By Michael Painter, MD
Hello. I am Mike Painter, and I track. I don't necessarily have a compelling reason to track health parameters such as exercise patterns, heart rate, weight, diet and the occasional blood pressure. Yet I do. I do most of my tracking with several small devices, simple sensors and software applications. My tracking is also pretty social—meaning I share much of my data widely and daily. You're welcome to see it—most of it is on Strava. Admittedly, I still keep some data daily on a paper calendar, and I do monitor diet and sleep in my head—i.e., nobody needs to remind me about my food splurge days. The local bakery is intimately aware of that data point as the employees witness me charge in, wild-eyed and drooling for a giant cinnamon roll every Thursday morning—almost without fail.
It all feels pretty normal to me.
Here's the rest of the story: I track to enhance athletic performance rather than monitor my health, per se, or even really my wellness. I am an avid cyclist and have tracked miles, location, accumulated elevation, heart rate and power readings and other data for years. I share that information with both cyclist colleagues I know and don't know on Strava. That site eagerly ingests my data—and among other things, plops it into riding (and running) segment leader boards, riding heat maps—and, most importantly, in training, trend graphs like the attached. All that data is incredibly helpful to me—it empowers me by making me face the numbers—it makes my training data- and reality-based. I don't have to guess to maximize my fitness and minimize my fatigue level in anticipation of a big event. I follow the numbers.
Is all that bad? To me, my obsession with tracking my athletic performance seems like an extension of observing data for health and wellness.
Last week I had the great fortune to participate in a breakout session at the very cool Stanford Medicine X conference in Palo Alto. I talked about RWJF’s pioneering work in patient engagement, including efforts like OpenNotes and Project HealthDesign. I also felt compelled to show my Garmin Edge 500, Garmin Forerunner 610 and heart rate monitor to the audience—mostly, to make the point that tracking is ubiquitous, helpful and powerful—and that it doesn't require Google Glass-level technology.
Turns out, those of us tracking aren't really odd-balls, after all. Last week I also had the opportunity to attend the annual Bay Area Heath 2.0 conference where the superb Susannah Fox gave a preview of new Pew research on the health information tracking behaviors of Americans. It's pretty interesting stuff. Guess what? About 60% of us track some aspect of our health—weight, exercise, and diet. Like me with my diet, many of us (49%) track in our heads. And for many (34%), technology is not a big factor, at least not yet. Paper is still big with today's trackers.
At both the Stanford and Health 2.0 conferences, I sensed a subtle snub against us athletic trackers in favor of real people and patients who use tracking tools for their health. I see it slightly differently. To me, it’s really a continuum from health and wellness to fitness and performance. Some of that leading-edge fitness and performance tracking shows us all the tremendous power of these tools. The thing that binds all this tracking behavior is the power of the data and self-awareness. Our own Project HeathDesign work, for instance, showed clearly that patients with Crohn's had higher satisfaction, better communication, and a better understanding of their illness and symptoms when they collected observations of daily living data. Those findings overlap pretty consistently with my own tracking experience.
One major worry: the vulnerable. In my prior community health center clinical practice, many of my patients struggled simply to catch multiple buses to get to the clinic or faced basic needs obstacles like gunfire in their neighborhoods or food deserts. Fastidious data tracking for self-awareness in that context seems challenging if not absurd. Still I wouldn't jump to conclusions. Even years ago, my patients surprised me with their enthusiastic embrace of technology—pushing to email or text me for instance. Many, if not most, of my patients with diabetes ended up tracking blood sugar by hand pretty consistently.
It will be interesting to see how our tracking evolves. I can imagine a world where we try hard to engineer health and wellness into everyone's environment—everyone's. But we'll obviously never completely engineer out the badness. We should also be able to use technology and tools as a buffer against the bad—to help us gain awareness of how we interact with that world in both positive and negative ways—and then use that information to help us achieve health, wellness—and, yep, higher performance.
Michael W. Painter, JD, MD is a senior program officer at the Robert Wood Johnson Foundation.
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