Think back to your last in-person doctor’s appointment and how it began. Probably, someone checked your blood pressure, temperature and weight, all of which give your doctor a snapshot of your overall health. While in-person visits are starting to come back, many patients are still getting care virtually, and may be for a while. To help compensate for not being able to conduct physical exams, some healthcare professionals are recruiting new partners in providing care: the patients themselves.
“We are depending on patients to track their data even more for televisits, because we have no other way of monitoring how they’re doing,” says Dr. Katherine Gergen-Barnett, a family medicine physician and vice chair of Primary Care Innovation and Transformation at Boston Medical Center.
According to Michael Snyder, a professor of genetics at the Stanford School of Medicine and director of the Center for Genomics and Personalized Medicine, at-home data-gathering could be an important way to stave off health complications in patients with chronic illnesses, who may not be in touch with their doctors as often as they were before the pandemic. For others, it could act as an important supplement to remote care that can help prevent emergency room visits.
Changes in vital signs can show up even before patients experience symptoms. For example, you’d likely have several high blood pressure readings before feeling dizzy or, worst case scenario, having a heart attack. For patients with conditions including high blood pressure, diabetes and lung disease, doctors will likely encourage additional tracking. Patients with congestive heart failure may be told to weigh themselves daily, since sudden weight gain is an important sign of heart failure.
While some devices automatically send information to doctors, Dr. Amitha Mushyam, a family medicine doctor at Northwestern Medicine McHenry Hospital, says most patients are responsible for collecting and tracking their own data, and then reaching out to their doctors if they are concerned about abnormal readings.
Information like blood pressure and glucose readings can also help doctors assess how medications are working, and whether patients would benefit from trying other treatments. For instance, if a patient’s blood pressure is getting higher over time, Mushyam says she might tweak a medication dosage or try a new prescription altogether.
The quantified patient
Typically, before the pandemic, Mushyam says she’d ask diabetic or hypertensive patients to track their blood sugar or blood pressure a few times a day for up to a week before visits, and then share it electronically before an appointment. This data provides a bigger picture of a patient’s health than just one reading at the doctor’s office.
Snyder says this information can be useful for doctors, but it’s also beneficial for patients — it’s helpful to catch something going wrong before symptoms appear, and monitoring people while they’re healthy can prevent unnecessary medical costs. “Right now, our medical system is set up to treat people after they are sick, but that’s much more costly and harder to reverse,” he says. “It’s much better to keep people healthy.”
For some at-risk populations, like pregnant women, the ability to track vital signs at home is especially important. Dr. Christina Yarrington, an ob-gyn and director of labor and delivery at Boston Medical Center, says her hospital recently began giving blood pressure cuffs to pregnant patients. While most pregnant women have higher readings, especially during the third trimester, excessively high blood pressure can signal potentially serious issues.
Normally, pregnant patients with hypertension would go to the doctor twice a week for blood pressure checks. Monitoring blood pressure from home both prevents unnecessary office and hospital visits, and prevents complications that could endanger the mother and her baby. “Some women are more vulnerable to issues like preeclampsia, which involves high blood pressure,” Yarrington says. “This component helps us to know a woman’s blood pressure before they’re feeling really sick, because by the time they feel it, they’re really sick.”
The technology Yarrington’s patients use, which is currently funded by a private donor, is automated. The devices automatically send blood pressure readings to the doctor with the click of a button. If the reading is high, the doctor will call the patient to discuss next steps for treatment, whether that’s admission to the hospital or continued monitoring from home.
“We want to enable women to take more control of their own health information, and to create a system of good and consistent follow-up that doesn’t require her to go to the clinic,” Yarrington says.
But data monitoring isn’t only valuable for patients with chronic medical conditions, whose devices are probably covered by insurance. Gergen-Barnett says primary care providers may appreciate being privy to informal kinds of data, collected from devices or apps that let people track their sleep, steps, nutrition and even moods. All of this information can help doctors better understand how patients are taking care of themselves and what they need to improve their overall well-being, especially when doctors aren’t able to conduct hands-on exams.
“Even during an acute visit, I am thinking about how to keep a person well,” Gergen-Barnett says. “We could talk about a rash you have, but I would still want to know how you are taking care of yourself — how are you sleeping, are you exercising and how is your stress level?”
Access to this type of data could also help otherwise healthy patients take more ownership over their health at home. If you have numerical evidence that you’re tossing and turning more at night, you could take measures to get better sleep. And if you see you’ve only taken 500 steps a day for the last few days, you might make a concerted effort to be more active.
While she recognizes the value of collecting patient data from home, Gergen-Barnett says she’s concerned about inequities that could surface. Not all patients have insurance that covers all types of monitoring, and not everyone can afford to buy a device themselves. For example, while a private insurance provider may cover an at-home blood pressure cuff for a pregnant woman, government health plans might not — or one type of insurance might cover better quality tracking devices than another. “We’re going to need better insurance coverage for all types of monitoring so we can actually take care of people,” she says.
How much health info do you really need?
It’s also important for patients to understand the limits of popular health-tracking devices. Sleep tracking is a prime example: When patients go in for sleep studies, specialists use clinical tools to monitor a number of different body functions, including eye movement, muscle activation, respiratory airflow and electrical brain activity (which is a direct measure of sleep). Sleep trackers used at home can collect various types of physiological data that’s relevant to sleep, but they can’t measure sleep directly. Instead, these devices often measure inactivity as a proxy for sleep. In other words, if you’re lying in bed motionless, a sleep tracker might assume you’re asleep, even if you’re just counting sheep.
Furthermore, while some patients find tremendous value in health-tracking, others may not benefit from having so much data at their disposal. In one 2017 paper, sleep clinicians argued that sleep tracking can be counterproductive. They observed instances of sleep clinic patients fixating on data from their sleep trackers, without accepting that it might not be accurate. These patients then developed perceived sleep issues as a result of failing to achieve the perfect night’s sleep. The study authors coined the term “orthosomnia” to characterize this data-based sleep problem.
Mushyam says tracking health data, especially blood pressure, sometimes triggers anxiety in her patients, causing them to prematurely visit the ER after a high reading. To get more accurate readings and prevent unneeded hospital visits, she tells patients to rest for 15 to 20 minutes before checking their blood pressure, or to wait a few hours after a high reading to see if it comes down. She also reminds patients that anxiety itself can cause blood pressure to spike. “If a patient’s blood pressure is truly high after a few readings, then they know to contact me so we can look into it,” she says.
For anyone who wants to try using a health-tracking device, Gergen-Barnett recommends teeing up your visit by sharing it with your doctor a day or two beforehand via an online patient portal. “That way, you don’t have to spend your whole visit talking about data,” she says.
If your doctor hasn’t recommended that you share information from an app or an insurance-covered medical device and you think your health would benefit from it, start a conversation. “If you aren’t getting clear enough guidance on what you should be monitoring, ask your doctor,” she says. “The patient should always feel like they are in the driver’s seat.”