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Better Health Management with Integrated Data

Sangeet Saurabh
16 min readMar 17, 2023

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In my previous blog posts, I explained that the human body is a complex system of interconnected parts. Our daily choices and behaviors can affect critical biological markers that may lead to long-term health issues. For instance, an unhealthy diet, lack of sleep, physical inactivity, stress, or a combination of these factors can lead to conditions like inflammation, leaky gut, or insulin resistance, which in turn can contribute to developing other chronic diseases over time.

Maintaining a chronic disease-free lifestyle requires individuals to actively manage and monitor their lifestyle choices and biomarkers. In this article, I will discuss how we can enable individuals to better manage their health under their healthcare providers' (HCPs) supervision by leveraging their data.

Typically, effective personal health management involves three dimensions:

  1. Mainstream medicine: This refers to the healthcare system, including doctors, hospitals, and other medical professionals. Regular check-ups and screenings of biomarkers help to identify any potential health issues.
  2. Lifestyle management: This includes making healthy choices in areas such as diet, exercise, stress management, sleep, meditation, and other lifestyle factors.
  3. Physiologic data monitoring through wearables: Wearable devices such as fitness trackers, smartwatches, and other monitoring tools can provide individuals with valuable data on their physical activity, sleep, heart rate, blood glucose level, and many other vital signs.
No integration between biomarkers and diagnostics in EMR and lifestyle data such as activity, sleep, diet, blood glucose, etc.

Individuals tend to approach the three dimensions mentioned above in their own unique ways, with limited integration among them. This lack of integration gives rise to several issues, including:

  1. Healthcare providers (HCPs) have a limited understanding of an individual’s lifestyle choices and physiologic data. Instead of relying on actual data, HCPs depend on anecdotal updates that may be biased. This lack of visibility into the actual data hinders the HCP’s ability to make specific recommendations, resulting in generic advice such as “eat well, sleep well, manage stress, and exercise.” Such generic advice is not actionable for patients.
  2. Understanding how lifestyle choices impact physiologic data and biomarkers is challenging for individuals. A lack of data-driven understanding of outcomes leads to a loss of motivation. Additionally, the lack of integration limits an individual’s ability to make incremental changes for better outcomes.

How will the integration lead to better health management?

Integrating the three dimensions of mainstream medicine, lifestyle management, and physiologic data monitoring through wearables can help individuals achieve better health outcomes in several ways. Here are some of the benefits of integrating these dimensions:

  1. Personalized actionable health management steps: By integrating lifestyle and wearable data with mainstream medicine, HCPs will gain a more comprehensive understanding of an individual’s health status. With access to such information, HCPs will better understand an individual’s daily activities and ask specific and targeted questions based on the data. Data-driven interaction will lead to departure from offering generic advice such as “eat well, sleep well, manage stress, and exercise.” Instead, HCPs can provide personalized and actionable recommendations based on the individual’s unique lifestyle and physiologic data. The personalized recommendations will help individuals make informed choices and achieve a healthier lifestyle.
  2. Improved motivation for healthy lifestyle management: Knowing that doctors are monitoring their health data will boost individuals’ motivation to use wearable devices and adopt healthier lifestyles. They will also gain a better understanding of how their daily behavior and lifestyle choices affect their health biomarkers. This increased awareness and visibility will consequently drive them to strive for a healthier lifestyle, resembling a gamified approach to lifestyle management.
  3. Better communication with HCPs: The availability of wearable devices and lifestyle data to HCPs will enable more contextual and deeper discussions. Giving HCPs a comprehensive 360-degree view of an individual’s health data will allow for more productive and efficient conversations even in less time, resulting in better health outcomes.
  4. Continuous treatment plan adjustment: HCPs can use data from wearable devices to monitor a patient’s progress and adjust treatment plans as needed. I have already seen this happen for COPD and diabetes patients through my products. But that’s just the beginning, and the potential is enormous for many chronic diseases.
  5. Early detection and prevention of chronic diseases: Regular monitoring of biomarkers through mainstream medicine and wearable devices can aid in the early detection and prevention of chronic diseases. By identifying potential health and lifestyle issues early on, individuals can take steps to prevent the development of chronic diseases.

