A Physician’s Perspective on Self-tracking
Self-quantification can shed real insights into how lifestyle affects health, says Joseph Kvedar, a physician and founding director of the Center for Connected Health at Harvard Medical School. The challenge will be in getting patients to adopt these tools.
I enjoy cycling on the weekends and think of it as a pleasant way to get some exercise and burn a few calories. On weekends when I had to do yard work instead of cycle, I resented it as a waste of time. This all changed about a year ago when I was looking at the stats from my Bodymedia armband. I discovered that I burn about 1.5X the amount of calories per hour of yard work as I do cycling. I also tend to get more minutes of high intensity exercise when doing yard work. I never thought about it before, but pulling weeds, squatting, standing up, trimming branches, hauling bushes, etc. is real exercise. The result of that insight is that I welcome my days of yard work now. I put in a pair of ear buds and lose myself in some music without guilt.
This is a perfect example of how objective, quantified information can lead to insights that prompt behavior change. We are in the midst of a real movement around the collection of data and the use of that data to gain insight about health and affect behavior change, often referred to either as personal informatics or the Quantified Self. At the Center for Connected Health, several of our programs have given us important perspective on how real-world patients are adopting - or not – personal data in managing their own health.
Our Diabetes Connect program, until recently, involved a device that measured glucometer readings and transmitted this data over an analog phone line to our database. A disappointingly high percentage of our patients were unwilling to take the step of plugging in a device to the glucometer and to the phone line and then pushing a single button to upload glucose readings. Even the opportunity to see their glucose readings quantified and shared with their health care provider was not enough motivation for some individuals.
There are likely several explanations. First, managing chronic disease, especially diabetes, can be complex and overwhelming for some patients, who are unwilling to take on anything more. Secondly, many patients’ minds hold the notion that a chronic condition is just too complex for patients to self-manage. Perhaps we as health care providers consciously or unconsciously fail to create the expectation that patients should take charge of their health. Our insurance plans and politicians reinforce the message that sick people are victims and health care is an entitlement. And last, it may be that the technologies to track this data are mature enough only to attract an early adopter crowd, who can more easily overcome technical challenges. Device manufacturers and others are working hard to make the technology as user friendly and simple as possible. Perhaps we’re not quite there yet, at least for the average health consumer.
I recently had the opportunity to talk with Gary Wolf, one of the founders of Quantifiedself.com, a frequent contributor to the New York Times Sunday Magazine and a Contributing Editor at Wired. When I asked Gary about this challenge, he spoke of segmenting folks beyond the simple binary classification of quantified selfers and the un-engaged. He suggested that as we learned more about the various segments, we’d glean corresponding strategies to inspire them to quantify and use their self-generated data to improve their health.
The power of quantification in chronic disease management is evident, yet we still need to improve the willingness of health care providers to embrace data from self-quantifiers. The good news here is that doctors are beginning to realize how much data their patients generate when out of the office and the value that data can bring to healthcare decision making. We also now have software solutions (decision support) that can plow through reams of banal, normal data and pull out those data points that are worthy of a highly trained professional’s analysis. I’m confident this problem will be overcome quicker than the passivity that I see in chronically ill patients.
For those individuals who are even a bit motivated to improve their health, quantified, objective information leads to insights that prompt behavior change. This is one of the primary strategies we will need to address the burden on an already beleaguered primary care workforce.
The question remains: Should we convert as many patients as possible into quantified selfers? How should we do it?
Joseph C. Kvedar, MD
Director, Center for Connected Health
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