Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Patients Favor Tracking, Sharing Health Data

Posted on February 3, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

To date, I’d argue, clinicians have been divided as to how useful medical statistics are when they come straight from the patient. In fact, some physicians just don’t see the benefit of amateur readings. (For example, when I brought my own cardiologist three months of dutifully-logged blood pressure and pulse readings, she told me not to bother.)

Research suggests that my experience isn’t unique. One study, released mid-last year by market research firm MedPanel, found that only 15% of physicians were recommending wearables or health apps to patients as tools for growing healthier.

But a new study has found that patients side with health-tracking fans. According to a new study released by the Society for Participatory Medicine, 84% of respondents felt that sharing self-tracking stats such as blood glucose, blood pressure, heart rate and physical activity with their clinician would help them better manage their health. And 77% of respondents said that such stats were equally important to both themselves and their healthcare professional.

And growing numbers of healthcare professionals are getting on board. A separate study released last year by Research Now found that 86% of 500 medical professionals said mHealth apps gave them a clearer understanding of a patient’s medical condition, and 76% percent felt that apps were helping patients manage chronic illnesses.

Patients surveyed by the SPM, meanwhile, seemed downright enthusiastic about health trackers and mobile health:

* 76% of adults surveyed would use a clinically-accurate and easy-to-use personal monitoring device
* 57% of respondents would like to both use such a device and share the data generated with a professional
* 81% would be more likely to use a consumer health monitoring device if their healthcare professional recommended such a device

Realistically, medical pros aren’t likely to make robust use of patient-generated data unless that data can be integrated into a patient’s chart quickly and efficiently. Some brave clinicians may actually attempt to skim and mentally integrate data from a health app or wearable, but few have the time, others doubt the data’s accuracy and yet another subgroup simply finds the process too awkward to endure.

The bottom line, ultimately, seems to be that patient-generated data won’t find much favor until hospitals and medical practices roll out technologies like Apple’s HealthKit, which pull the data directly into an EMR and present it in a clinician-friendly manner. And some medical pros won’t even be satisfied with a good presentation; they’ll only take the data seriously if it was served up by an FDA-approved device.

Still, I personally love the idea of participatory medicine, and am happy to learn that health trackers and apps might help us get closer to this approach. As I see it, there’s no downside to having the patient and the clinician understand each other better.

Will AI (Artificial Intelligence) Provide Your Own Personal Health Coach?

Posted on November 20, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Adhering to the principle that health improvement is based on sustained behavior change, and that behavior change is based on a profound intervention by health care providers in a patient’s daily activities, a certain fantasy has made the rounds of the health care industry. In this article I’ll describe this fantasy and a product by Lark Technologies that starts to realize the fantasy in real life.

First, a bit of comparison. Some 15 years ago I shed a lot of weight (and kept it off) through firm but supportive monitoring by the health care profession. I went to my primary care physician every three months, and visited a nutritionist twice. I also exploited my personal network, conveying my goal to all my friends and lining them up to support eating habits that would lead there.

This model doesn’t scale well. Furthermore, a visit every 90 days is no match for the temptations that scream at me from the billboards and restaurant windows. (Believe me, as a chronic dieter I am very aware of the food industry’s marketing techniques.) So numerous technologists have imagined virtual assistants that follow you around and act like an intrusive Mom, asking you why you’re buying that donut or whether you’ve signed up for the health club yet.

These assistants would have to be subtle and very well tailored to your personal style to be affective. At the recent Connected Health Conference, MC Joseph Kvedar laid out a requirements list for such assistants. They must be:


To serve billions of people, these systems can’t depend on constant communication with health professionals. Somehow, software must be observer of your habits, come to know you from your demographics and health conditions, and intervene at appropriate moments with messages that have a chance of getting through the armor of your established routines.


This fancy word just reflects the kind of empathetic adaptions each of us does all the time to reflect the situation we’re in. Just as we would shout “Stop” to someone about to step in front of a trolley but “Excuse me, did you want this trolley?” to someone absorbed in her cell phone, contextual software understands that you like donuts (but would enjoy a good fruit salad if offered one), that you like to exercise before work instead of at lunch time, and so on. The interventions it makes for each person would be unique.


Positives work better than negatives in getting people to go along with suggestions. “Did you know that another round on the track will put you ahead of your walking record for yesterday?” works better than “Hey, you’ve been sitting for two hours–get up!”


If a user doesn’t like an app, he always has the option of turning it off. Therefore, a health app must reflect the user’s goals, not the goals of hie doctor, his daughter, or the Centers for Medicare & Medicaid Services. Empowering software will ask you what matters to you–for instance, being able to play with your grandchildren or stay in your third-story apartment–and remind you of these goals as a way to persuade you to stay on track.


