Electronic Health Records

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Should employers use mHealth to track your mood, diet, sleep?

By Jennifer Bresnick

An employer-provided game to track calorie-cutting or a contest to promote exercise outside of work hours can encourage healthy choices and make workers happier, EHRIntelligence reported yesterday.  But what happens when a company tries to take that engagement one step further, and use mobile health apps and self-monitoring devices to track some pretty intimate details of their employees’ lives inside and out of the cubicle?  Wired.com reports that one company in Portland, Oregon is attempting to do just that, asking a few test subjects to try uploading how much they sleep, when they exercise, and what they eat to a central server so their bosses can see what makes their employees happier, healthier, and more productive on the job.

The idea is part of the movement towards a “quantified self”, or the idea of using mHealth to record and monitor a variety of health-related factors, including heart rate, sleep cycles, calories consumed, exercise completed, and even more exotic metrics like skin temperature, sweat output, and blood flow.  Eventually, such data may prove useful to physicians and might even be incorporated into a patient’s EHR to give providers a complete picture of a patient’s health and wellbeing.  With more than 90% of physicians believing that mHealth apps will eventually benefit patient care, especially when linked to an EHR or patient portal, some experts, like Dr. Eric Topol, believe that “the smart phone will be the hub of the future of medicine.  And it will be your health-medical dashboard.”

Citizen, the mobile design company in Oregon collecting employee data, is making an effort to make that prediction a reality.  By using a system called “Citizen Evolutionary Process Organism”, or “C3PO” for short, Citizen can tap into a service it calls Health Graph, a collection of data from common exercise buddies Fitbit and RunKeeper as well as an employee mood tracking service, online music players, project management trackers, and time trackers.

These data sources come together to create a picture of how employees function during their day-to-day tasks, what songs make them more productive, and how the amount of sleep they got and the afternoon snack they grabbed from the vending machine affects their concentration.  “We didn’t think we’d stick with a normal corporate health and wellness program,” says Quinn Simpson, who helped develop the system. “We’re already data visualizers. We already do quantified self.”

In theory, it’s an interesting idea that has important implications for researchers and physicians sifting through clues for how our habits affect our risk for common conditions such as diabetes, obesity, and heart disease.  But privacy is a huge concern, especially since it’s the employer that’s holding this wealth of personal information.  Not bound by HIPAA, employers may question what their privacy obligations are when reviewing this data.  It’s hard enough to have a Facebook account with pictures of an old college party when looking for a job: how will the fact that you don’t go to sleep until 2AM, never go to the gym, and eat Pringles for breakfast every day affect your application?

“Sirens are going off in my head. There’s certainly the potential for abuse,” says Beth Givens, the director of Privacy Rights Clearinghouse.  “Health data can be used for many different purposes, and in an age of ‘big data’ can reveal things about you that you may not even know about,” added Lee Tien, a senior staff attorney with Electronic Frontier Foundation, another privacy advocate. “And the laws that protect health information often only protect that information within the health care system — [meaning] doctors and those involved in medical treatment and health insurers.”  Without a clear privacy policy, including a stipulation that no mHealth data should be used to make HR decisions and a detailed plan for what happens to the data when an employee leaves the company, participants may be treading a dangerous path towards legal ambiguity and potential violations.

Citizen’s pilot program is strictly voluntary right now, and the eight participants are aware that they’re giving up their privacy rights in the interest of exploring the potentials of the system, figuring out which metrics are useful and which are superfluous.  As mHealth expands in popularity and more people use their smartphones to keep tabs on their health, productivity, and wellbeing, Citizen may be leading the way towards a new definition of the “meaningful use” of health IT.




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