The healthcare revolution, by Valeria Duflot: For an empowered patient and integrated care for all
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Since MobiHealthNews’ most recent roundup in June, at least eight more digital health and fitness crowdfunding campaigns have launched on Kickstarter. This time, many of the devices and apps focused on specializing in a specific fitness category. One campaign offered a platform specifically for triathletes to train for events, while another created a tool that is designed to track the movements that tennis players make on the court.
Although Kickstarter recently altered its requirements to further explain, among other things, which health-related campaigns were not allowed on the site, the ones that have launched since have shown which could make it past the new filters. They include a smartphone breathalyzer, headphones that measure heart rate and blood oxygen saturation, and an app that aims to support family caregivers.
Below are eight crowdfunding campaigns that have recently launched on Kickstarter.
“Generally, health is just so heavily regulated. It's just a painful business to be in. It's just not necessarily how I want to spend my time. Even though we do have some health projects, and we'll be doing that to a certain extent. But I think the regulatory burden in the U.S. is so high that think it would dissuade a lot of entrepreneurs.”
Tarun Khanna, Professor at Harvard Business School, highlights the ability of entrepreneurs to provide solutions to social problems by telling the story of a cardiac hospital in India. Khanna points out that the founder, a cardiac surgeon and entrepreneur, has been able to achieve incredible results unmatched by private or public institutions around the world by rethinking the scale on which healthcare is delivered. Khanna emphasizes that this kind of entrepreneurship can solve social problems in ways that often governments cannot.
If only our lives were more predictable and certain, we’d feel a greater sense of security and safety. Yet, much of what happens to us is beyond our ability to control. This is true whether we live in a third-world country or in the most advanced scientific and technological environment. It’s also true whether we’re struggling to make ends meet or living in the lap of luxury.
No one is immune from life’s uncertainty. But for the chronically ill — which includes those who suffer from chronic pain — it can feel as if the number of life factors subject to uncertainty has increased exponentially. Indeed, perhaps the hardest thing about being chronically ill is the uncertainty it brings to almost every aspect of life.
Here are six ways in which uncertainty is a particular source of stress for the chronically ill:
1. Uncertainty about how we’ll feel on any given day. It’s hard to make plans because we can’t be sure how sick we’ll feel or how much pain we’ll be in on any given day. For me, even after I’ve woken up, I don’t know how I’ll feel as the day progresses because my symptoms can flare at any moment. In addition, resting for days in advance of a commitment doesn’t assure that I’ll feel okay when the day arrives.
It took me a long time to begin to make peace with the uncertainty of my symptoms. On a day when I have an obligation that I can’t cancel, I find it helpful to tell myself: “Whether you feel your usual sick self or your extra sick self, this is something you have to do, so do it as gracefully and with as little complaining as possible.”
2. Uncertainty about what social commitments to make. This is related to #1. We’re constantly engaged in a balancing act of not over-committing ourselves, but also not unnecessarily isolating ourselves from others. These mental gymnastics are exhausting. They begin for me as soon as someone asks if he or she can come over for a visit. If I say “yes,” how do I know I’ll be well enough to keep the commitment when the day arrives? Shouldn’t I just say “no” since I might to have to cancel on short notice? On the other hand, if I say “no” and then feel well enough to visit on that day, I’ve passed up an opportunity to be in the good company of another person. Whew. Managing chronic illness is hard work!
In the end, each of us has to make the best educated guess we can as to what to do when the opportunity to socialize arises. In my case, because I never have a day when I don’t feel sick, I tend to choose the “safe” alternative and decline the offer of a visit, even though I recognize this means I may well be more isolated than is necessary.
3. Uncertainty about how we’ll be treated by others, including family, friends, and doctors. I’ve had people talk to me as if I’m a child. There’s a word for this frustrating phenomenon: infantilization. The unpredictability of how we’ll be treated by others can be extremely stressful. Will they understand that chronic illness hasn’t turned us into children? Will they speak to us in a pitying voice? Will they shy away from meaningful interaction altogether, as if we’re contagious?
I have two strategies for handling this particular uncertainty. First, I reflect on how even well-intentioned people may behave unskillfully for reasons related to their particular life history and their cultural conditioning. This helps me not to take their behavior personally. Second, I remind myself that, despite this illness, I know in my heart that I’m a whole and complete person; then I re-commit to making sure that’s good enough for me.
4. Uncertainty about how much help to ask for. People write me all the time about this dilemma, and I face it too. Do I line up people to go to the grocery store when my husband is out of town, or do I wait and see if I can go myself? About a year ago, when he was gone for two weeks, I told him that he need not stock up on too much food because I could go to the store if I needed to. But I forgot how much energy it takes just to do the little household tasks that he handles when he’s home. As a result, I didn’t have any “juice” left to go to the store. For five days, the only veggie I ate was spinach! Then my neighbor, Nadine, learned from one of my Facebook posts that I was home alone, and she asked if I’d like her to go to the store for me. Needless to say, I jumped at her kind offer.
