Doctors are on board with wearable devices and see their potential to improve patient care, but integration into clinical practice still faces significant roadblocks.
Most physicians (97%) reported reviewing wearable data in some capacity, and large majorities reported that wearable data provide at least some clinical advantage for patient care, according to a survey of more than 2,000 physicians across six countries (US, Canada, UK, France, Germany and Spain). Only 3% of physicians say they never review such data.
The most commonly reviewed data categories are broadly similar across countries: heart physiology, activity and function, biometric/physical events and alerts, and sleep.
According to the survey, 77% of U.S. and 74% of non-U.S. physicians see some clinical advantage in wearable data.
In fact, 82% of physicians personally use wearables, according to the survey conducted by the American Medical Association’s Center for Digital Health and AI and Medscape.
The survey results indicate that doctors, by and large, see the value of data from smartwatches, fitness trackers and biosensors, but widespread clinical integration is held back by structural barriers rather than lack of motivation.
The study examined physician use of patient-generated wearable data, trust in data quality, reimbursement, workflow challenges and factors influencing adoption.
"What surprised me is that the technology is ahead of the healthcare system, not ahead of physicians," American Medical Association CEO John Whyte, M.D. told Fierce Healthcare. "The systems are not set up to maximize that data for clinical impact."
The data needs to be actionable and not just available, Whyte noted.
For wearable data to be used more broadly in clinical practice there needs to be stronger clinical validation, clearer payment and liability frameworks, better tools for interpreting data, and workflows that fit seamlessly into clinical practice, AMA President Willie Underwood III, M.D., said.
The survey found that when patients ask their doctors to review wearable data, physicians typically act, with consistent responses across countries. This points to patient demand as one of the most reliable levers for closing the gap between exposure to and integration of data from wearables, the report authors wrote. The implication is that activating demand through patient education, literacy tools on wearable, and clinician-facing communication resources may be one of the most direct strategies for accelerating clinical use.
The integration of wearable data into routine clinical practice remains limited but varies by country. Across all the countries studied, less than 6% of physicians currently integrate wearable data into workflows. But, differences in physician adoption were more closely tied to reimbursement, workflow feasibility and regulatory conditions than physician interest, the survey found.
Germany and Spain have the largest reported near-term pipelines of physicians ready to integrate these data, whereas fewer than one in five physicians in Canada or the United Kingdom indicated a high likelihood of integration in the next 12 months.
The United States resembles Canada in its overall wearable data use profile, with moderate current integration and a modest near-term pipeline of physicians who anticipate integration in the next 12 months.
A look at reimbursement pathways and other findings
Reimbursement pathways and structural conditions significantly influence how frequently physicians review wearable data.
In the U.S., Current Procedural Terminology (CPT) codes for remote patient monitoring require FDA-cleared devices used under a clinician-directed plan of care and do not extend to consumer-grade wearables regardless of FDA-cleared features. As a result, there is no current dedicated reimbursement pathway for review of consumer wearable data.
Across the four countries with defined payment mechanisms—Canada, France, Germany, and the United States—physicians in countries where a reimbursement pathway is available review wearable data more often than those who do not participate in such pathways. Germany showed the strongest effect, consistent with the availability of the country's DiGA pathway.
But payment alone is not sufficient to spur broader adoption, the survey found. Physician enthusiasm, legal liability concerns and clinical readiness also affect integration. France had reimbursement pathways but integration is still low because physicians have concerns about liability and confidence in the data, Whyte noted. The United Kingdom reported high wearable use by physicians but low feasibility and no payment pathway.
Germany has both the highest feasibility—meaning physicians are more confident they can use wearable data during a routine visit—and the lowest clinical concerns of any country surveyed. Germany is also the country where a payment pathway is both available and most actively used.
The United Kingdom and Canada have the lowest feasibility scores and among the highest concern levels, and neither has a billing pathway.
The United States has the highest share of physicians already using wearable data in clinical workflows, but it also has a large proportion of physicians who are interested yet do not use these data routinely. Liability concerns, feasibility gaps and lack of automation appear to be major constraints.
