The Thermia online health educational tool, developed at Boston Children’s Hospital, has enabled one-month-faster prediction of seasonal influenza outbreaks in China, via its digital integration with a commercially-available wearable thermometer. The findings appear in a new study published in the American Journal of Public Health.
“The fact that we were able to predict influenza outbreaks faster than China’s national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level,” says the study’s lead author Yulin Hswen, who is a research fellow in Boston Children’s Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health.
Although the Boston Children’s team has previously demonstrated that social media can be used to track disease, this is the first time they’ve shown that outbreaks can be predicted through an integrated wearable device and online tool.
“Collectively, we are still coming to terms with the data deluge from wearable devices, but it is imperative that we begin to generate value from this data,” says the study’s senior author Jared Hawkins, PhD, who is the director of informatics at Boston Children’s Innovation and Digital Health Accelerator (IDHA). “From a public health perspective — as we have shown with this latest study — there is enormous potential for tapping this data for research, surveillance and influencing policy.”
Mining digital health data to predict influenza outbreaks
Thermia, a fever educational tool created by the Boston Children’s team, works as a standalone digital application or can receive a child’s temperature reading directly through the iThermonitor, an FDA-approved, patch-like thermometer that is worn under the arm. This integration is possible under a license agreement between Boston Children’s and the iThermonitor’s manufacturer, Raiing Medical Inc., which is based in China. Although the wearable is available around the world, consumers in China have been the earliest adopters of the device.
In China, the Thermia-empowered iThermonitor has quickly gained popularity among digitally-savvy parents who have purchased the wearable device to monitor their child’s temperature. When iThermonitor detects a fever, parents can access Thermia via web or mobile and answer online questions about the child’s current symptoms and medical history.
Data collected from these interactions is anonymized and analyzed by the Boston Children’s team to track disease at the population level. Using this method, the team collected nearly 45,000 data points from China’s Thermia users between 2014 and 2016. They discovered that outbreaks of “influenza-like illnesses”, which had the hallmark signs of influenza, could be detected digitally in real time.
In comparison to the influenza surveillance data collected by the National Health and Family Planning Commission (NHFPC) of the People’s Republic of China, the data from iThermonitor and Thermia identified emerging outbreaks of the flu an entire month earlier.
Where there’s internet, there’s public health data
“Delays in clinically-reported data and lack of data availability contribute to the challenges of identifying outbreaks rapidly,” says John Brownstein, PhD, who is the chief innovation officer at Boston Children’s and the director of the Computational Epidemiology Group and the IDHA. “As a result, we have more and more opportunities to use real-time, low-cost digital solutions like Thermia to improve disease surveillance.”
In China, for example, the National Health and Family Planning Commission normally conducts their influenza surveillance by reporting and confirming cases as children are seen by clinicians at health facilities.
But this kind of traditional disease surveillance program is susceptible to a lag before an emerging outbreak is recognized. Factors that contribute to this lag time include patients’ proximity and likelihood of traveling to a clinic, the availability of trained clinicians who can identify the signs of influenza and whether or not local laboratory resources are available to confirm cases.
In contrast, China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant.
“In geographically large and densely populated countries like China, tools like Thermia can provide better on-the-ground disease surveillance than by relying on data that is only captured at the point of treatment in the clinic,” says Hswen.
As Thermia and the iThermonitor gain further use by consumers around the world, the anonymized data will provide the Boston Children’s team with opportunities to track disease in other regions.
Access Thermia to learn about your child’s symptoms and contribute to Boston Children’s anonymized disease database.