5. Uncertainty over how we’ll react to a routine medical procedure. No one likes to get a tooth filled, let alone a root canal. Then there’s that lovely procedure known as the colonoscopy. If people don’t have health problems, at least they have a good idea of what side-effects to expect. For the chronically ill, however, a routine procedure can trigger a flare in symptoms from which it can take days or weeks to recover.
This uncertainty about how we’ll fare can have serious consequences. I find myself putting off routine procedures because of the uncertainty of how I’ll react to them. The only one I’m diligent about is the colonoscopy because my mother had colon cancer. Fear trumps uncertainty in that instance.
I’ve learned that the best way to handle a colonoscopy or any procedure I’m concerned about is to acknowledge the stress I feel due to the uncertainty of how it will affect me, while also telling myself that this is important self-care — important for maintaining what I think of as “wellness within illness.”
6. Uncertainty about the future. Most of us don’t know what course our chronic illness will take. Will we stay the same year after year? Will we get progressively worse? Or, will we wake up one morning and not be in pain or feel sick anymore? Because we don’t know the answers to these questions, it’s hard to plan for the future.
This uncertainty can be in relation to long-term decisions — for example, how long we might be able to live independently. For me, it’s often in relation to what I’d do should my own caregiver need a caregiver. I had a taste of this possibility last year when my husband had a severe allergic reaction (probably to something he ate), and I had to take him to the Emergency Room. This experience drove home to me, both my limitations and the toll that uncertainty about the future takes on me.
With effort, I can sit in a chair for about two hours before I feel as if I’m going to keel over. Once we got to the ER, I sat by my husband’s bed as they hooked him up to an IV and put an oxygen mask on him. Then I waited as he lay there, barely conscious and unable to communicate with me. In addition to being worried about him, I was under stress because of the limitations imposed by my illness. Specifically, I had no idea what time frame we were looking at: would we be there for an hour or for six hours? (It turned out to be the latter.)
After two hours, I could barely sit upright in the chair, so I told the nurse that I suffered from a chronic illness that made it necessary for me to lie down for a short time. She politely told me that I should go home and call them in a couple of hours to see how my husband was doing. No way! I wasn’t going to leave him alone when he’d yet to respond to their treatment. Not knowing what else to do, I called our friend Richard. When he arrived, I left him the room with my husband and went out to our van to lie down for a while.
As I lay there, uncharacteristically, I felt as if my life had come to a sorry state. Here I was, in a parking lot, lying on the dog’s hair-covered and not-so-fragrant blanket, pulling whatever I could find over me in order to keep warm (including newspapers), using my lumpy purse as a pillow. When I returned to the ER, my husband had his eyes open and was no longer disoriented. After another two hours, they discharged him and I drove us home.
Once I felt confident that he’d be okay, uncertainty about the future hit me hard. What if I needed to be at his bedside in the hospital for days at a time? What if he developed a chronic medical problem and needed a caregiver of his own to take over the household tasks? Should I even be spending time worrying about events that may never materialize? (This kind of “should” always contains a dose of negative self-judgment.)
This is a mental balancing act I engage in frequently. I deal with it by trying to walk a middle path between not polluting the present moment by dwelling on the uncertainty of the future, but also not ignoring the need to plan for some very real possibilities that could come to pass.
Living with life’s uncertainty is difficult without the added challenge of chronic illness. Sometimes the activities I loved before I got sick feel as if they’re dangling in front of me like a carrot on a stick. Will I ever be able to do any of the things I treasured so much before I got sick? What does the future hold? I just don’t know.
In my book, How to Wake Up, I suggest an approach to uncertainty:
Upon getting up each morning, we can reflect on how we can’t be certain if the day will unfold as we think it will and then resolve to greet it nonetheless with curiosity and wisdom. Greeting the day with curiosity means being interested in what each moment has to offer. And greeting it with wisdom means not turning away in aversion from our experience, even if it’s unpleasant and even if it’s not what we had hoped for.
What I’m recommending here is that we work on making peace with life’s uncertainty since it’s an inevitable part of the human experience. This is a daily practice, and on those days when we fall short and simply can’t greet what’s before us with curiosity and wisdom, we can at least take good care of ourselves by acknowledging with compassion how hard it is to live day in and day out with the uncertainty of chronic illness.
French startup KelDoc is raising $1.4 million (€1 million) from Alven Capital and business angels. KelDoc is what you could call a ZocDoc for Europe. But managing doctor appointments is a very regulated market, and KelDoc has a deep understanding on how this kind of service needs to be adapted to the French and European markets.
At heart, KelDoc is a website and smartphone app to look and find the right doctor for you. You can then browse his or her calendar to book an appointment. It doesn’t cost anything for the patient, but doctors need to pay $270 (€200) per month to use KelDoc.