For instance, by leveraging wearable device data on sleep, heart rate, and activity levels and monitoring blood pressure and cholesterol levels, HCPs can identify individuals at risk of developing cardiovascular disease. With this information, HCPs can provide targeted interventions such as lifestyle changes or treatments to help reduce that risk.

Let’s walk through an example.

Integrating the three dimensions of mainstream medicine, lifestyle management, and physiologic data monitoring through wearables can be helpful for individuals with gout to manage their condition. Gout is a type of arthritis that occurs due to an excess of uric acid (Hyperuricemia) in the body. When the uric acid level increases, it can form crystals in the joints, leading to inflammation, swelling, and intense pain.

Pain, swelling, and inflammation related to gout attacks are typically treated with medications such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids. Additionally, medicines such as allopurinol are prescribed to lower uric acid levels. Patients also receive generic “one size fits all” advice to make lifestyle changes, including limiting their intake of purine-rich foods such as red meat, seafood, and alcohol, staying hydrated, and maintaining a healthy weight. Despite taking medicines and putting their best effort into making lifestyle changes, many patients continue to experience recurrent gout attacks.

Treating the gout attack permanently may involve identifying and treating the underlying lifestyle or medical conditions that cause Hyperuricemia. Identifying the underlying root cause can be complex. There can be two scenarios -

  1. The body produces an excess of uric acid.

The uric acid production in the body can be of two types -

  • Exogenous Uric Acid — Such uric acid is connected to consuming food high in purine (red meat, liver, etc.), fructose, and alcohol. When we consume such food, they are broken down by the body into uric acid.
  • Endogenous Uric Acid — These are driven by purines produced naturally within the body as part of natural cellular metabolism. Body cells are in a perpetual state of death and renewal. Purines are produced by damaged or dying cells. While endogenous purines are necessary for normal physiological processes, the body’s production of purines can be influenced by certain factors, including genetics, diet, and lifestyle. For example, high-stress levels, alcohol consumption, a sedentary lifestyle, and/or a diet high in sugar and processed foods may increase the body’s production of endogenous purines, potentially leading to elevated uric acid levels.

2. The kidney cannot filter out and excrete uric acid from the blood.

The kidneys play a critical role in processing uric acid and maintaining proper uric acid levels. Once uric acid is generated, the kidneys filter it out of the bloodstream, and subsequently, it is eliminated from the body through urination.

However, in some people, the kidneys may not effectively filter and excrete uric acid, leading to elevated levels of uric acid in the blood, which can increase the risk of developing gout. Several factors can affect the kidneys’ ability to filter and excrete uric acid, including certain medical conditions such as kidney disease, high blood pressure, and diabetes, as well as certain medications. Recent research suggests that the gut microbiome may also play a role in kidney dysfunctions by producing uremic toxins. It is important to note that lifestyle factors such as diet, physical activity, stress management, and sleep quality can influence these medical conditions.

Whether Hyperuricemia is because of excess uric acid production or kidney dysfunction, it is a complex interplay of various factors, including lifestyle management, underlying medical conditions, and physiological and health biomarkers. A comprehensive system, which provides a 360-degree view of the patient and considers all these factors, may benefit HCPs and patients.

By utilizing continuous physiologic and lifestyle data from wearables and frequent uric acid monitoring, HCPs could gain a better understanding of the correlations among physiologic data, lifestyle habits, biomarkers, and diagnostic data. With this information, HCPs could design a personalized treatment plan that considers the patient’s unique situation, ultimately leading to better management and a more permanent solution to gout attacks.

For patients, having access to such a system could provide a better understanding of how their lifestyle choices connect with medical conditions and impact their gout attacks. This understanding could lead to deeper conversations with HCPs and more targeted lifestyle changes designed to manage gout attacks. Additionally, knowing that HCPs are monitoring their data could motivate patients to stick to their treatment plan and take a more active role in managing their condition.

