Beyond the Clinic: A Large-Scale Evaluation of Augmenting EHR with Wearable Data for Diverse Health Prediction

Abstract

Electronic health records (EHRs) provide a powerful basis for predicting the onset of health outcomes. Yet EHRs primarily capture in-clinic events and miss aspects of daily behavior and lifestyle containing rich health information. Consumer wearables, by contrast, continuously measure activity, heart rate, and sleep, and more, offering complementary signals that can fill this gap. Despite this potential, there has been little systematic evaluation of the benefit that wearable data can bring to health outcome prediction on top of EHRs. In this study, we present an extensible framework for multimodal health outcome prediction that integrates EHR and wearable data streams. Using data from the All of Us Program, we systematically compared the combination of different encoding methods on EHR and wearable data, including the traditional feature engineering approach, as well as foundation model embeddings. Across ten clinical outcomes, wearable integration consistently improved model performance relative to EHR-only baselines, e.g., average delta AUROC +6.8% for major depressive disorder, +9.7% for hypertension, and +12.6% for diabetes. On average across all ten outcomes, fusing EHRs with wearable features shows 8.5% improvement in AUROC. To our knowledge, this is the first large-scale evaluation of wearable-EHR fusion, underscoring the utility of wearable-derived signals in complementing EHRs and enabling more holistic, personalized health outcome predictions. Meanwhile, our analysis elucidates future directions for optimizing foundation models for wearable data and its integration with EHR data.