Wearables and Other Innovative Technologies and Applications Are Tools, Rather Than a Strategy, To Improve Patient Care and Clinical Outcomes

Commentary Health and health care continue to be transformed by technological advancements, providing the possibility for more precise medicine, improved diagnostics, more complete remote patient monitoring, enhanced clinical training, and better shared clinical decision-making. Importantly, many of these innovations are not isolated to the hospital or clinic setting but have found their way directly into patient—or consumer—pockets. These include applications with algorithms embedded in much of the technology we routinely use, including smartphones like the Apple iPhone. Although there is substantial promise in digital health solutions, abundant challenges, including regulatory and practical implementation issues, remain that need to be addressed to optimize their use clinically1. The work by Brodke et al. helps us take an important step forward in understanding what value digital health tools may have in a clinical context to improve patient care. Brodke et al. should be applauded for their practical, robust pilot study examining the Apple Health platform. This study moves beyond prior work demonstrating the ability of Apple Health to assess function at a similar level to gold-standard gait measurement systems2,3 by helping to establish that such platforms can have a more relevant clinical application. The authors show that the Apple Health platform can accurately assess changes in key mobility parameters following a lower-extremity fracture and monitor recovery following surgery for such injuries. The application can also help identify patients who are likely to have sustained postoperative nonunions. In addition, the examination of the relationship between patient-reported outcome measures (PROMs) and key mobility parameters captured by the Apple Health platform is critical to understand, particularly as alternative payment models from public and private payers seek to measure and financially reward clinical outcomes in lieu of the traditional fee-for-service approach. Thus, it is important to determine what useful clinical metrics may or may not be captured by PROMs and digital health platforms, and this work should be done and championed by practicing orthopaedic surgeons. The pragmatic use of the Apple Health platform is both a notable strength and limitation of this study. With 61% of U.S. smartphone users having an Apple iPhone4, the findings of this study are generalizable to a sizeable number of patients. However, this also means that the findings of this study may not apply to nearly 40% of U.S. smartphone users—and these estimates also do not account for those individuals without a smartphone. Further, as of 2024, the Android (Google) market share is much larger worldwide, at nearly 72%4, suggesting that any study finding that requires the use of the Apple Health platform by patients may be further limited globally. Overcoming this barrier by ensuring consistency across similar platforms and/or improved interoperability is key. Perhaps most importantly, although these types of studies are essential to furthering musculoskeletal care as technology advances, it is imperative to remember that collecting data—even when they are valid and appropriate—simply for the sake of collecting data is not valuable. Given the large upfront cost—whether financial, human capital, or otherwise—to collect high-value data, there must be an overarching strategy at the individual, group, division, department, and/or organization level guiding how to optimize the data's use to further patient health while ensuring that costs do not increase exponentially. Unfortunately, in today's health-care landscape, we have extremely large amounts of data already, yet only a very small fraction is utilized meaningfully. The lack of a clear strategy leads to unwieldy information technology systems and a growing level of burden for patients and clinicians to have such data collected and to figure out how to best use them. Money is often wasted, as stakeholders mistakenly believe that more data and the latest AI tools and algorithms are the solution to the health and health-care issues they face. This is a false belief. A push for more data and more AI tools by itself will not solve any of the problems hindering health and health care today, including within orthopaedic surgery. Future work should not only seek to better understand new technologies and which data are a "must" to drive improved orthopaedic patient care but also how they should be utilized as part of a complete health-care transformation strategy. This is key.