I find this trait a bit redundant, if software is empowering. Dr. Kvedar suggested that people using this kind of personal agent get a discount on their health care premiums. I’m a fan of intrinsic rewards, myself. But the distinction can be hard to make. If an app sends you a message from your wife saying, “So proud that you lost five pounds this week!” is it an intrinsic or extrinsic reward?

At the conference I had the privilege of meeting with Julia Hu, cofounder and CEO of Lark Technologies, who showed off their personal weight loss coach, Lark Chat (available for download for Apple and Android). It was amazing how closely this software–available since this past April–matched the simulation that Dr. Kvedar showed off in his opening talk.

Lark Chat uses Siri software to accept voice input or a text message, which is then submitted to artificial intelligence software to respond appropriately to the user. When I told it what I (pretended I) had for lunch, the software readily understood french fries and salad, and made a comment on each. It did not understand what to do with breaded, fried fish, which ought to have triggered a warning. But it has been trained to understand a number of different foods enjoyed by different ethnic groups. Users can also opt into sharing the data collected by Lark so that it can run analytics and improve its interventions.

The interface is enjoyable and popular. According to Hu, “Over the last four months, the Lark coach and its users have text messaged each other 350,000,000 times. Based on a typical chronic disease case manager’s load, that’s equivalent to 25,402 full time nurses and coaches.” This adds up to the longest user engagement record of any interactive apps in the weight loss space.

The industry has been taking notice. Business Insider recently named Lark one of the 10 most innovative apps in the world, and Apple once featured it as the “Best New App” in their App Store. Forrester Research named Lark the “Most Innovative Digital Health Product of the Year” in 2015 and published an exclusive report on it.

People are getting accustomed to apps such as Foursquare and interfaces such as Siri that in previous ages might have been seen as annoyingly intrusive. As our relationships to devices and software evolved, we may find apps such as Lark Chat the perfect support for behavior change. And we may all become better people as a result. If only Mom could have created an app for me.

Wearables Data May Prevent Health Plan Denials

Posted on August 27, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This story begins, as many do, with a real-world experience. Our health plan just refused to pay for a sleep study for my husband, who suffers from severe sleep apnea, despite his being quite symptomatic. We’re following up with the Virginia Department of Insurance and fully expect to win the day, though we remain baffled as to how they could make such a decision. While beginning the complaint process, a thought occurred to me.

What if wearables were able to detect wakefulness and sleepiness, and my husband was being tracked 24 hours a day?  If so, assuming he was wearing one, wouldn’t it be harder for a health plan to deny him the test he needed? After all, it wouldn’t be the word of one doctor versus the word of another, it would be a raft of data plus his sleep doctor’s opinion going up against the health plan’s physician reviewer.

Now, I realize this is a big leap in several ways.

For one thing, today doctors are very skeptical about the value generated by patient-controlled smartphone apps and wearables. According to a recent survey by market research firm MedPanel, in fact, only 15% of doctors surveyed see wearables of health apps as tools patients can use to get better. Until more physicians get on board, it seems unlikely that device makers will take this market seriously and nudge it into full clinical respectability.

Also, data generated by apps and wearables is seldom organized in a form that can be accessed easily by clinicians, much less uploaded to EMRs or shared with health insurers. Tools like Apple HealthKit, which can move such data into EMRs, should address this issue over time, but at present a lack of wearable/app data interoperability is a major stumbling block to leveraging that data.

And then there’s the tech issues. In the world I’m envisioning, wearables and health apps would merge with remote monitoring technologies, with the data they generate becoming as important to doctors as it is to patients. But neither smartphone apps nor wearables are equipped for this task as things stand.

And finally, even if you have what passes for proof, sometimes health plans don’t care how right you are. (That, of course, is a story for another day!)

Ultimately, though, new data generates new ways of doing business. I believe that when doctors fully adapt to using wearable and app data in clinical practice, it will change the dynamics of their relationship with health plans. While sleep tracking may not be available in the near future, other types of sophisticated sensor-based monitoring are just about to emerge, and their impact could be explosive.

True, there’s no guarantee that health insurers will change their ways. But my guess is that if doctors have more data to back up their requests, health plans won’t be able to tune it out completely, even if their tactics issuing denials aren’t transformed. Moreover, as wearables and apps get FDA approval, they’ll have an even harder time ignoring the data they generate.

With any luck, a greater use of up-to-the-minute patient monitoring data will benefit every stakeholder in the healthcare system, including insurers. After all, not to be cliched about it, but knowledge is power. I choose to believe that if wearables and apps data are put into play, that power will be put to good use.