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The Wow of Wearables

February 19, 2015

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.

Kvedar_treadmill desk

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!

14 Comments leave one →
  1. permalink
    February 19, 2015 10:09 pm

    Nice post Joe. A couple of points:

    1. I think we will be looking at a future which incorporates wearables, ingestibles, etc along WITH a smartphone/device. I see the smartphone as a “digital hub” for all of the data we can gather from other devices. Sure, it can record it’s own data, some of which may be fairly accurate, but I see it more as a central location to store data and analyze for actionable changes that the user can make to affect their health.
    2. I tell my patients that the best pedometer is the one that they will use. For many, this is a wearable device. For others, the phone is just fine so long as the battery drain isn’t prohibitive. I have found that patients who are aware of their activity levels, tend to be more cognizant of their health overall. Even if the margin of error in terms of daily steps is 10-20%, just having a rough estimate and internalizing the information can be the first step to change. It’s like when a patient who eats a particular food on a regular basis finally gets the courage to look at the nutrition label for the first time. It can spur significant change, even if down the road a bit.
    3. I strongly agree with your point regarding feedback loops and actionable data. Many of the current platforms suffer from an inability to explain to the user what their data means, how it can affect their health, how it compares with others, etc. These insights are what get patients “hooked” on wearables. I do think that Jawbone does a nice job of this in their “up” app. Fitbit has a way to go here, and others tend to be more reporters of data rather than providing real world interpretation.


    – Jeff

    • February 21, 2015 3:19 pm

      The problem with services that try to offer “real world interpretation” is that they usually don’t have enough context to do so in a useful manner. In consequence, the “actionable insights” are either misguided, or obvious things your mom probably told you to do.

      That’s not to say that the there isn’t any value in the data, but to benefit from your data, you need to educate yourself and be willing to expend some effort.

      • February 21, 2015 3:33 pm

        True, but just because today’s efforts are not inspirational, it doesn’t mean we should stop trying.

  2. February 20, 2015 6:51 am

    All good thoughts and insights, consistent with our learning.

  3. February 23, 2015 3:29 pm

    Reblogged this on CrossInnovating and commented:
    A pragmatic summary on the intersection of mobile and wearable technologies.

  4. February 25, 2015 8:00 am

    The smartest tool will be the one that can triangulate data – from wearables, ingestibles, mobile, home and other sensors etc – to provide a rounded picture that takes account of context, content and process. Takes me back to my early research days – grounded theory and triangulation is all – there is no one truth!

  5. February 26, 2015 2:49 pm

    One variable that may not have been considered is frequency of demand for the data by patients. For instance, Timothy Ferriss has a great harbinger of wearable glucose monitoring 24/7 in his Four-Hour Body book — it drives you crazy figuring out whether it was the cupcake you ate 10 minutes ago or the orange juice for breakfast which had the effect of slowing spikes in glucose. The FDA just okayed blood oxygen fingertips for COPD, but for healthy consumers it might be a waste tracking all day. Once we start to see real-time biometric data the wearables could be a real traffic jam, and keeping track of it all at once periodically with one tap on your mobile sounds like a better way.

    • February 26, 2015 9:27 pm

      lets agree that the future is not a continuous stream of any particular data point (glucose readings, O2 levels, etc, but rather a synthesis of these data and software-derived insights that cull out meaningful relationships among these data

  6. Mark Prince permalink
    February 28, 2015 7:55 am

    Observations re: varied applications and usage scenarios are appreciated.

    Remote sensors and phone based apps are not mutually exclusive – rather, they provide a basis for tailored data acquisition, e.g., few of us want to sleep with the phone (and the charger) in our pillow case.

    Well after the point when injestibles arrive and achieve social and economic balance, there will still be room for phone trackers *and* separate sensors.

    Many market segments and associated applications fundamentally require external sensors for rich telemetry.

    A better HuffPo clickbait headline would focus on “tricorder” concepts for general, continuous data acquisition on the visible horizon.

    Clinical/acute applications will generally tolerate stand-alone / disposable solutions. Targeted/limited use scenarios are the likely landing zone for injestibles/disposables… although this vector faces the same old compliance headwinds.

    Implantables, on the other hand…

  7. Suresh Ganesan permalink
    March 8, 2015 10:14 pm

    Agree with Dr Kvedar’s analysis..when it comes to wearables (especially the ones that track activity related information) it is the applicability vs the quality of science that will dictate the adoption of a wearable vs smartphone as the tool. I would view that Smartphone will end up being the consumption channel while sensor technology will find its way into wearable that will be very specialized. Already some of the major Pharmas are experimenting with sensors (sleek hand gloves) that could pick up even very mild hand tremors in patients with potential MS and help with disease management. Ingestibles and patches are also becoming reality where they collect multiple parameters like body temperature, heart rate (continuous) etc., which are delivered through smartphone for the end user and care providers. @ Cognizant we believe, putting the feedback loops (virtual or real) is critical in influencing the right behavior, and to sustain that positive behavior change, a combination of Hi-Tech and Hi-Touch (human touch) is essential..
    Concepts like “chip in a pill” are a reality today and these technologies could help the patient and care giver well informed about one’s health, all data delivered through smartphone. In his recently published book titled “The patient will see you now” Dr. Eric Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, documents this looming powershift, thanks to our Smartphones!



  1. What We Are Reading | Quantified SelfQuantified Self
  2. The Wow of Wearables

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