Turf Battles and Collateral Damage: Are We Really Putting the Patient First?

Last week, Medpage Today reporter Sarah Wickline Wallan tackled a very controversial issue in medical practice.  In her piece, Ms Wallan explores the ongoing battle between Dermatologists and AHPs (Allied Health Professionals) over the performance of dermatologic procedures.  As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified Dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice. According to the Journal of the American Medical Association, nearly 5 million dermatological procedures were performed by NPs and PAs last year–this has Dermatologists seeking practice limits–ostensibly to protect “bread and butter” revenue streams from biopsies, skin tag removals and other common office based interventions.

In response to this controversy and the article, I was asked to provide commentary for Med Page Today’s Friday Feedback.  Each week, the editors at MPT discuss a controversial topic and have physicians from all over the country share their feelings on the issue in order to provide readers with a mulit-specialty perspective.  This “Friday Feedback” feature is typically released on the web near the end of the day on Fridays and often spurs a great deal of social media activity and discussion.  Based on reaction to Ms Wallan’s article our topic this past Friday was “Specialty Turf Battles”.  Each respondent was asked to provide commentary on the growing angst between Dermatologists and Allied Health Professionals.    As I began to reflect on the issue itself and its potential impacts on all aspects of medicine, I felt that a complete blog would be a more complete forum to discuss my thoughts.

First of all I want to say that AHPs are essential to providing care in the era of the Affordable Care Act.  NPs and PAs are able to help meet the needs of underserved areas and do a remarkable job complementing the care of the physicians with which they work.  With the rapidly expanded pool of newly insured, as well as the increase in administrative tasks (electronic documentation) assigned to physicians, AHPs must help fill in the gaps and ensure that all patients have access to care.  In my practice we are fortunate to have many well qualified AHPs that assist us in the care of our patients both in the hospital as well as in the office.

We must remember, however, that physicians and AHPs have very different training.  Each professional posses a unique set of skills and each skill set can complement the others.  Many of us in specialty areas spend nearly a decade in post MD training programs and learn how to care for patients through rigorous round the clock shifts during our Residency and Fellowship years.  In addition, we spend countless hours performing specialized procedures over this time and are closely supervised by senior staff.  Most AHPs, in contrast, do not spend time in lengthy residencies and often have limited exposure to specialized procedures.  Turf battles have existed for decades and are certainly not limited to Dermatology–nor or they limited to MDs vs AHPs.  In cardiology in the late 1990s, for instance, we struggled with turf battles with Radiology over the performance of Peripheral Vascular Interventions.  In many areas, these battles resulted in limited availability of specialized staff to patients and a lack of integrated care.  Ultimately, the patients were the ones who suffered.

Fortunately, in the UNC Healthcare system where I work (as well as others across the country) we have taken a very different approach.  After observing inefficiencies and redundancy in the system, several years ago our leadership (under the direction of Dr Cam Patterson) decided to make a change.  The UNC Heart and Vascular Center was created–Vascular surgeons, Cardiologists, Interventional Radiologists, and Cardiothoracic surgeons–all working under one cooperative umbrella.  Patients are now discussed and treated with a multidisciplinary approach–Electrophysiologists and Cardiothoracic surgeons perform hybrid Atrial Fibrillation ablation procedures, Vascular surgeons and Interventional Cardiologists discuss the best way to approach a patient with carotid disease–all working together to produce the BEST outcome for each individual patient.  We have seen patient satisfaction scores improve and we have noted that access to multiple specialty consultations has become much easier to achieve in a timely fashion.  Most importantly, communication among different specialties has significantly improved.

Unfortunately, with the advent of the ACA and decreasing reimbursement I suspect that turf battles will continue.  Financial pressures have become overwhelming for many practices and the days of the Private Practice are limited–more and more groups will continue to “integrate” with large hospital systems in the coming years.  Specialists such as Dermatologists and others will continue to (rightly so) protect procedures that provide a revenue stream in order to remain financially viable.  However, I believe that our time will be better spent by working together to improve efficiency of care, quality of care and integration of care.  NPs and PAs are going to be a critical component to health care delivery as we continue to adapt to the new (and ever changing) ACA mandates.  We must put patients FIRST–turf battles and squabbles amongst healthcare providers will only limit our ability to provide outstanding, efficient care.  Let’s put the most qualified person in the procedure room–and make sure that ultimately patients get exactly what they need.

