A Kaiser Permanente video visit.

Doctors, technologists, and entrepreneurs have a lot of different visions of the future of medicine, and they don't always line up. Dr. Robert Pearl, the Executive Director and CEO of The Permanente Medical Group, part of Kaiser Permanente, thinks some digital health offerings -- like video visits -- will revolutionize medicine. Others -- like health monitoring wearables -- are going nowhere, he told the crowd at Partners HealthCare Connected Health Symposium.

"I don’t think very many of us want to have a thousand continuous traces of the patient's heart rhythm, and the last place we want it is inside the medical record," he said. "Clay Christensen talks about 'What’s the problem you’re trying to solve?' Today, the majority of wearables solve a problem called December. Because in December you want to give someone a present and a Fitbit is about the right price."

But the problem with wearables isn't just that most people don't use them or stop using them, Pearl said. It's that they're not clinically valuable because all they do is monitor. Hospital monitoring is only valuable because it's paired with the possibility of intervention.

"I tell clinicians 'find a patient you sent home tonight, that you would have been happy to send home tomorrow morning if they were to be monitored tonight'," he said. "They can't find one, because you don’t stay in the hospital to be monitored, you stay to be treated when the monitor says your vitals drop. You’re there for the treatment, and that’s why I think wearables will not have the impact people are saying."

But he contrasted that with video visits, which he thinks can solve a real problem. His group plans to do more video than in person visits in 2018.

"When a patient hurts their foot, we tell them 'Keep it elevated and come in three days for a wound check'," he joked. "Did you ever try going to your car with your foot elevated above your head? Very hard to do, even harder to drive that way. A video allows us to see if that wound is infected without the patient having to come in."

Pearl also talked about Kaiser Permanente's mobile strategy, saying that relying on patients' smartphones was a no-brainer in 2015.

"Patients have already purchased the phones," he said. "They carry the phones with them. They check them every six minutes and half of them sleep with them. What more do our patients need to do for us to meet their needs?"

In contrast to Dr. Joseph Kvedar's comments earlier in the morning, Pearl said he believes big data has great potential, even when it relies on predicting a patient's behavior based on the behavior of a similar cohort.

"I think we have to understand that medicine in the 21st Century is actually a science," he said. "Most of the things that we do are science.We just don’t follow it. The variation amongst individuals [in treatment decisions] can be three to five times. For medications there can be six or eight different ones. There is a best way, and we increasingly have the information to figure out what that is. And we’re right now in the process of creating this pathway, utilizing the outcomes of the best physicians to now help everyone to advance."