Continuous monitoring of a patient’s uric acid level, physiologic and lifestyle data may allow HCPs to adjust the treatment plan in real time without waiting for the next appointment. As the patient makes lifestyle changes, HCPs can continuously monitor the impact on the patient’s biomarkers. The visibility into continuous data may enable them to make informed treatment decisions and adjust the treatment plan for better outcomes. This approach may allow HCPs to identify potential issues early and take proactive steps before the next gout attack happens.

There are other benefits to such an integrated approach too. As Dr. David Perlmutter in his book “Drop Acid: The Surprising New Science of Uric Acid” points to recent research, Hyperuricemia has been linked to several other health issues, including impaired blood flow, heart dysfunction, inflammatory and immune response, blood sugar control, digestive processes, and nutrient absorption. By addressing Hyperuricemia, patients not only manage their gout attacks but also reduce the risk of developing other chronic diseases in the future.

What are the challenges of doing the integration?

Integrating three dimensions of mainstream medicine, lifestyle management, and wearable data is not easy, as it poses several challenges at many different levels. However, by establishing a solid partnership between healthcare and technology professionals and taking an incremental approach to solving one use case at a time, we can progress with the integration process and move our healthcare system in this direction.

Enumerating all the challenges in detail would require a book-length discussion. However, I will highlight some of the crucial challenges and provide some ideas on how to overcome them.

1. Functional Level

Objection 1: The HCPs’ time is already constrained. Where will HCPs find time to monitor this additional data?

Indeed, the objection raised is valid. In order to address it, it’s essential to leverage technology and data science. HCPs should not be burdened with the task of performing data analysis themselves. Instead, we should use technology and data science to bubble up the relevant information to HCPs in an easily understandable format.

Additionally, it’s essential to establish standards for sharing different types of data. The International Diabetes Center has set a great example in this regard by defining standards for visualizing Continuous Glucose Monitor (CGM) data. Most endocrinologists and patients can interpret data from this report and make informed treatment adjustments accordingly.

Ultimately, the goal should be to create a system that allows HCPs to make more informed decisions about patient care without adding unnecessary burdens or complexity to their workflow. If done right, we should free up HCPs’ time from healthier patients, enabling them to spend more time on patients with complex health issues. By leveraging technology and data science intelligently, we can work towards achieving this goal and improving patient health outcomes.

Objection 2: People may not comply with wearable devices. Everybody is not equally health conscious.

Certainly, this objection is also valid. The system may not be effective for everyone. However, even if it works for only 30 to 50% of the population, it could still significantly reduce the burden of chronic diseases. We may need to target early adopters initially and gradually expand our market share.

Furthermore, a study published in the Journal of General Internal Medicine found that patients were more likely to make positive lifestyle changes related to diet and exercise when they received recommendations from their doctor. The study also revealed that patients who received personalized advice were more likely to make changes than those who received generic advice. I observed this firsthand when I launched a wearable device-driven remote patient monitoring product for COPD and diabetes management. Therefore, integrating wearable data, lifestyle data, and healthcare systems will likely boost the system’s adoption.

Objection 3: Medical science on the interconnectedness of organ systems and lifestyle is still new. Is it ready for mainstream adoption?

Yes, the objection is correct. Medical science is constantly advancing and has made significant progress in understanding the interconnectedness of organ systems and lifestyle factors such as diet, exercise, and stress. While there is still much to learn and discover in this field, we can already make significant progress in chronic disease management by incorporating the scientific progress made so far.

By treating the root cause of chronic diseases and making treatment more preventive through the incorporation of the progress of medical science, we can improve the overall health and well-being of patients. Technology can play a significant role in making these medical advancements more mainstream and accessible to the masses safely and effectively.

Several leading doctors from most reputed medical schools and healthcare organizations, including Dr. Mark Hyman, Dr. Christopher M. Palmer, Dr. Dale Bredesen, Dr. Robin Berzin, Dr. Saray Stancic, and Dr. Dean Ornish, have published studies or written books demonstrating the benefits of an integrated approach to healthcare for chronic disease management. With the use of technology and data science, we have the opportunity to spread these advancements to a broader audience and improve healthcare outcomes for all.

2. User Experience Level

Objection 1: Managing wearable and capturing lifestyle (e.g., diet, meditation, etc.) habits will be complex and require a lot of manual data entry. People may not enter the data.