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The Dangerous Stranger Lurking in the Dark: Using the AliveCor Device to Identify Asymptomatic Atrial Fibrillation

Surgery has many well defined risks–we perform procedures when the benefits far outweigh the risks.  As healthcare providers, it is our job to carefully discuss the risks and benefits of any medical procedure with our patients prior to the planned procedure and make sure that they understand what we are doing, why we are doing it and what our ultimate goals include.  We often discuss bleeding, infection, and other common post operative risks and then other risks that are specific to the particular procedure being performed.  Now there may be a new perioperative clinical marker–atrial fibrillation–that can identify patients at risk for other complications such as stroke, long after discharge from the hospital.  Atrial fibrillation is the most common heart rhythm problem in the entire world and is associated with stroke in patients who are at risk.

This past week the Journal of the American Medical Association published a new study examining both the incidence of atrial fibrillation after ANY surgery as well as the conferred risk of stroke.  The study involved over 1 million patients and the results were quite alarming–nearly 28K patients had peri-operative atrial fibrillation and of those, almost 14K patients experienced strokes that occurred after discharge.  Even more disturbing was the fact that the rate of atrial fibrillation was even higher in non cardiac surgery patients (as compared to those undergoing cardiac surgery).  Many surgical patients may be discharged without knowing that they have atrial fibrillation or that they are at risk.  Some may present with cryptogenic strokes and suffer life changing devastation.  The data is very clear about the prevention of stroke in atrial fibrillation.  Based on a risk score (known as the CHADS2-vasc) we are able to quickly calculate and assess risk for stroke (based on several common predisposing factors) and appropriately choose an anticoagulant for each patient.  It is also clear that anticoagulation in high risk populations reduce stroke rates significantly.

There is no doubt that atrial fibrillation results in significant morbidity and mortality in the US today.  According to data from Circulation published in 2013, one in every 19 deaths is due to atrial fibrillation related stroke and nearly $37 billion dollars is spent on patient care due to this disease.   Even  more disturbing is the fact that many patients with atrial fibrillation are totally asymptomatic and may not even know they have the arrhythmia at all—many patients’ first presentation with atrial fibrillation is sadly a presentation with a devastating stroke.  The recent article in JAMA further emphasizes the negative impact that silent atrial fibrillation can have on patients.  As clinicians, we remain vigilant for the presence of atrial fibrillation and often we are able to identify and screen those at high risk–however, many patients are missed and preventative therapy with anticoagulation is never prescribed.

What is the Answer?  How can we better screen asymptomatic patients for atrial fibrillation in a cost effective, broad based way?

The Alive Cor iPhone EKG application and device is the first of its kind.  It is an FDA approved device that can record a single lead electrocardiogram directly from your fingertips, display the tracing on the iPhone screen and transmit the tracing to the cloud for review.  The device is now available direct to consumers for purchase and no longer requires a physician prescription.  In May, a clinical trial was published that demonstrated that the Alive Cor device could be used to easily screen large groups of consumers for atrial fibrillation in a cost effective way.  In the study, which was published in May in Thrombosis and Haemostasis, investigators screened 1000 asymptomatic pharmacy customers for atrial fibrillation using the Alive Cor device and found that 1.5% of them actually had atrial fibrillation upon screening.  The cost effectiveness per stroke saved in the US was estimated to be a cost savings of nearly 20%.

Given the high prevalence of both symptomatic and asymptomatic atrial fibrillation worldwide, it is essential that healthcare providers strive to do a better job screening for this sometimes silent disease.  The identification of patients at risk for stroke from atrial fibrillation (and subsequent anticoagulation) is the best way to reduce both the cost and devastating morbidity and mortality associated with the disease.  With technology such as the AliveCor device readily available to both patients and clinicians it is essential that we begin to utilize this device for massive, cost effective screening efforts.  As healthcare reform shifts focus on prevention of costly disease,   we must continue to focus on improving screening and care for those at highest risk.

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What Color is My Pill Doc? Using Technology to Improve Medication Compliance

It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process.  In addition, patient engagement and co-management of their disease has been proven to improve outcomes.  This past month a new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance–when a pill looks differently patients often simply stop taking them as prescribed.  In this study, a change in pill color was associated with a 34% increase in medication discontinuation and a change in pill shape was associated with a 66% increase in medication discontinuation.  In cardiovascular patients in particular, the sudden discontinuation of medications can result in increased hospitalizations for chest pain, congestive heart failure and other more serious acute cardiovascular events. For other disease processes such as diabetes, medication non compliance can be devastating and life threatening as well.