Cardiologists and endocrinologists were the most likely to use wearable data in clinical care, while primary care physicians, neurologists and pulmonologists reported greater challenges related to relevance, reliability and practicality, according to the survey.
The survey also looked at the impact of regulatory trust and clinical evidence. Approximately half of physicians across all six countries reported that regulatory clearance or approval is essential to or strongly influences their trust. But regulatory approval does not solely determine data integration, the survey indicated.
The factors that separate physicians who are integrating wearable data into their workflows from those who are not center around trust in the data, clinical skills in applying these data and implementation concerns, with skills rising to the top.
Physicians value randomized controlled trials (RCTs) and peer-reviewed studies most for confidence, with around 60% ranking them first. Investment in RCTs and development of society guidelines create the broadest possible impact, the report noted.
Health information technology developers and electronic health record systems also need to more effectively integrate this data into patients' medical records, Whyte noted.
"[Companies] really have to work with physicians, not just tech, but with physicians as to how this data needs to best be incorporated and how clinical workflow happens," he noted.
"The value here that physicians see is instead of knowing your heart rate, your blood pressure, some other data point once in the office every six months or every year or every two years, this data is being collected continuously. How do I utilize that data? Physicians feel that it can be a valuable source of clinical information, particularly in the field of cardiology and it can help with disease management. It's really about seeing the right data at the right time in ways that physicians can actually use," Whyte said.
Recommendations for stakeholders
The report offers recommendations for physicians, policymakers and healthcare technology companies to close the gap in wearable data integration.
Physicians should prioritize review of wearable data from algorithms that carry published clinical validation. And doctors should advocate within their practice or health system for structured wearable data workflows that make data review feasible within routine visit time rather than absorbing it as uncompensated, unstructured effort.
Doctors also should proactively discuss false-positive and false-negative results with patients, and set expectations about what types of alerts will prompt clinical action to mitigate patient anxiety and liability concerns.
And physicians should establish a consistent in-practice approach to recording when and how wearable data inform clinical decisions. "Medical-legal liability is the top-ranked workflow concern among U.S. physicians in the survey, and rigorous documentation is the most immediately available risk management tool," the report authors wrote.
For policymakers, the AMA is calling for the development of billing code pathways for in-visit review of consumer wearable data, distinct from remote monitoring of prescribed
devices.
"What we should be doing is really creating these clear, dedicated reimbursement pathways for review and integrating wearable data into workflow," Whyte noted.
Policymakers also should consider regulatory frameworks that build trust and confidence in health data, including privacy and security protections and requirements to capture and represent data in standardized, consistent ways.
Earlier this year, the Food and Drug Administration (FDA) made a move to relax its oversight of general wellness devices. The FDA updated its guidance to allow more wearables to fall into a general wellness category and skip the agency's expensive review process before going to market.
"There needs to be a process where we can see the evidence and there's standards and transparency. We should know has [the device] been clinically validated in what population under what circumstances, and that should be stratified based upon risk in terms of what it's assessing," Whyte noted.
In the U.S., regulators should issue guidance clarifying how existing CPT remote monitoring codes apply or do not apply to in-visit review of patient-owned consumer wearable data, the AMA report authors said.
Medical device makers and health tech companies need to build clinical credibility through evidence, the report noted. Medical device companies should publish specialty-stratified algorithm accuracy reports that compare each detection data type against named medical-grade standards.
These companies also should prioritize two distinct evidence investments: rigorous peer-reviewed clinical outcomes data to address the skeptical majority and published validation data sets and real-world performance evidence to convert physicians already close to adoption.
Companies also should provide transparent access to validation data sets and methods and communicate cleared features prominently and distinctly from general wellness outputs to address the physician trust gap in the United States.
Health tech companies need to implement and support Fast Healthcare Interoperability Resources (FHIR)-based standards for consumer wearable data to enable consistent ingestion, AMA said. Health tech and EHR companies need to build capabilities to incorporate wearable data smoothly into physician workflows, such as replacing “phone-based” review with auto-uploading verified data into the EHR in a structured format.
And health tech vendors also should embed bias checks into data standards, such as clearly indicating where algorithms have been validated and where performance is uncertain.