Automated, Real-Time Integration of Biometric Data From Wearable Devices With Electronic Medical Records: A...

A major barrier to the incorporation of biometric data into clinical practice is the lack of device integration with electronic medical records (EMRs). We developed infrastructure to transmit biometric data from an Apple Watch into the EMR for physician review. The study objective was to test feasibility of using this infrastructure for patients undergoing radiotherapy.

The study included patients with breast or prostate cancer receiving ≥3 weeks of radiotherapy who reported owning an Apple Watch. Daily resting heart rate (HR), HR variability, step count, and exercise minutes were automatically transferred to our EMR using a custom app installed on each patient's iPhone. Biometric data were presented to the treating radiation oncologist for review on a weekly basis during creation of the on-treatment note. Feasibility was defined a priori as physician review of biometric data for at least 90% of patients. Time trends in biometric data were tested using the Jonckheere-Terpstra test. Patient satisfaction was assessed using the System Usability Scale (SUS), with scores above 80 considered above-average user experience.

Of the 20 patients enrolled, biometric data were successfully transmitted to the EMR and reviewed by the radiation oncologist for 95% (n = 19) of patients, thus meeting the a priori feasibility threshold. For patients with radiation courses ≥4 weeks, exercise minutes decreased over time (P = .01) and daily mean HR variability increased over time (P = .02). The median SUS was 82.5 (IQR, 70-87.5).

Our study demonstrates the feasibility of real-time integration of biometric data collected from an Apple Watch into the EMR with subsequent physician review. The high rates of physician review and patient satisfaction provide support for further development of large-scale collection of wearable device data.