The Challenges of Managing Poly-pharmacy

In general, today’s patients are taking more medications for a multitude of ailments and even for the most astute patients keeping track of doses and regimens can be a challenge.  Add in changes in color and appearance of chronic medications and the task can often be overwhelming for elderly patients with cognitive decline.  According to a study published in the Journal of the American Medical Association in 2008, nearly 81% of adults aged 57-85 took at least one pill and 29% took 5 or more drugs.  In addition, nearly 50% took concomitant over the counter drugs and/or supplements as well.  Side effects, drug-drug interactions and other concerns have led many physicians to attempt to streamline medication use and avoid the dreaded “poly-pharmacy” patient.  However, this serious public health problem is further complicated by patient non-compliance issues.  Many regulators argue for more FDA intervention as well as requiring generic drug makers to conform to non generic shapes and colors when manufacturing generic substitutes.  However, I believe that this data argues for a more comprehensive, patient centered approach to increasing medication compliance.

Leveraging Technology in Seniors

Technology today is ubiquitous in nearly all age groups. According to a Pew Research poll, most seniors utilize the internet and a large majority of these users interact via tablets, computer or other mobile devices.  As we age, we tend to live with more chronic illnesses and seem to require more daily medications.  Given the fact that now seniors are actively engaged on the internet, it makes sense for medical professionals to use these powerful tools to assist patients with management of their disease.  Many EMR systems already incorporate “patient portals” which allow for direct patient access to certain parts of their medical record such as test results, appointments, etc.  In addition, there are websites such as Pill Identifier that allow patients and physicians to search a large database of drug images in order to more accurately identify a medication–this is particularly useful when a patient approaches a visit in an Emergency Room or has a consultation with a new physician.

Based on the newly released study in Annals, it is clear that pill identification (and consistency of appearance) is critical in maintaining patient compliance with chronic medical regimens. Regulatory agencies are slow to act–forcing private generic drug makers to keep the size, shape and color of the generic consistent with the brand name is not realistic.  I believe that we can use tablet technology to quickly address this issue.  What if we create an application (downloadable to mobile phone, tablet and laptop) that is able to quickly identify all shapes colors and sizes of a particular drug? Currently there is a pill identifier app on the market but it requires the user to enter color shape and size in order to identify the correct medication–are there better apps yet to come? Ease of use and accuracy will be key components to any new medical applications aimed at older adults.

What Are Potential Solutions?  What Can WE Do Now?

As healthcare providers, we must do a better job encouraging the use of technology to help identify drugs and promote compliance.  The Annals study is a stark reminder that even though we may prescribe the best, most evidence based regimen to treat disease, it takes very little for our patients to become sidetracked–something as simple as a change in shape or color may result in the discontinuation of an effective, potentially life-saving medical treatment.  As physicians, we sometimes forget the “simple things” such as the importance of consistency and routine for our patients.  The culture of healthcare in the US no longer allows for the extended office visit and frequent follow up in order to ensure that patients are compliant with their treatment plans–we are asked to see more patients, in less time and the documentation requirements have become paramount in practice.  We must look for alternative ways to assist our patients with managing their disease while at home–I believe technology is the answer.  We must provide education and resources for our patients and assist them in the identification and use of medical applications.  With technology, we may be able to extend our reach–and support for our patients–well beyond the walls of our office.

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More (or less) Hope and Change (for the worse) In Healthcare: Are Doctor Shortages Really All Due To Training Bottlenecks?

There is no doubt that Affordable Care Act has changed the landscape of medicine in the US.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.  As a result, medicine today is more about increasing patient volumes, completing reams of paperwork and administrative duties than it is about interacting with patients and providing superior care.  The American Academy of Family Practice (AAFP) estimates that there will be a significant shortage of primary care physicians in the next several years unless we increase the number of primary care trainees by more than 25% over the same time period.  In fact, the AAFP suggests that the primary care workforce must increase to 260K physicians by the year 2025–which translates to an additional 52K primary care doctors.

Given the need for more physicians and the pending shortage (particularly in primary care), many analysts have suggested that the reason for the shortage is a lack of training slots in primary care.  The ACA will add an additional 32 million patients to the pool of insured and primary care doctors will be at a premium.  In the New York Times this week, the editorial board collectively penned an article discussing their thoughts concerning the doctor shortage.  The NYT editorial board suggests that the shortage is all about an imbalance between Residency training slots and medical school graduates and can be easily corrected by federal funding of a larger number of training positions.  However, I think that the issue is much more complex and the solution is far from simple.

