Why Your Smartwatch Could Break Our Healthcare System

Here’s What We Should Do About It

Every beep and buzz from our smartwatches, fitness trackers, and health sensors might feel like a step toward better health—but could they actually be hurting the systems meant to protect us? The flood of health data our devices generate is overwhelming, and what’s worse, it often doesn’t help our doctors. In fact, it could do more harm than good

The sheer volume of information doesn't often translate into actionable insights for doctors—and can be a challenge for patients too. We need to find the home for this data, or interpretations and patterns rather than that data itself, to respect the needs of both patients and physicians.

I happen to be kind of an expert on translating insights from wearables: I have type 1 diabetes. It is a lonely disease—patients need to interpret blood glucose readings, consider factors like food intake and stress and physical activity, and determine insulin amounts - treatment decisions—independently, multiple times a day. It is a disease that is managed in real time. A constant stream of real-time data matters to me, but not to my endocrinologist.

The Data Deluge: “Empowering” Patients, Overwhelming Doctors

Our wearables churn out data every minute of the day, promising empowerment and control. But for healthcare providers, this endless stream is less of a blessing and more of a burden, threatening to drown them in a sea of noise. It can obscure critical insights, burden physicians with unnecessary data, and ultimately detract from the quality of care.

I manage my diabetes with an open-source automated delivery system that uses a continuous glucose monitor (CGM) that checks my blood sugar every five minutes. Imagine if my CGM were interoperable with the EMR in my endocrinologist’s office - pushing 288 readings per day into the black box of the EMR. Talk about information overload! While this real-time data is essential for me to manage my condition, it is not practical for my endocrinologist to sift through these readings during our quarterly visits. Instead, we focus on trends—patterns that inform treatment decisions—rather than the noise of minute-to-minute fluctuations.

A graph of 24 hours’ worth of diabetes data - insulin, food, blood glucose.

Monolithic EMRs Can Collapse Under Their Own Weight — Open Firewalls Instead

I’m an open source acolyte and I worked on the U.S. government’s nationwide healthcare interoperability standards. I'm committed to my company Phase2's mission to create better health using digital. So why am I suggesting we eschew some forms of healthcare interoperability, specifically around wearable data?

EMRs are buckling under the weight of existing clinical information. Instead of cramming them full of every piece of data our wearables produce, let’s rethink how we integrate technology into healthcare in ways that leverage the strengths of wearable technology without overwhelming clinicians.

I think we must embrace the fragmented market: let’s open the firewalls so that physicians can view relevant wearable data in the forms in which it’s analyzed and visualized by the sources that collect it—by visiting websites or looking at patients’ phones or printouts.

And let’s not force EMR developers to create interfaces and data visualizations for all of the quantified information that every one of the CGMs, fitness trackers, sleep trackers, period trackers, scales, and other commercial health wearables provide. Contextually questionable patient-generated health data has no place in EMRs. (Whereas doctor-prescribed monitoring systems may.)

This approach can reduce the burden on EMRs but also enhances the physician's ability to focus on critical health issues.

The Smart Solution: Separate, Simplify, and Save Our Healthcare System

There’s a smarter way forward: keep wearable data on separate platforms built to analyze and visualize health trends, sparing our EMRs the burden of information overload. These kinds of platforms can filter and process the data, presenting only the most relevant information to healthcare providers. Platforms like Validic and Healthie are already leading the way in this space, offering solutions that integrate with EMRs but keep the bulk of the data off the clinician's primary dashboard. This way, physicians can review summarized trends and significant alerts without getting bogged down by the details.

Thoughtful Integration: Filtering and Preprocessing

If we are to integrate wearable data into EMRs, it must be done thoughtfully, with an emphasis on filtering and preprocessing. Middleware solutions like Redox offer a way to standardize and filter data before it reaches the EMR, ensuring that only clinically relevant information is included. This approach reduces noise and allows physicians to focus on actionable insights rather than being inundated with raw data.

Platforms that integrate wearable data with EMRs can use clinically-defined algorithms to highlight significant trends or anomalies, such as consistent patterns of hypertension or irregular heart rates. This can allow EMRs to flag and notify patients or doctors of potentially harmful trends, allowing necessary interventions instead of data overwhelm.

Low blood sugar, which can happen when a type 1 diabetic has too much insulin, is a medical emergency - patients suffer from confusion, dizziness, rapid heartbeat, sweating, seizures, and even loss of consciousness. It requires immediate treatment with fast-acting carbohydrates (sugar). If I go low as I’m writing this, it’s up to me to treat it. My doctor literally can do nothing from where he is. I think that having an EMR act on a single low glucose value is, frankly, a waste.

But when I visit my endocrinologist every three months, while he could view the approximately 26,000 blood glucose readings since our last visit, instead we look for and discuss only trends. He would never ask me why my blood sugar went up to 192 after dinner three weeks ago, because quantifying my life to that degree is senseless for both of us (because management is minute-by-minute for me, and assessed quarterly for him). Looking at treatment trends at the level he and I do is medically relevant and allows my physician to apply his expertise where it matters.

It All Comes Down to People

Our devices capture data relentlessly, but without the wisdom to interpret it in the context of our unique health journeys.

The value to consumers can be great—who doesn’t appreciate seeing an upward trend on sleep quality and a steady trend on weight maintenance? But outside of those windows, the value of many commercial wearable device data diminishes without context.

As we rush toward a data-driven future, we must remember that human judgment—our doctors’ ability to see the person behind the numbers—must always come first.

Our bodies are complex systems that can’t be quantified easily or simply. Physicians rely on qualitative information—voice, demeanor, movement, posture, facial expression, breathing, coloring—and synthesize that with relevant medical information, training, and experience to interpret, to help their patients be well. Sure, vitals matter, but each individual’s experience of pain, or tiredness, or symptoms, is unique–and essential to understanding the body’s interlaced systems.

Just because we collect the data doesn’t make it useful in every context. New tech is not meant to replace every traditional human interaction. Wearable data has the potential to transform healthcare, if it is integrated in a way that supports, rather than hinders, clinical workflows. Instead, let’s keep the focus on the conversation between physician and patient, allowing patients to share their symptoms—and their data—in context, when and where it matters.

I’ve purposefully been a little contrarian and cheeky here, because I’d love to have you engage in the conversation!

This debate is far from settled. As technology and healthcare continue to intertwine, we need every voice—especially those of experts, clinicians, and technologists—to join the conversation. Let’s explore this together, challenge each other, and find the solutions that will truly enhance patient care.

This post originally appeared in LinkedIn, August 21, 2023. Smartwatch image by Vince Tardy.