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Pardon my cynicism, but it strikes me either as naivety or fanboy-ism to label the Apple Watch as the "tipping point" for healthcare tech. Wearables for consume

Pardon my cynicism, but it strikes me either as naivety or fanboy-ism to label the Apple Watch as the "tipping point" for healthcare tech. Wearables for consumer health that touch on actual healthcare in a few areas are a pretty low hanging, low yield fruit if you want to talk about 'disrupting' the industry. Maybe I'll eat my words in a few years when wearables somehow force EHR systems to be interoperable or tackle some of the other massive issues in healthcare tech. I doubt it, though. This is nothing against the Watch tech itself. There's probably a lot of cool applications for that tech. I just don't think Apple's advancement of wearables is monumental to the healthcare industry, or potentially disruptive. > The FDA – Running Hard to Keep Up With Disruption Honestly, I don't really know what he's talking about with this 'disruption.' Just because the FDA is trying to keep pace with all the tech being built by health tech startups, it doesn't mean anything is getting disrupted. I have yet to see what I would consider a disruptive technology sweeping over the healthcare industry.

nradov 8y ago
Today the primary driver for clinical systems interoperability is federal government regulations (Meaningful Use, HITECH Act, MACRA, etc) plus requirements from payers (insurers). Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs, but that's really for iPhone / iPad devices and not directly related to wearables. EHR vendors are actively working to enhance their applications to cope with new data streams coming in from consumer wearables as well as connected home healthcare devices such as smart scales and blood pressure monitors.
- kendallpark 8y ago
  > Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs Is this actually the case? I haven't heard any talk of this at my institution, or on r/medicine.
  - nradov 8y ago
    Apple has signed up a number of prominent provider organizations but it's certainly not universal. Federal regulation will probably be necessary to get that data opened up everywhere.
gwbas1c 8y ago
The point will come when not regularly wearing one of these devices is considered hazardous to one's health... And this point will probably come before self-driving cars. Some examples: I always wondered why I had a lot of trouble sleeping. Doctors laughed at me, until an orthodontist told me I should get checked for sleep apnea. Turns out I had very severe sleep apnea. I would have like this diagnosed much sooner in my life. My Dad had afib, had it been diagnosed sooner, his surgery wouldn't have been a "get it done now" situation. Once the true positives outweigh the false positives, everyone's going to consider these essential for health. That moment will probably be in 2-5 years.
- breckuh 8y ago
  > The point will come when not regularly wearing one of these devices is considered hazardous to one's health I 100% agree. I think we are on the cusp of the "cyborg" era, like it or not. Humans will wear health tracking devices at all times. Already 10M+ do, from basically 0 a decade ago. Personally the sleep tracking and heart rate data from wearing my bands since 2014 led me to a diagnosis and fix for a number of health issues. But the real promise lies ahead, as new and better sensors are engineered. In addition to helping with traditional health issues, devices will increasingly allow the conscious part of your mind to have real-time self-awareness of the biological factors going on that influence your thoughts and decisions and answer questions like these: - Did you say "no" to that thing because it was the right decision or because your blood glucose level was so low? - Was your high productivity level today a fluke or influenced by the high caffeine level in your system? - How "tired" are you really? Some people might not like it, but I don't know if they'll have a choice. Not taking advantage of these technologies would put them at a disadvantage in school, work, sports, and perhaps all other areas in life. I think that moment is more like 10-20 years out, but otherwise agree with you.
pg_bot 8y ago
Speaking as someone who owns a company that makes electronic health records, interoperability between systems is not the bottleneck that people in technology think it is. The time it takes to request and receive records on a patient is measured in days not minutes. Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself. (Why would I expect EPIC to be able to talk with Cerner if it can't even talk with itself) I think most doctors and patients would agree that getting information in a timely manner is more important than the mechanism by which it is transferred. While interoperability is something to strive for it's not the thing holding the system back.
- kendallpark 8y ago
  > Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself. This is what I'm talking about. We're so far away from actual interoperability it's not even funny. > The time it takes to request and receive records on a patient is measured in days not minutes. Yup. > While interoperability is something to strive for it's not the thing holding the system back. Not sure I follow you. The siloed data seems to be a pain point for most docs. Patient is admitted for evaluation of X, Y, Z concerning symptoms. Patient was admitted to a different hospital a week ago for the same symptoms. Different hospital is on a different system, so I can't get the patient's history from that visit. Guess I need to have the records faxed over tomorrow morning. In the meantime, let me go order a bunch of tests that are probably totally redundant to what was run last week, but I can't get that data right now, so gotta run them again. Huh, that's a interesting x-ray. Wish I had the prior.
  - pg_bot 8y ago
    The problem is that the fax takes until tomorrow morning, not that it comes as a fax. You could get the information over the phone, carrier pigeon, or smoke signal it doesn't matter the mechanism. (the latter two are likely not HIPAA compliant) The systems could be completely interoperable, but you would still have the same bureaucracy that slows everything down. Just because the systems can talk to each other, it doesn't mean that I can just automatically grab whatever patient data whenever I want. There are rules and procedures you need to follow when dealing with PII. If you are cavalier with these systems you will be fined or sued into oblivion. Time until transfer of data is the hard part, which is independent of interoperability. There are bigger fish to be fried in this space, so if we are triaging healthcare technology I would put this low on my list of things to take care of.

