April 2020

mHealth Update: Google Makes a Move in the Ongoing Tech Wars
By Adam Beards
For The Record
Vol. 32 No. 3 P. 30

On November 1, 2019, Fitbit announced that it had entered a definitive agreement to be acquired by Google for $2.1 billion in cash, or $7.35 per share.

Founded by CEO James Park in 2007, Fitbit has found success in the wearable technology market. The company experienced rapid growth from its inception, and has since sold more than 90 million wearable devices, boasting 28 million active users as of 2019. These wearable devices have been capturing personal health information such as heart rate and daily step count from a wide userbase.

With the business acquisition, Google will obtain all of Fitbit’s information, representing a significant opportunity for the technology giant to advance health care through the use of artificial intelligence (AI) and predictive analytics.

“Google is an ideal partner to advance our mission,” Park said in a Fitbit press release. “With Google’s resources and global platform, Fitbit will be able to accelerate innovation in the wearables category, scale faster, and make health even more accessible to everyone.”

Praveen Veerabhadrappa, PhD, an associate professor of kinesiology at Penn State Berks who has been conducting research into the efficacy and accuracy of Fitbit wearable devices, believes that Google acquired Fitbit mainly to compete with Apple and secure footing in the burgeoning health care technology industry.

“Fitbit devices have been tracking health metrics for over a decade now. They have more data than Apple, more than Samsung,” Veerabhadrappa says. “Google is trying to get that data and try new things.”

Matthew Rhudy, PhD, a professor of engineering and Veerabhadrappa’s research partner, adds, “Fitbit has the name. More than anything, Google wants that name.”

The acquisition represents a strategic move in the evolving “tech wars” between economic giants such as Google, Apple, Facebook, and Samsung. The new commodity that is being warred over is consumer data, including viewing and spending habits, and, now, health information.

“Data is the new gold, the new currency. Data is the future,” Veerabhadrappa says.

But there are questions to be raised as to whether a business titan such as Google will handle sensitive patient information with the care that it deserves. Other industry experts are also concerned with the accuracy of personal health information transmitted via wearable technology.

Joseph Kvedar, MD, president-elect of the American Telemedicine Association and a professor of dermatology at Harvard Medical School, is optimistic about the future of wearable tech but maintains that privacy is of utmost importance. “That Google was motivated to acquire Fitbit is emblematic of how much potential people think wearables have,” he says. “Your data are becoming a value in the world, but you have to be given the option of when and whom gets to see it.”

In a press release, Rick Osterloh, senior vice president of devices and services at Google, said, “Privacy and security are paramount. When you use our products, you’re trusting Google with your information. We will never sell personal information to anyone. Fitbit health and wellness data will not be used for Google ads. And we will give Fitbit users the choice to review, move, and delete their data.”

Data Uses
What data do Fitbit devices gather and is the information accurate?

According to the legal section on Fitbit’s website, “Your device collects data to estimate a variety of metrics like the number of steps you take, your distance traveled, calories burned, weight, heart rate, sleep stages, active minutes, and location.”

Some of these metrics, such as calories burned, are still in the early stages of development and are not quite accurate enough to be used in clinical studies. However, variables such as heart rate and step counting can be quite accurate, according to research performed by Veerabhadrappa and Rhudy.

Typically, clinical studies and academic research can be slowed dramatically by a lack of subjects. Of note, studies with a low number of participants are often viewed as being less statistically valid. But with a population size of 28 million active Fitbit users, Google will be able to make rapid advances in clinical studies and wide-scale population analytics.

For Google, prediction seems to be the name of the game. If you’ve crafted an e-mail via Gmail recently, you may recall a “predictive text” function that aims to know what you will type before you type it. Google accomplishes this is by using an algorithm that interprets what people type and when.

Now with the acquisition of Fitbit, Google may be able to perform a similar predictive function with patient health data.               

The Future of Decision Making in Health Care
Jacob Krive, PhD, a professor of biomedical and health information sciences at the University of Illinois-Chicago, believes that wearable technology and, by extension, AI have many uses in the hospital setting. “The more data you have, the more exploration you can do,” he says.

For example, elderly patients may wear Fitbits or other wearable technology to remotely monitor their vital signs in the comfort of their home. Should an event—such as a dip in heart rate below a certain threshold—occur, the device sends a message to a caseworker.

“In a lot of cases where the patient suddenly deteriorates, if only we had that benefit of noticing several hours earlier, they might have been saved. This is what we’re missing,” Krive says.

In those instances, a piece of wearable technology could act as a kind of “digital sentinel” that keeps watch over a patient and is ready to alert a hospital worker should an emergency arise. Passive use of these devices could help mitigate some of the personnel scarcity common to hospital settings.

Wearable fitness trackers can also be used to automatically update EMRs. This kind of continuous updating could help keep a patient’s records more current and accurate, facilitating diagnosis of any future health complications.

Varun Malik, DO, a resident at Penn State Health St. Joseph, who has worked with portable EKGs to measure patient heartbeat data remotely, believes wearable technology can be used to speed up the diagnostic process. “It definitely saved resources,” he says. “A lot of time goes into diagnosis and triage. If the right technology existed, you could correlate past medical history and current medical history and triage a person much quicker.”

While the data’s value is unquestioned, the information becomes useless if proper security protocols are not enforced. Typically, Institutional Review Board controls will ensure that sensitive information is kept private, but for larger corporations such as Google, it may be easier for some of these controls to fall by the wayside.

“Let’s remember that Google is a commercial company and an aggressive one. They have shareholders and will move faster,” Krive says. “And moving faster is not always conducive to privacy.”

One of the potential complications of the Google/Fitbit deal is that Fitbit users may not be aware of the depth of information that they have signed away. Typical terms of service contracts are lengthy and often go unread by consumers. “You’re presented with a five-page thing you sign to make go away,” Krive says. “I think people would care more if they understand what their health information means.”

Kvedar is more hopeful about the ways in which Google will use patient information. “The conversation about privacy and data ownership is an important one. Of course, there’s a potential downside, but I feel the potential upsides outweigh that,” he says.

While Kvedar understands the value of AI in health care settings, he believes that humans must still play the central role in patient care. “We see applications where computers can do the kinds of tasks that humans find daunting—sifting through all of the literature about a patient, giving you a complete synopsis at a moment’s notice. But we still have to have human judgment, human caring, and emotional intelligence,” he says.

As Fitbits and other wearable technology become more commonplace in the health space, it seems a combination of both AI and human ingenuity may be the most promising path forward—AI to provide and synthesize data from the wrist, and human intelligence to make decisions and extend the healing hand.

— Adam Beards is a freelance writer based in Bernville, Pennsylvania.