Primary care is an incredibly challenging specialty and requires a broad knowledge of much of medicine.  Reimbursements for primary care work continue to lag and physicians are now spending more time with administrative duties than they are with patients.   I do not believe that the so called post graduate training “bottleneck” will come into play.  I would suggest that many primary care training slots will go unfilled over the next 5-10 years even without increasing the numbers of available positions.  Increasing training slots for primary care specialties may do nothing to alleviate shortages if there are no students who wish to train.  While medical school enrollments have increased over the last decade, much of this increased enrollment may be due to a lack of jobs available to recent college graduates.  Moreover, as the ACA continues to evolve, physicians are now realizing lower compensation rates, increased work hours, more administrative duties and LESS time spent caring for patients.  Many physicians are forced to double the number of patients seen in a clinic day–resulting in less than 10mins per patient–in order to meet overhead and practice expenses.  In a separate article in the New York Times, author and cardiologist Sandeep Jauhar discusses the increased patient loads and subsequent higher rates of diagnostic testing that is required in order to make sure that nothing is missed–ultimately increasing the cost of care.

For most of those who have entered medicine, the attraction to the profession is all about the doctor-patient interaction and the time spent caring for others.  I would argue that the primary care shortage (and likely specialist shortage) will worsen in the future.  Many bright minds will likely forego medicine in order to pursue other less government-regulated careers.  In addition, many qualified primary care physicians will opt out of the ACA system and enter into the rapidly growing concierge care practice model.  The answer to the physician shortage may be more political than not–politicians must realize that laws and mandates only work if you have citizens willing to devote their time, energy and talents to the practice of medicine.  Going forward, more consideration must be given to physician quality of life and autonomy must be maintained.  In order to make healthcare reform sustainable, those in power must work with those of us “in the trenches” and create policies that are in the best interest of the patient, physician and the nation as a whole.  Cutting costs must be approached from multiple angles–not simply reducing the size of the physician paycheck.

Medicine remains a noble profession.  Those of us that do continue to practice medicine are privileged to serve others and provide outstanding care.  In order to continue to advance, we must continue to attract bright young minds who are willing to put patients and their needs above their own–at all costs.  I think that there is still HOPE to save medicine in the US.  It is my HOPE that our government will soon realize that in order to continue to propagate a workforce of competent, caring physicians we must provide time for physicians to do what they do best–bond with patients and treat disease.  (as opposed to typing into a computer screen and filling out endless reams of electronic paperwork).  It is my HOPE that those physicians in training  that will follow in my generation’s footsteps will realize the satisfaction that comes from impacting the health and lives of patients over time.  It is my HOPE that the ART of medicine can be saved before it is too late….

 

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Privacy in the Era of Mobile Tech and Social Media: Facebook Fallout and New Innovations for Protecting Your Privacy

Did Facebook cross the line when conducting human behavior social experiments last year?  I think so.  When conducting scientific research on human subjects investigators are held to very high standards.  Currently there is global outrage over the experiment and government regulators from several countries are currently looking into the matter a bit more closely.  As I described in my blog a few days ago, Facebook recently published a paper in the Proceedings of the National Academy of Science reporting on a study that they conducted in September 2013.  In this study, researchers purposefully manipulated the News Feeds of randomly selected users in order to determine effects on mood and emotion.  None of the subjects were aware of the experiment and none had provided specific informed consent.

Many academic investigators as well as social media experts from across the globe have taken issue with the lack of specific informed consent and the utilization of subjects without any notification–until the paper was published in a well respected academic journal this last week.  Some groups have petitioned the Federal Trade Commission (FTC) and Facebook has had very little to say–other than “we are sorry…and we are adopting stricter internal review standards for future research.”

How can we avoid situations like this in the future?

Obviously, with the Facebook situation, public outrage and potential regulatory action by governments in many parts of the world may help limit these types of activities by social media platforms in the future.  Currently, several countries including both the US and many throughout Europe are discussing ways to limit privacy incursions such as the Facebook experiment in the future.

Unfortunately, the utilization of data by large social media platforms and organizations may not be the biggest threat to you and your privacy.  Hackers and other criminals are grabbing data from consumers–without their knowledge–from mobile devices such as tablets and smartphones.  These devices are placed in the hands of children, and often lie around the house and are frequently left “on” and unattended.

One inventor from New York City–Michael Sorrentino– has created a new device that can help keep you, your family and your data a little safer.

