The Tao of Wearables


The hype around wearables is deafening.  I say this from the perspective of someone who saw their application in chronic illness management 15 years ago. Of course, at that time, it was less about wearables and more about sensors in the home, but the concept was the same.

Over the years, we’ve seen growing signs that wearables were going to be all the rage. In 2005, we adopted the moniker ‘Connected Health’ and the slogan, “Bring health care into the day-to-day lives of our patients,” shortly thereafter.  About 18 months ago, we launched Wellocracy, in an effort to educate consumers about the power of self-tracking as a tool for health improvement.  All of this attention to wearables warms my heart.  In fact, Fitbit (the Kleenex of the industry) is rumored to be going public in the near future.

So when the headline, “Here’s Proof that Pricey Fitness Wearables Really Aren’t Worth It,” came through on the Huffington Post this week, I had to click through and see what was going on.  Low and behold this catchy headline was referring to a study by some friends (and very esteemed colleagues) from the University of Pennsylvania, Mitesh Patel and Kevin Volpp.

Other authors were Meredith Case and Holland Burwick.  Also notable was that the study was published in JAMA.  In this research letter, the authors compared several fitness wearables to smartphone-based apps as tools to track activity.  They asked healthy volunteers to walk either 500 steps or 1,500 steps on a treadmill, and compared step counts on multiple devices as well as on smartphone pedometer apps.  It is worth spending some time reviewing their data tables.

The first take-home for me was that steps counted on the wearable devices and the mobile apps, when walking on a treadmill, are pretty accurate.  I was somewhat chagrined to learn this. I have a treadmill desk and this time of year spend many evenings walking while reading email.  It always seems like I’m walking farther than the Fitbit tells me, but now I know I’m probably just tired at that hour.

Their main point, however, is that smartphone apps are as accurate as these wearable devices.  This makes sense intuitively, as we’ve known that smartphones have embedded accelerometers, which can be used to track the movement of the phone.  For years, there have been apps that can take this data and, by applying some software algorithms, show activity that the phone has traveled as steps walked by the owner.  I believe they were initially not so accurate. However, a bigger problem in the early days was that these apps drained the phone’s battery because the processor always needed to be on while tracking the accelerometer’s activity. This has been remedied in the most recent generation of mobile phones, as they now have separate processors dedicated to this sort of continuous tracking.

Thus, we have plentiful pedometer apps (a search on the Apple App store produced too many to count). We’ve also solved how to run these apps in the background without disrupting the phone tasks or draining the battery. So, is it time to ask, “do we really need fitness wearables anymore?

I’d frame the question a different way. Is the future of patient-generated data migrating to the mobile phone (the proverbial digital Swiss Army Knife of life) or will it be migrating to the realm of micro-sized wearable seeds, ingestibles, injectables, bandaids and the like?  I was a fellow panelist with tech guru and futurist Nicholas Negroponte, and in an off-handed comment, he said that wearables are just a temporary fad and that the future is in ingestibles.

On the one hand, it’s tempting to think about a world where all of your health-related data are generated on and analyzed by software resident on your mobile device. One big challenge to this vision is that we don’t always have our phones on our person. Some folks carry them in a bag, etc. This latter point calls into question the experiment that our friends at Penn did and, more impressively, that JAMA chose to publish it. The quality of the science is quite high but the applicability is questionable.

Also, there are many other health sensing applications than just pure activity tracking. What about continuous heart rate or blood pressure monitoring. It’s hard to imagine getting those done without some sort of sensor.

Going back to the eye-catching headline from the Huffington Post and channeling Mark Twain, I’d have to say that reports of the death of wearables have been greatly exaggerated. The power of sensor-generated data in personal health and chronic illness management is simply too powerful to ignore.

The last point to be made, however, is that wearables and their attendant feedback loops are relatively weak motivators on their own. In fact, the same group from Penn came out with an opinion piece, also in JAMA one week earlier, thoughtfully talking about this point.  Our Connected Health research team at Partners HealthCare has shown repeatedly that the motivational messaging that puts these feedback loops in context is the true driver of behavior change.

