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Undark: Putting Digital Health Monitoring Tools to the Test

PHYSICIANS CALL IT the 5,000-hour problem. If you have a common chronic condition such as cardiovascular disease or diabetes, the expert in charge of your health for almost all of your 5,000 waking hours annually is — you. And, frankly, you won’t always make the best choices. “The behavior changes that are necessary to address chronic disease are much more in your hands than in the doctor’s,” points out Stacey Chang, executive director of the Design Institute for Health at Dell Medical School in Austin, Texas. “To cede that control to the doctor sometimes is actually counterproductive.” With that in mind, a rapidly evolving set of new digital health tools is angling to help patients engage better with their own care. Wearable health monitors already on the market help to track heart rate, footsteps, or blood glucose levels; sophisticated home health sensors can report on weight and blood pressure; and phone apps can present key feedback and maybe even offer personalized advice. The only problem: It has thus far proved very difficult to know what really works. Indeed, despite a veritable avalanche of “digital health” products, from Fitbits to telehealth heart sensors, and despite floods of data flowing both to the people who use them and to their physicians — and even despite clear evidence that many doctors very much want these new gadgets to work — there is still precious little clinical data proving that they are providing major patient benefits or delivering more cost-effective care. As with everything else in health care, the reasons for this gap are many, but one major factor is the difficulty of getting patients to embrace new forms of self-monitoring and self-care beyond the novelty period — and to a point where such technology might actually make a difference. Many early attempts to truly test the efficacy of such digital technologies have shown them to be a flop in clinical trials — in large part because participants drop out. An analysis of five health apps built with Apple iPhone software, for example, found that only about one-eighth of participants, or less, were still hanging in after 10 weeks. Another recent study out of Singapore found that about 200 people outfitted with fitness trackers showed no better health outcomes than a similar control group after a year. And when Cedars-Sinai Medical Center in Los Angeles invited about 66,000 patients registered on its portal to share data from their fitness trackers, less than 1 percent did so, according to a paper published last year in the journal PLOS One, part of the open-access Public Library of Science. Read more at