The State of Personal Connected Health Evidence and A Call to Action

Sep 27, 2017

Patty Mechael

Executive Vice President

Personal Connected Health Alliance

As part of the Personal Connected Health Alliance’s (PCHAlliance) efforts to define personal connected health, evidence was identified as a key driver for shaping the field.  To assess the current state of evidence in this newly emerging domain, we conducted a systematic review of published literature to gather the available data on health outcome measures. Our team reviewed over 1,450 citations and selected 53 randomized controlled studies and trials for analysis, on topics related to mobile technologies, remote patient monitoring, web-based counseling and other personal connected health technologies.

The resulting paper, Personal Connected Health: The State of the Evidence and a Call to Action, provides important insights and identifies a number of gaps--and opportunities--to validate personal connected health technologies. This publication aims to set an initial baseline for the current body of evidence in personal connected health in key sub-domains, namely behavior change and self-care, remote patient monitoring, remote counseling and mental health, as well as more broadly through key condition-specific studies.  It is a solid beginning, but much work still needs to be done to develop an evidence base for personal connected health.

The use of technology to promote behavior change or to help individuals care for personal health conditions was the largest of the themes identified.  The majority of studies utilized fully automated web-based programs, text message delivery systems or smartphone apps.  Evidence of effectiveness is mixed in this group of studies. Web-based cognitive or pain management platforms is a key sub-theme in this area. These may be fully automated educational systems or platforms that mimic counseling based on cognitive behavioral therapy or may contain partial support from a live therapist.  

The remote patient monitoring studies included technology that enables healthcare providers to capture and receive quantitative data about their patients when they are away from the clinic or hospital.  Most studies here employed either implantable devices such as cardiac defibrillators, or peripheral instruments connected to devices in the home that could transmit physiological data to the healthcare provider, including blood pressure, weight, or blood glucose. While the results from these studies are also mixed, those showing no significant difference in mortality and re-hospitalization rates between remotely monitored patients and those receiving care in the facility were seen as evidence that this type of intervention could be used effectively and safely for this population. These studies are important and demonstrate how remote patient monitoring can be used to reduce the burden of in-clinic visits for some patients and facilities.

Publications related to remote counseling and mental health involving technology to enhance or deliver therapy for depression or other mental health issues stood out as a separate theme. These studies lacked any quantitative remote patient monitoring and relied heavily on trained professionals to deliver the mental health therapies.  The technologies used in these studies include telephone or internet-based video. Improved mental health outcomes were demonstrated in all of the studies addressing depression and PTSD through telemedicine. These successful results are probably due to the proven success of the cognitive behavioral therapy (CBT) delivered by a trained professional and less to the specific use of technology, although the use of phone and internet video for these services increases access and coverage of the services.

Moving forward, a key challenge will be maintaining an evidence base that is relevant, as even current studies quickly become outdated due to the rapid pace of technology development. Much of the published data is criticized for small sample size and scope, clinical rigor, validation of devices and apps, and the significant challenges to design randomized control trials in connected health. But the potential of personal connected health is clear, and the body of evidence is growing.

To support this, we are recommending six areas of focus for future research and investment in personal connected health: increased study size; development and dissemination of consensus-based guidelines for research methodologies; identification of approaches to accelerate research without compromising quality of results; validation of apps and devices in comparative studies; initiation of studies to explore new ways for individuals to take more control to improve their health; and the development and promotion of a Research Priority Agenda for personal connected health.

As we continue to gather more and more data exhaust from personal connected health devices and other data sources derived from the Internet of Things, we will be able to update research methodologies and engage in more effective multi-site and large-scale trials to prove the compelling case for personal connected health technologies. In addition, collaboration between all parties-- consumers, clinicians, industry, researchers and regulatory bodies--will be critical to validate personal connected health tools.

PCHAlliance is fully committed to bringing together the global ecosystem to help nurture and build the evidence needed to support the adoption of personal connected health and keep pace with innovations in the field. We invite you to join us in this mission to make health and wellness an effortless part of daily life.