Ogdie A. Using Personal Technology to Track and Improve Outcomes in Inflammatory Arthritis. Presented at: Interdisciplinary Autoimmune Summit; July 10-12, 2020 (virtual meeting).
Ogdie reports consulting for AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Lilly, Novartis Pharmaceuticals, Pfizer, Takeda Pharmaceutical Company and UCB; grant funding from Novartis Pharmaceuticals (to Penn), Pfizer (to Penn), Amgen (to Forward/NDB); and royalties (to husband) from Novartis Pharmaceuticals.
Rapid development of personal technologies may lead to improved outcomes but additional challenges for the clinical and research communities dealing with conditions like inflammatory arthritis, according to a presenter at the 2020 Interdisciplinary Autoimmune Summit.
Alexis Ogdie, MD, MSCE, associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, addressed what she called the “new normal” of the COVID-19 era as it pertains to personal technology. “Many of us are just getting back to seeing patients in the office,” she said. “That was the old normal. The new normal is using personal technology.”
Ogdie aimed to discuss how everything from smartphone telemedicine visits to wearable health outcome trackers can be used to leverage improved health care behaviors and outcomes in patients with immune-mediated conditions.
She broke this approach down into six components, including remote monitoring, understanding the problems, delivering interventions, reviewing self-directed feedback and interactions, predicting outcomes and offering direction for research. Moreover, the discussion was framed in the context of the so-called 5,000-hour problem.
“A patient comes in to see us for a 15-minute or half-hour visit,” Ogdie said. “Then they come see us in 3 months or 6 months. Think about all those hours in between those two points in care.”
In that intervening time, technology may be used to validate or refine patient-reported information. For example, actigraphs used to measure sleep in patients with RA provide complementary information to patient-reported outcomes.
Using data from those actigraphs, clinicians can then tailor interventions using a Fitbit or other wearable device. Clinicians can make use of everything from social norms to rewards to help patients change behaviors and reach goals. In addition, the device can provide real-time feedback to the patient to encourage continuation of the intervention and information that clinicians may use to make necessary changes or tweaks.
Despite these advantages, Ogdie stressed that wearables have their limitations. “You have to actually wear them, and charge them, and sync them,” she said.
Cost can be problematic for many patients. “Setup is not always intuitive,” Ogdie added. “Inter-device correlation can be low but intra-device correlation tends to be pretty good.”
The issues extend to the cosmetic. “The really good research-grade ones are ugly and that matters to patients,” Ogdie said.
Ogdie added that over- and under-estimation of the efficacy of wearable technologies is possible. However, she stressed that many of these limitations have always been limitations for technology in medicine, including poor quality, poor battery life and design issues. In addition, clinicians and patients alike may be uncomfortable with the technology.
Authentication can also be an issue, as can system integration.
The relationship between the device and the patient population must be considered, as must security and HIPAA compliance.
Despite these concerns, there is no doubt that wearable technology is here to stay, likely even in the post-COVID era, when in-patient visits can become normal again. “COVID has taught us a lot about how to interact with patients virtually,” Ogdie said. “I am hoping that the new normal will be that connected health is part of our day-to-day management of patients.”