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Wearable tech gaining in health care, but privacy is a concern

Apple watches, Fitbits, and other wearable technology — such as the smart onesie for babies at risk for sleep apnea being developed at Drexel University — present a tantalizing prospect in health care.

Health-care professionals see such internet-connected devices as a way to keep tabs on whether patients are following treatment plans, to track vital signs between office visits, and to perform ongoing diagnostic tests on diabetics or others with chronic illnesses.

"The ability to develop these wearables introduces a lot more potential for treatment that's a lot closer to the patient and outside of a formal hospital setting," said Kapil R. Dandekar, a professor of electrical and computer engineering and director of the Drexel Wireless Systems Laboratory. The laboratory is developing a onesie that alerts parents through their smartphone if their baby stops breathing.

But — and it's a big one — Dandekar said, wearable technology connected to the internet "does introduce concerns when it comes to the security and privacy of users," which need to be weighed against the medical benefits.

Medical uses of fitness trackers create special challenges for health systems, which labor under strict privacy compliance standards, but it is not clear how severe the privacy threat through hacking is.

In the broader public realm, the popularity of fitness trackers and their integration with social media add to the flood of information that data-analytics firms use to profile consumers.

"What companies are trying to do is find as many data points as possible and to share them across a whole variety of avenues in order to create profiles of us and decide whether or not we are targets, favorably or unfavorably, for certain kinds of products and services," said Joseph Turow, a professor at the University of Pennsylvania's Annenberg School for Communication.

Makers of fitness tracker are well-aware that their data fit into that universe. In September, an executive from Fitbit called the company's "tremendous database of biometric data on millions of people" one of its big assets that "could have tremendous value for other people in health care."

Although Philadelphia-area health systems see potential in wearables, worries about patient privacy are a key factor holding back wider adoption of the devices, especially because of the hacking threat.

"We haven't yet incorporated wearables as much as we'd like because we think that's the weakest link," said Stephen K. Klasko, president and chief executive of Jefferson Health and Thomas Jefferson University. For example, Klasko would like to use an Apple watch or a smart television to test whether a diabetic is at risk of going blind and should see an ophthalmologist.

Another challenge to medicine's widespread adoption of the technology is figuring out how to integrate the data into patients' electronic medical records in a way that provides insight for doctors.

"It's probably not useful for me to know the step count on every day for the last year since I saw my patient, but it would be helpful to know trends, said Mitesh S. Patel, a primary-care physician at the Crescenz Veterans Affairs Medical Center in West Philadelphia, who is exploring ways to integrate wearable technology into medicine.

"Almost every patient I see, I give them a spiel about how to be more physically active and monitor their diet," said Patel, who is also on the faculty at the Penn Medicine Center for Health Care Innovation and the Center for Health Incentives and Behavioral Economics.

"The challenge is after they leave my office, I may not see them for six months or a year," Patel said, "so these types of devices can help to monitor their behavior and provide me feedback on how they are doing," Patel said.

Patel has also participated in research showing that just handing a patient a fitness tracker is not enough to get the person to walk more. He runs clinical trials, including one now involving 100 people who suffered heart attacks, to test incentives.

In Patel's studies, the data that come to the health system from the device is protected under federal patient privacy rules, but the privacy policy of the device also applies to any information gathered by the device company, said Patel.

Bill Hanson, the chief medical information officer at Penn, said: "We're not in any position to protect the patient from that company's practices."

A report last month by the Center for Digital Democracy and American University, both in Washington, warned that wearable devices and the apps that go with them "fall between the cracks of an already weak and fragmented health-privacy regulatory system in the United States."

"Many of these devices are already being integrated into growing digital health and marketing ecosystem, which is focused on gathering and monetizing personal and health data in order to influence consumer behavior," according to the report, "Wearable Devices in the Big Data Era: Ensuring Privacy, Security, and Consumer Protection."

Even more disturbing, the report says, the information gathered through wearables, part of an individual's vast "digital exhaust" from everyday internet use, could enable profiling and discrimination "in employment, education, insurance, finance, criminal justice, and social services."

Technology advocates have a far more optimistic view of wearables' potential in health care.

"The goal is to present ultimately a unified picture of us as a digital patient" by uniting information from fitness trackers, corporate wellness programs, and Walgreens with electronic medical records," said Brendan McCorkle, CEO of CloudMine, of Philadelphia.

Through a partnership with Validic, a Durham, N.C., company, CloudMine is integrating patient-generated health data into electronic medical records, where doctors can see it and use it, McCorkle said.

Penn, the Philadelphia region's biggest health system, does not count itself among the "players in organized medicine that are wildly enthusiastic" about wearables, Hanson said.

They could be tremendously useful, "but there are risks, there are technical issues to be worked out, there are data-packaging issues to be worked out; there are all these issues having to do with privacy," he said.