When the report called Tracking for Health was released last month, media headlines announced:
“Over Two-Thirds Track Health Indicators!”
This statistic, borrowed from the Pew Research Center’s Internet & American Life Project’s report, referred to the 69 per cent of people who say they keep track of things like their weight, exercise, heart rate, food, stress or other health indicators. It also, however, includes almost half of self-reporting trackers who, according to Pew’s Susannah Fox, track these health indicators for themselves or others – but only in their heads.
Surprisingly, very few headlines ran the real news from the report:
“Only 21% Use Technology to Self-Track!”
The 21% who report using some kind of self-tracking technology are split among using a medical device (like a glucometer), phone app, spreadsheet, or website.
Yet as of last autumn, more than 500 tech companies are busy developing The Next Big Thing in self-tracking tools.
So after the Pew report came out, Fard Johnmar wrote in his DigiHealth Pulse column last month:
“The disconnect between consumers’ low appetite for technology and the activities of these developing new self-tracking technology tools has some wondering whether technology will ever ‘win the hearts and minds’ of most.
“It may take some time for self-tracking technologies to reach the mainstream, if a majority of digital health early adopters are not yet using them.”
Two systematic reviews by Dr. Caroline Free published in the journal PLOS Medicine last month examined evidence on whether mobile technology can help improve health behaviours, improve disease self-management, or help health care delivery processes.
Her conclusions? First, that rigorous studies in low- and middle-income settings (where experts believe that mobile health technology may have tremendous potential) largely do not exist.
In the first study, only three of the 75 clinical trials involving patients considered to be good quality trials with a low risk of bias showed any clear benefits: two of these tested health tech interventions developed to help smokers quit (both conducted in the U.K.) and one trial in Kenya examined an intervention that helped HIV-positive patients take their medications accurately. That’s three trials out of 75 investigated.*
The second study was a systematic review that evaluated the effectiveness of mobile technology-based interventions for health care providers or services. Researchers reviewed 32 trials of interventions designed to support communication among health care providers, and 10 trials of interventions targeting communication between health services and their health care consumers (things like appointment reminders and information about test results).**
Results showed only “modestly improved aspects of clinical diagnosis and management”. Most notably, the use of mobile technology-based photos for diagnosis resulted in incorrect diagnoses compared with face-to-face-diagnosis.
And despite what the health tech hypemeisters are assuring us, technology like patient appointment reminders was better than no reminders, but not better than reminders by phone or mail.
The trouble with us pesky patients – specifically those living with serious chronic health issues who would likely benefit most from monitoring these health indicators – is precisely that: we are patients.
As such, we represent a demographic described by Mayo Clinic physician Dr. Victor Montori as those who struggle with what’s known as “the burden of treatment“. He explains:
“A patient’s education level, literacy, state of depression, pain, fatigue, social connectivity and supports, financial status – all of these affect a patient’s capacity to do the ‘work’ of being sick.
“This workload can simply exceed capacity to cope.”
David E. Williams, in his January Health Business post called Health Tracking Apps Not Yet Ready to Make a Big Impact, added that the current generation of health apps is not going to take us very far, and here’s why:
“It’s tedious to enter data, and many people would rather just forget about their illness then spend a lot of time gathering, entering and analyzing it. And even if the information is tracked it doesn’t mean it will be used.
“Until we get to really smart, passive devices, which will take a decade or more, you should expect to see successive editions of the Pew report saying more or less what this one says.”
This article also appeared as guest post on the Center for Advancing Health’s Prepared Patient blog on April 8, 2013.
* “The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review”, Free C, Phillips G, Galli L, Watson L, Felix L, et al. (2013) PLoS Med10(1): e1001362. doi:10.1371/journal.pmed.1001362
** “The Effectiveness of M-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis”, Free C, Phillips G, Watson L, Galli L, Felix L, et al. (2013)
PLoS Med 10(1): e1001363. doi:10.1371/journal.pmed.1001363
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