Yes, this is a valid concern. To address this issue, it is crucial for technology and medical science teams to collaborate and ensure that the wearables offer a seamless user experience, from setup to everyday use. Ideally, data capture should not require any user intervention.

Capturing lifestyle data is a complex problem that requires close collaboration between technology and medical science teams. Companies like Level Health, Whoop, and Noom have made significant progress in capturing diet-related information, but more work is needed to make it work for all age groups. Young, tech-savvy, health-conscious individuals typically use consumer devices, but healthcare devices must cater to everyone, including older and less tech-savvy populations.

Medical and Data science teams collaboratively have to play a vital role in simplifying the user experience. Let’s take diet as an example. Capturing the exact diet is complex. But through continuous glucose monitoring (CGM), it is possible to capture daily glucose level spikes. Daily spikes may act as a proxy to understand the dietary behavior of the patient.

3. Technology Level

Objection 1: Integrating EMR systems with other systems poses significant challenges, including regulatory compliance (such as adhering to HIPAA regulations) and data security concerns. Moreover, many EMR systems are often closed with minimal APIs, further complicating the integration process. How do we overcome them?

While this is a valid concern, we can overcome these challenges by adopting a targeted approach. Instead of integrating with all EMRs simultaneously, we can focus on specific use cases and gradually scale up as we gain experience and expertise.

Another critical aspect is defining standards for each type of data. While HL7 and FHIR have made significant strides in data portability, we need to refine these standards for continuous wearable and lifestyle data. By standardizing data, we can facilitate interoperability between different systems and ensure that patient data is exchanged securely and competently.

Objection 2: Lifestyle and wearable data are often dispersed across various devices and systems. How can we effectively integrate this data and make them available to HCPs?

Data standardization can also help overcome the challenges of integrating lifestyle and wearable data across multiple devices and systems. To drive the adoption of their products, vendors and developers will adopt and implement these data standards.

Objection 3: Wearable data is limited to some basic physiology. For most advanced data, either wearables are not available or expensive. So, the integration of EMR and wearables will have a limited impact.

While it is true that wearable devices have limitations in terms of the type and depth of physiological data they can collect, significant advancements have been made in recent years. Many wearables can now track a wide range of data beyond just basic physiological measurements. For instance, some devices can track sleep patterns, heart rate variability, arrhythmia, blood pressure, and even blood glucose levels. Wearable technology is rapidly advancing to capture physiological data connected to many other diseases, including uric acid.

Moreover, wearable devices are becoming increasingly affordable and accessible, making them more widely available to patients. These advancements in wearable technology mean that integrating electronic medical records (EMRs) and wearable data can significantly impact healthcare management.

4. Business model level

Objection 1: Our current healthcare payment model is a “break-fix” service-driven model. This continuous data-driven model may work differently than the current business model.

Yes, this is correct. This objection requires a significant transformation. Firstly, HCPs will need to be trained in the necessary skills and knowledge to utilize continuous data to enhance patient care effectively. Additionally, transitioning from a “break-fix” service-driven model to a continuous data-driven model in healthcare payment will require a multifaceted approach. I outlined an outcome-driven strategy for achieving this transformation in a previous blog.

In his book “The Innovator’s Dilemma,” Clayton Christensen proposed many ideas for an established business to lead disruptive innovations. Those ideas are highly relevant to healthcare system innovation. The traditional “break-fix” service-driven model is firmly established in healthcare. Transforming to a continuous data-driven model will require healthcare systems to challenge their current business models and processes. To achieve this transformation, the healthcare system should be willing to experiment with new technologies and strategies, even if there may not be an immediate return on investment. With a concerted effort, this shift is achievable and can lead to better health outcomes and more cost-effective care.

In Conclusion

The integration of mainstream medicine, lifestyle management, and physiologic data monitoring through wearable devices has the potential to significantly enhance the quality of life for both patients and healthcare professionals. By utilizing a comprehensive view of patients’ data, healthcare professionals can identify potential health risks earlier and provide personalized treatment plans, resulting in improved patient outcomes and potentially reducing the burden of chronic disease on the healthcare system.

