake up, roll over, and open a sleep-tracking app on their phone to pore over sleep metrics.
Instead of presenting patients with their health data, providers are now fielding questions about health data that patients bring in with them. “Patients are increasingly bringing in their health data from apps and wearable devices,” says sleep specialist and psychiatrist Alex Dimitriu, MD, founder of Menlo Park Psychiatry & Sleep Medicine in Menlo Park, California. “I discuss electronic health data with patients every day.”
And poor sleepers aren’t the only ones using personal health tracking technology. These days, most pregnant women have at least one pregnancy app on their phone offering health tracking, education, and support. “I would say most of my patients use a pregnancy-tracking app, and often a couple of apps at once,” says Kathleen Pizzolatto, CNM, ARNP, of CHI Franciscan Health in Tacoma, Washington.
Many people have more access to health data than ever before, thanks to sophisticated sensors embedded in everything from smartwatches to socks. Per a 2019 Gallup poll, about one in three Americans reports tracking their health data using a phone or tablet app. What does this mean for providers as they manage their patients’ questions and expectations, debunk myths, and help patients navigate the complexities of our digital world?
QUANTIFYING PERSONAL HEALTH DATA
The explosion of interest in personal health-tracking represents the growth of the Quantified Self (QS) movement, says Wendy Sue Swanson, MD, chief medical officer for Before Brands (maker of Spoonful One), a company dedicated to the prevention of childhood food allergies. Founded in 2007 by Gary Wolf and Kevin Kelly, the QS movement supported individual access to health and personal data.
In 2009, Swanson began the nation’s first hospital-based health blog as Seattle Mama Doc, a role she held through 2019. “In 2009, blogs were fairly new, and the prevailing view in healthcare was, ‘No, don’t look on the internet for health questions, come to see your physician,’” she says. “That was a completely errant view that devalued patient experience and patient education, and presumed that the only way to get information was from your own physician.”
As patients sought and used more of their own health data, healthcare had to change. “We saw that people were getting information online anyway, from their friends and from companies marketing to them,” says Swanson. “Widespread misinformation about vaccine safety is one example. Parents were learning about vaccines online from their friends, not from their doctors.”
In the 11 years since Swanson began blogging, consumers have demanded increasing access to personal health data, with young parents leading the charge. Health-tracking is most popular among young, affluent women, per the Gallup poll. “There’s a whole revolution of gadgetry in pediatrics allowing parents to track their baby’s data,” Swanson says. From Lumi, the Proctor & Gamble smart-diaper baby monitor that shows sleeping, feeding, and diaper activity—which Swanson helped develop—to the Dr. Mom otoscope that allows parents to spot ear infections at home, to the Kinsa QuickCare Smart Stick digital thermometer, devices let parents track their baby’s every moment, movement, and milestone without setting foot in a doctor’s office.
EMPOWERED PATIENTS, IMPROVED OUTCOMES
As new consumer products compete to provide users with ever-increasing amounts of health data, providers may spend more time helping patients sort out whether the data is useful, or even accurate. Personal sleep-tracking data from smartwatches is one example, says Dimitriu. While smartwatches may provide basic information about some aspects of sleep, the technology is still evolving. Users may not know that the sleep-stage readings from a wrist-worn device are nowhere near as accurate as the data from a lab-based sleep study that tracks brain waves.
When Dimitriu talks technology with patients, he often educates them on the limitations of personal sleeptracking gadgets. “Sleep tracking is still emerging,” he says. “It’s now where health tracking was 10 years ago.” This type of technology is still in its infancy, agrees Swanson, but it presents opportunities for providers to address some of healthcare’s pressing problems, like how to care for growing patient panels and spend more meaningful time with each patient.
For example, digital tools can help providers scale messaging to create much-needed efficiencies in clinical settings. “Does a pediatrician need to tell each patient the same thing over and over in every appointment?” Swanson asks. “Using digital tools, we could send certain health messages specific to that appointment, or that child’s developmental stage, to a parent an hour before an appointment, and the parent could ask questions if needed. This has been a huge miss in the digital space.”
Health-tracking technology can also help bridge language, knowledge, and communication barriers between providers and patients, says Dimitriu. “Many of my patients use the Dalyio app to track moods, and it’s helpful because everyone’s version of ‘having a bad day’ or ‘a bad night’s sleep’ is different,” he says. “These devices also benefit users by adding awareness and granularity.”
When a patient tracks their own heart rate via a wrist-worn fitness monitor, they can reference a data point that helps inform decision-making, says Pizzolatto. “That gives a provider something more solid to go on than when a patient calls and says, ‘I feel like my heart is racing,’” she says.
And sometimes, home-based health technology is more about reassurance than actionable data. “If a patient wants to use a fetal Doppler monitor at home to hear their baby’s heartbeat, and it makes them feel better about their pregnancy, that’s fine with me,” says Pizzolatto. “But they still need to learn about doing a fetal-kick count to monitor the baby’s movement, because that’s the information their provider needs.” But, Pizzolatto points out, self-monitoring and the learning that comes with it can empower patients to make positive changes. “When patients are monitoring their own health, I think they’re more active participants in their own healthcare,” she notes. “And when patients work with their provider to develop a plan, we know they’re more likely to follow it, which leads to more positive outcomes.”
Ultimately, personal health-tracking is paving the way for providers to spot trends in patient populations that could track viral illness and speed pandemic response, says Swanson. “Patients like the shiny new app on their phone, but the potential for the back-end data is huge,” she says. “If a physician tracks 1,000 patients and can see trends in temperature, they’d be able to spot abnormalities and patterns too.”
Helping patients understand their own health data is central to the future of healthcare, says Swanson. “23andMe is a beautiful example of this,” she says. “[Founder] Anne Wojcicki was trying to emancipate personalized data. It doesn’t need to live in your health record. We can give it to you and help you understand it over time.”
Alex Dimitriu, MD, is dual board-certified and founded Menlo Park Psychiatry & Sleep Medicine. He treats patients with a wide variety of mental health–related issues such as anxiety, PTSD, depression, bipolar disorder, ADHD, and sleep disorders.
Kathleen Pizzolatto, CNM, ARNP, is an advanced-practice provider with CHI Franciscan. She provides care for women from adolescence through menopause, with a focus on gynecology and care for women during pregnancy and childbirth.
Wendy Sue Swanson, MD, served as founder and chief of digital innovation at Seattle Children’s Hospital before joining Before Brands as CMO. She leads communication to clinicians and parents around the development of early food allergies, and champions digital health, prevention, and healthcare advocacy.