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Called the iPatch case, this device may change the way you think about your mobile device and its self contained camera.  Hackers and other criminals can actually utilize your own smartphone camera to take pictures of your home or office and can even build a 3D model of your house.  This can result in identity theft, theft of real property or utilizing your images without consent for whatever purpose the criminals deem necessary.  Disguised as a harmless camera application that is often downloaded, these programs can access your camera and obtain images without your knowledge or consent.  Other malware programs have been developed and innocently disguised as harmless games or apps for download.  Software has been developed (and sold by hackers for less than $50 dollars) that can infiltrate your device and control your cameras–stealing sensitive documents, creating models of a home or office or even snapping shots of your children.

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The device–called the iPatch is now in development.  Mr Sorrentino is currently working on the prototype and will be marketing the device once produced.  WIth the iPatch device one flip of a switch will cover and eliminate photo functionality from both the front and back camera of your smartphone.  The device is being developed through crowd-sourcing efforts and is expected to enter production this year.

Mobile technology is changing the way we interact and how we share information.  Issues such as the Facebook “experiment” should give us all pause to consider our safety as we continue to embrace social media, mobile technology and information sharing.  In the future, innovations such as the iPatch are likely to continue to emerge and will ultimately provide us with more options for staying safe while staying engaged and connected in our busy technology driven lives.  Most importantly, as parents, we must set good “mobile behavior” examples for our children and take measures to improve the security of our devices and our information.  Social Media is embedded in the fabric of our lives–and this is a good thing–we must, however, take care to continue to be vigilant and protect ourselves and our families from the new world of cyber-crime.

 

Experimenting with The Emotional Impact of Facebook: New Issues Surrounding Social (Cyber) Studies Without Specific Consent

Facebook, twitter and other social media platforms have become a hotbed of data for marketers, business and product development experts.  In addition, social media has created a new way to observe and investigate some of the intricacies of human behavior and social interaction.  Last week, a study conducted using Facebook users as subjects was published in the Proceedings of the National Academy of Sciences and reported this weekend by the Wall Street Journal as well as the New York Times.  This study, while interesting, has raised a new debate on the ethics of using social media users in social experiments without their consent.  While Facebook claims that they have all rights to perform such experiments under their terms of engagement–that all users sign when they create a Facebook account, many Facebook loyalists are upset and feel as though they have been manipulated and violated.

As an academically trained Cardiologist at Duke University and now faculty at the University of North Carolina, I have had a great deal of experience in medical research throughout my career.  There are basic principles and rules that must be applied when designing and conducting any investigation involving human subjects.  All scientific research on human beings requires informed consent.  In the University setting, we have Institutional Review Boards that provide oversight to any human experimentation–these boards function to protect the rights, safety and privacy of patient subjects.  When researchers manipulate variables and look to examine results, patients can be affected–either positively or negatively.  There has been a great deal of outrage over the recently published Facebook experiment.  Many debate whether or not Facebook has crossed ethical lines by performing a study involving manipulating variables without the consent of the user.  While the attorneys at Facebook will argue that its users give blanket consent to research under their terms of service– I believe that the rules that all of us must follow in any type of human experiment should apply.  Social media and networking is now a part of everyday life and spans all age groups–all of us are affected in some way.

This recent report is no surprise–We have known that Facebook and other social media outlets have gathered data on users for years.  Google and Yahoo have certainly utilized data obtained from individuals search preferences in order to promote advertising of certain goods and services on their homepages.  In fact, Facebook has an entire data science team that is given the job of collecting and analyzing data from nearly 800 million users worldwide.

In the latest investigation, researchers set out to determine if the content of posts on a user’s newsfeed could influence mood.  For one week in January 2012, the accounts of over 600K randomly selected users were manipulated by the research team.  According to Facebook executives,  the identities of the individuals in the study group were blinded and no personal information was shared. What they found was impressive–users whose news feeds were flooded with more negative postings tended to produce more negative content themselves and those users whose newsfeeds were  flooded with positive and inspiring news predominantly produced more positive content themselves.  Previous research in the area of emotional contagion seemed to indicate that in order to pass on a mood or emotion, in person contact and non verbal cues are required.  After conducting the Facebook experiment, the authors concluded that now emotion and mood can be passed on in an online environment without any in person contact at all.  Moreover, emotions shared on social networks can provide a system for large scale spread to millions simply as a result of negative or positive posts by others.   While this information is interesting and potentially quite useful to the both the business and scientific communities, this utilization of human subjects as “emotional guinea pigs” without informed consent has created outrage among many throughout the internet.  Manipulating the emotions of Facebook users within the framework of this experiment has been seen as an abuse of trust by many who are engaged in social networking and calls into questions the ethics of social experimentation via online platforms.