nradov 8y ago

Today the primary driver for clinical systems interoperability is federal government regulations (Meaningful Use, HITECH Act, MACRA, etc) plus requirements from payers (insurers). Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs, but that's really for iPhone / iPad devices and not directly related to wearables. EHR vendors are actively working to enhance their applications to cope with new data streams coming in from consumer wearables as well as connected home healthcare devices such as smart scales and blood pressure monitors.

kendallpark 8y ago
> Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs Is this actually the case? I haven't heard any talk of this at my institution, or on r/medicine.
- nradov 8y ago
  Apple has signed up a number of prominent provider organizations but it's certainly not universal. Federal regulation will probably be necessary to get that data opened up everywhere.

gwbas1c 8y ago

The point will come when not regularly wearing one of these devices is considered hazardous to one's health... And this point will probably come before self-driving cars. Some examples: I always wondered why I had a lot of trouble sleeping. Doctors laughed at me, until an orthodontist told me I should get checked for sleep apnea. Turns out I had very severe sleep apnea. I would have like this diagnosed much sooner in my life. My Dad had afib, had it been diagnosed sooner, his surgery wouldn't have been a "get it done now" situation. Once the true positives outweigh the false positives, everyone's going to consider these essential for health. That moment will probably be in 2-5 years.

breckuh 8y ago
> The point will come when not regularly wearing one of these devices is considered hazardous to one's health I 100% agree. I think we are on the cusp of the "cyborg" era, like it or not. Humans will wear health tracking devices at all times. Already 10M+ do, from basically 0 a decade ago. Personally the sleep tracking and heart rate data from wearing my bands since 2014 led me to a diagnosis and fix for a number of health issues. But the real promise lies ahead, as new and better sensors are engineered. In addition to helping with traditional health issues, devices will increasingly allow the conscious part of your mind to have real-time self-awareness of the biological factors going on that influence your thoughts and decisions and answer questions like these: - Did you say "no" to that thing because it was the right decision or because your blood glucose level was so low? - Was your high productivity level today a fluke or influenced by the high caffeine level in your system? - How "tired" are you really? Some people might not like it, but I don't know if they'll have a choice. Not taking advantage of these technologies would put them at a disadvantage in school, work, sports, and perhaps all other areas in life. I think that moment is more like 10-20 years out, but otherwise agree with you.

pg_bot 8y ago

Speaking as someone who owns a company that makes electronic health records, interoperability between systems is not the bottleneck that people in technology think it is. The time it takes to request and receive records on a patient is measured in days not minutes. Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself. (Why would I expect EPIC to be able to talk with Cerner if it can't even talk with itself) I think most doctors and patients would agree that getting information in a timely manner is more important than the mechanism by which it is transferred. While interoperability is something to strive for it's not the thing holding the system back.

kendallpark 8y ago
> Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself. This is what I'm talking about. We're so far away from actual interoperability it's not even funny. > The time it takes to request and receive records on a patient is measured in days not minutes. Yup. > While interoperability is something to strive for it's not the thing holding the system back. Not sure I follow you. The siloed data seems to be a pain point for most docs. Patient is admitted for evaluation of X, Y, Z concerning symptoms. Patient was admitted to a different hospital a week ago for the same symptoms. Different hospital is on a different system, so I can't get the patient's history from that visit. Guess I need to have the records faxed over tomorrow morning. In the meantime, let me go order a bunch of tests that are probably totally redundant to what was run last week, but I can't get that data right now, so gotta run them again. Huh, that's a interesting x-ray. Wish I had the prior.
- pg_bot 8y ago
  The problem is that the fax takes until tomorrow morning, not that it comes as a fax. You could get the information over the phone, carrier pigeon, or smoke signal it doesn't matter the mechanism. (the latter two are likely not HIPAA compliant) The systems could be completely interoperable, but you would still have the same bureaucracy that slows everything down. Just because the systems can talk to each other, it doesn't mean that I can just automatically grab whatever patient data whenever I want. There are rules and procedures you need to follow when dealing with PII. If you are cavalier with these systems you will be fined or sued into oblivion. Time until transfer of data is the hard part, which is independent of interoperability. There are bigger fish to be fried in this space, so if we are triaging healthcare technology I would put this low on my list of things to take care of.