That will no doubt be delivered via your smartphone!

Joseph Kvedar heads the Center For Connected Health.

18 replies »

  1. Dr. Jha,

    the short answer to your question – EVERYONE will have access to the data.

    Don’t think so? just ask Ashley Madison. or 20 million US Govt workers. or anyone who shopped at Target.

    Also expect to be bombarded by advertisements for Ambien, et. al, when your “fitbit” discovers that you do not get 8 hrs of REM sleep per night.

    And maybe ads (sent to your computer, or cellphone) for Viagra when fitbit determines (by using its patented software) that you only were able to get to a 4 out of 5 on your “IIEF” –

    And when you file for disability after being injured in an accident, your insurance carrier will deny you based on the fact that you were able to reach 9 METS at least 2x per week.

    All that so millenials can brag about how many steps they took on the way to Starbucks.

  2. I appreciate your re-framing of the question, Joe. I would add that the smartphone is a conduit and display screen of all user-generated data, which in many cases makes it complementary rather than substitutive to these ‘extender’ devices, whether wearables or sensory devices that extend a smartphone’s native sensory capabilities.

    Data gathered from ingestibles, like your motivational messages, will be displayed via smartphone. The ability of these ‘extender’ devices to remain relevant depends in part on the rate that smartphones add new embedded sensors. That being said, I see the phone OEMs staying within a basic range of embedded sensors that ‘device developers’ can extend upon, develop software for, and contribute to the phone’s ecosystem…much the way that the app stores have functioned on the software side. Fostering the success of dependent entrepreneurs is good business for the smartphones.

    I think this becomes even more clear as we look beyond the ‘quantified self’ users in the U.S. to the very serious medical applications that smartphones offer consumers too poor to have had access to more traditional diagnostic / treatment methods. One of my recent posts explores this through the lens of diabetes in India: http://www.globalhealth.care/2015/02/smartphones-enable-patients-to-manage.html

  3. I think a better name should be invisibles. There is a general denial of all things health by the people most in need of help. Yes, you can get the “superfit” to buy and wear “wearables,” but try giving it to the average senior with mild weight issues and diabetes- no way. The problem is that most people deny their own frailty and mortality. My friend Khan Siddiqui, founder of Higi, has it right. Health monitoring has to be a by product or another pleasurable activity, something transparent, invisible, to the wearer.

  4. Isabelle Falque-Pierrotin is CNIL President and Chair of the WP29 group of the EU national data protection authorities. At a talk today at the MIT Media Lab, (will be posted soon at http://www.media.mit.edu/video/talks ) she predicted that wearables will drive attention to industry privacy practices and cause people to demand meaningful consent and choice.

    The MIT Media Lab is arguably the heart of the Big Data and Wearable Sensors discussion.

    More tweets about the European perspective delivered today are at #MLTalks

  5. As Adrian infers, once again, technology advances are far outstripping policy. Today’s consumer cares little about privacy if it gets them a discount, use of a free app etc. What is worrisome is what will happen in say 2, 3, 5 yrs time when all of the sudden folks are being denied life insurance or disability insurance, maybe they are seen as potential credit risk and the list goes on.

    We are treading on very thin ice.

  6. Our surveys at the Health Research Institute highlight the current contradiction. Consumers have great faith in — and high expectations for — health wearables. In one survey 56% of adults said they believe wearables can extend longevity by 10 years. Yowsa! But here’s the rub: they don’t want to spend much money on devices themselves and they confess they lose interest after a few months. So great potential, but big hurdles.
    Full report here:

  7. Put these comments together:

    > It will help least those who most need it.

    > this matters to a generally healthy adult how? … What makes you think people want or need this?

    Whether wearables, ingestibles, patches, whateverables, health tracking consumer tech has not met its killer app. Right now it’s for people who have an opinion about kale, the high-information worried well. Its killer app is when it becomes part of a solution to how do we drive down costs by taking better care of the chronically ill, especially the low-information and often low-income chronically ill. For organizations that put themselves at economic risk for the health of these populations, these magic gadgets will be a wonder. So the “which device?” question goes moot — it will depend on which modality works best with each particular population, patient, and caregiver.