Beyond the ethical considerations that this type of investigation raises, I believe that this study actually may provide a very important message to those of us who utilize social media in medicine.  Social media is a powerful tool that allows us to communicate ideas, describe new technology and treatments and disseminate information.  This communication can be quite broad and the audience can be rather diverse–patients, colleagues and industry leaders.  As physicians, our voices can be heard well beyond our respective institutions and social media allows us to reach broadly.  Because of this reach, and the power of social and involves We must remain positive and hopeful.  Our words can greatly influence the outlook of those who read our blogs, follow us on twitter and check our Facebook postings.  We must inform, discuss and improve awareness.  We must remain positive in order to continue to inspire those who look to us for their care.

The issues raised by the recent Facebook study will need to be addressed.  Going forward, social media users, as well as those that manage major online networks such as facebook, twitter and YouTube (and others) must decide how and when to conduct social networking experiments in a way that provides both useful data and also protects the privacy and rights of those involved in the experiment itself.

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Data is (Em)Power(ment) for Patients: Using Fit Bit to Impact Disease Management

For scientists and researchers who are developing new treatments for disease, Data is power.  For patients, Data can mean empowerment.  Devices that track health indicators are readily available.  These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature.

This week in the Wall Street Journal, the medical applications of the Fit Bit device are explored.  The Fit Bit is a basic pedometer that tracks movement, steps taken, calories consumed and (in certain models) sleep habits.  This device is commercially available for around 100 dollars and was initially embraced by serious athletes in order to improve performance.  Now, according to researchers, these devices may be able to impact health outcomes–both inside and outside of the hospital or healthcare setting.  These impacts may forever change how physicians and healthcare systems think about managing chronic disease.

As I have mentioned in previous blogs, I firmly believe that smartphone applications for medicine are going to be a part of mainstream medical practice in the coming years.  Providers will prescribe apps just as they do pharmaceuticals.  In the case of the Fit Bit device and others like it, data obtained from physiologic monitoring can be used to assess physical fitness and progress towards obtaining specific health goals.  In several recent studies, researchers at Massachusetts General Hospital in Boston, have found that the Fit Bit users who have diabetes are more likely to have better control of their blood sugars and achieve weight loss related goals better than those who do not use the device.  Many patients with type 2 diabetes can better control their blood sugars through reduction in BMI (body mass index) and the data provided from the Fit Bit device seems to have a positive correlation with weight loss in this particular patient sample.  In the hospital setting, researchers at the Mayo clinic found that in post-operative cardiac surgery patients, the Fit Bit was able to identify patients that needed more physical therapy intervention–by tracking movement in the early post-operative days.  It is likely that by identifying and intervening early in patients who are not progressing after surgery we will be able to prevent many common complications such as deep vein thrombosis (DVT), pneumonia and other morbidities associated with lack of activity after surgery.

At this point, the FDA has no immediate plan for regulation as long as they are not specifically created to treat a particular medical condition or disease process–however, I do expect regulators to act on all types of biomedical data collection devices within the next 5 years.  According to the WSJ, the health monitoring device industry is projected to exceed 5 billion dollars in 2016–largely due to our focus on patient engagement and prevention.  Concerns have been raised as to the security of data and as to the reliability of the data generated by these devices.  As with most new medical innovations, there is still much work to be done.  We must create secure servers where patient’s data can be safely deposited (and HIPAA compliant) and easily accessed by their healthcare providers in order to provide necessary changes to care.  In addition, the patient must be able to access their own data in order to assess progress, adjust goals and optimize their lifestyle changes in order to produce better health outcomes.  Additional concerns have been raised around the legal implications of a large repository of medical and physiologic data—are physicians responsible for every reading and every piece of data in the repository?  Will there be frivolous lawsuits initiated by ambulance chasers (or Fit BIt chasers) in the future?

I contend that more data is better.  Data provides me with the power to make better decisions for my patients.  Data provides my patients with real, meaningful feedback.  When we are sick, we often feel as though we have lost the ability to determine our own destiny and lose any semblance of control.  Data allows patients with chronic illness to actually regain some sense of control—and achieve ownership of their disease with the power to invoke change.

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