Furthermore, an integrated healthcare system can equip individuals with a more comprehensive understanding of their health, empowering them to take proactive steps to prevent and manage chronic diseases.

Despite the immense potential benefits of this integrated approach, several challenges must be addressed to realize its potential fully. However, by addressing these challenges, we can move towards a more personalized and comprehensive approach to healthcare management.

References -

1. Dr. David Perlmutter MD (a Board-Certified Neurologist and six-time New York Times bestselling author, Board of Director & a Fellow of the American College of Nutrition)

  • Drop Acid: The Surprising New Science of Uric Acid (Book)

2. Dr. Christopher M. Palmer MD (Assistant Professor of Psychiatry at Harvard Medical School) -

3. Dr. Dale Bredesen, chief resident in neurology at the University of California, San Francisco (UCSF) & Chief Science officer (Apollo Health)

4. Dr. Robin Berzin, MD (Founder and CEO of Parsley Health)

  • State Change: End Anxiety, Beat Burnout, and Ignite a New Baseline of Energy and Flow (Book)

5. Dr. Mark L Hyman MD (The Head of Strategy and Innovation of the Cleveland Clinic Center for Functional Medicine, Board President for Clinical Affairs for The Institute for Functional Medicine — https://drhyman.com/)

6. Dr. Justin L Sonnenburg (Professor, Microbiology & Immunology, Stanford — https://sonnenburglab.stanford.edu/)

7. Dr. Ayesha and Dean Sherzai, MD (Neurologists and co-director of the Alzheimer’s Prevention Program at Loma Linda University — https://thebraindocs.com/)

8. Dr. Saray Stancic MD (board-certified physician — https://drstancic.com/)

9. Dr. David A. Sinclair, A.O., Ph.D. (Professor at Harvard Medical School)

10. Dr. Andrew Huberman, Ph.D. (Neuroscientist, professor of Neurobiology at Stanford School of Medicine)

11. Dr. Robert H. Lustig, M.D., M.S.L. (Professor emeritus of Pediatrics, neuroendocrinology, UCSF)

  • Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (Book)

12. Dr. Emeran Mayer, MD (Distinguished Research Professor in the Departments of Medicine, Physiology, and Psychiatry, UCLA)

  • The Mind-Gut Connection: How the Hidden Conversation Within Our Bodies Impacts Our Mood, Our Choices, and Our Overall Health (Book)
  • The Gut-Immune Connection: How Understanding the Connection Between Food and Immunity Can Help Us Regain Our Health (Book)
  • The Mind-Gut Connection podcast — https://emeranmayer.com/podcasts/

13. Dr. Atul Gawande (General & Endocrine Surgery, Brigham and Women’s Hospital & professor at Harvard Medical School)

  • Being Mortal (Book)

14. Dr. Brittany Henderson, MD, ECNU (board-certified in internal medicine and endocrinology — https://www.drhendersonmd.com/)

  • What You Must Know About Hashimoto’s Disease (Book)

15. Dr. Steven E. Phillips, MD (Yale-trained, world-renowned expert on zoonotic infections)

  • Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again (Book)

16. Dr. Dean Ornish (Professor of medicine UCSD & Physician Consultant of Bill Clinton)

  • Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (Book)

17. Dr. Kristen Willeumier, Ph.D (Neuroscientist with research expertise in neurobiology and neuroimaging — https://www.drwilleumier.com/)

  • Biohack Your Brain: How to Boost Cognitive Health, Performance & Power (Book)

18. Dr. Aseem Malthothra (British Cardiologist)

  • A Statin-Free Life: A Revolutionary Life Plan for Tackling Heart Disease (Book)

19. DUTCH (Dried Urine Test for Comprehensive Hormones) podcasts —

20. American Psychological Association —

21. Rand Corporation —

22. Centers for Disease Control and Prevention (CDC)

23. Sleep, Recovery, and Activity through several consumer devices

Integrated Health
Healthcare
Gout Treatment
Data Science
Healthtech

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Sangeet Saurabh

Written by Sangeet Saurabh

41 Followers

Combining data science and technology with medical science to lessen chronic disease's burden and enable people to live longer, happier, and healthier lives.

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