  8. I don’t carry my smartphone with me most of the time. It’s usually on my desk or in my bag.

    I do wear a Fitbit; I started 18 months ago, because I was wondering if the sleep and step tracking might be useful for helping stressed out middle aged caregivers (who may or may not be carrying smartphones all the time).

    I think connected health devices will have a role in helping patients and clinicians collaborate to improve a patient’s health. But Adrian Gropper’s points are well taken; we are allowing ourselves to be under surveillance and I just hope the information won’t be abused by insurers and marketers.

  9. Will my wife have access to the data?

    I don’t want her to see what (or who) gives me a flutter.

  10. Here’s my pitch for a show …

    Let’s update SuperSize Me for the data-driven, tracker obsessed era

    We’ll create Quantified Guy. We will take an ordinary guy and we’ll monitor him – we’ll track his every movement and his every function / his every level / his every lipid

    Quantified Woman would be equally interesting, if not superior

    Are you out there AMC?

  11. This all sounds very exciting.

    My kids have accidentally told me I’m getting a watch which tracks HR, calories, distance, etc as a surprise for my birthday. Suddenly I’ll be flooded with data which will say what I already suspect – I need to get off my posterior more often.

    Wearables have the potential to help the poor, un empowered chronically ill.

    I think it will use by the rich, over empowered, chronically worried well (and a few weekend warriors like me).

    It will be most useful in upper east side Manhattan when the ambulance can respond promptly to ST segment elevation.

    It will help least those who most need it.

  12. Figure out a way to measure oxygen consumption easily and you would become rich indeed. It is supposed to be the principal coorelate of muscle fitness. But I think you have to measure oxygen in vs oxygen out while riding a bike or doing work for a given time.

  13. It’s entirely possible that Fitbit and its offshoots/competitors will prove to be a fad that will fade in time. But I hope not. They can be fun motivators and could play an important role in addressing obesity and sedentary lifestyle. The emerging adoption of Apple’s HealthKit by several leading health centers is a good sign that “patient engagement” tech will spread. How fast and deep is still an open question.

  14. Does it really matter whether the monitor is a home monitor, your phone, your wearable, your ingestible, or your implant?

    We’re sure to have all of these from Samsung TVs that send your room conversation to the cloud ( http://techcrunch.com/2015/02/10/smarttv-privacy/#Gu11mE:XT1 ), to Hello Barbie that sends your daughter’s conversation to the cloud ( http://www.networkworld.com/article/2885757/microsoft-subnet/how-long-will-it-take-for-internet-of-things-hello-barbie-to-be-hacked.html ), to pretty much every activity tracker, to your implantable cardiac defibrillator ( http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiac-rhythm/patient-management-carelink/medtronic-carelink-network-for-cardiac-device-patients/index.htm ).

    The common denominator is that the boundary we used to know is now being breached routinely. We are approaching total corporate surveillance. Our data is being sold, and worse, it’s being stored for whatever uses might be profitable at some point in the future. What will they be able to deduce from this data three years from now? Why would anyone take the chance by participating?

    The thing is that all of this surveillance is unnecessary. Our monitoring devices could be open source software. Voice recognition can run on a $10 chip without going out to the cloud. Our cloud connections could be pairwise pseudonymous the way Apple HealthKit deals with health apps. Out terms-of-use could limit data retention to 10 seconds or the duration of a session.

    Who will set these limits and help develop the new social norms?


  15. “Also, there are many other health sensing applications than just pure activity tracking. What about continuous heart rate or blood pressure monitoring. It’s hard to imagine getting those done without some sort of sensor.” — And this matters to a generally healthy adult how? For what purpose? Who’s going to analyze it? At what cost? Will it lead to the inevitable reimbursable visit “just to follow up on that one little suspicious blip in your heart rate?” What makes you think people want or need this?

    How about a sensor that tells me when there is doctor near by, so that I can run in the other direction?