Co-founder and CEO Eduardo Ronzano has an interesting background as well. He was born in Spain, studied in the U.K. and now lives in France. In other words, he knows how to do business in Spain, the U.K. and France. He also has both engineering and business degrees. You can call Ronzano the swiss army knife of European entrepreneurs.
Even more interesting, Ronzano was working at fundraising firm Global Equities when French startup Joliebox got acquired by Birchbox. He knows what it’s like to compete with a bigger startup in the same space on another continent.
You can call Ronzano the swiss army knife of European entrepreneurs
When Ronzano started KelDoc, he wanted a board to challenge him and keep him on track. Among other people, Bart Dessaint joined the board. Dessaint now works for Andreessen Horowitz, which is totally unrelated with KelDoc but a funny coincidence — the startup is probably the only French company with an Andreessen Horowitz partner at its board.
Compared to other French competitors, KelDoc is the one who works the most within legal contraints. You can be sure that nobody will ever find out whether you’re taking a lot of doctor appointments.
In addition to that, KelDoc has spent a lot of time developing plugins for existing doctor calendars and CRMs. This way, when a doctor uses KelDoc, he or she doesn’t have to do anything but install the plugin. When someone books an appointment, it will appear in the calendar right away. Similarly, if a doctor needs to move an appointment, the patient will receive a text alerting him or her of the change.
And it’s working. 160,000 people have visited the website so far, and more than 10,000 appointments were made through KelDoc. Even more important, many doctors are switching to KelDoc. Between the first quarter and the second quarter of 2014, 50 percent more doctors signed up to KelDoc.
“KelDoc now has a very good reputation and many doctors are spreading the word,” Alven Capital partner Jeremy Uzan told me in a phone interview.
It’s clear that KelDoc will expand outside of France in the coming months. “The company is doing well and could have continued without this new funding round,” Uzan said. And Ronzano doesn’t hide it either. “We want to expand,” he said. “My ambition is really to expand in Europe.” Yet, KelDoc’s main challenge is that it needs to be faster than ZocDoc when it comes to taking over the European market.
This has been a year marked with pessimism about the future of biosensing wearables. We’re not buying it.
For the past 15 months, Rock Health has been conducting industry research on the growing wearables and biosensors market, and we mean growing. Venture funding of biosensors and wearable technology increased 5X from 2011-2013—more than double the growth of digital health overall during the same period. The merging of these two spaces into a singular category—biosensing wearables—is where we see the most potential to impact healthcare.
Today there are an overwhelming number of trending wearables, but not all of them are capable of measuring or telling us something about our health. Similarly, there are plenty of biosensors that measure physiological inputs but do not have a wearable form factor. That’s why biosensing wearables are exciting: they allow for continuous physiological monitoring in a wide range of wearable form factors.
ABI research predicts that in 2014, 90 million wearable computing devices will be shipped, of which approximately 74 million will be biosensing. However, the purchase of a biosensing wearable device does not currently equate to long-term usage. According to a survey by Endeavor Partners, the rate of engagement for activity trackers drops below 50% within 18 months. To combat this phenomenon and scale beyond early adopters, we identified three axes—functionality, reliability, and convenience—on which companies should innovate in order to provide consumers with high utility. Moreover, as biosensing wearables advance across all these three axes, there is significant potential to disrupt not only the consumer electronic markets but also the healthcare markets.
It’s a crowded market, but there’s a growing tail of opportunity for biosensing wearables. We’re also pretty confident this space will continue to develop as tech giants like Apple, Samsung, and Googlestart playing in the sandbox.
Today, most biosensing wearable companies are responsible for both the hardware and software components of their product, which has created a siloed ecosystem. And it can be daunting for a startup team to master the entire stack. The solution? A platform (though we’re not quite there yet). While a few data aggregators have attempted to become the platform that increases data liquidity, we seem to have simply built more fragmentation on top of the universe of devices.
This is where the tech giants come into play. Both Apple and Samsung have announced health platforms designed to capitalize on their existing consumer scale to attract industry players. If there is a successful scaled platform, this can help overcome the current software challenges associated with fragmentation. Pure software players could define valuable use cases without worrying about choosing a specific type of biosensing wearable. Similarly, hardware companies could build for a specific use case and be able to connect to multiple endpoints through the scaled platform, thereby eliminating the current challenge of having to be a “full stack” company (owning and having to be exceptional at hardware, software, and integration).
Hopefully, this means biosensing wearables will leverage their consumer learnings and evolve into highly functional and accurate devices with applications across the industry. We’re just at the beginning stages.
Want the details? Watch the video of webinar broadcast here.
In the last years of the nineteen-eighties, I worked not at startups but at what might be called finish-downs. Tech companies that were dying would hire temps—college students and new graduates—to do what little was left of the work of the employees they’d laid off. This was in Cambridge, near M.I.T. I’d type users’ manuals, save them onto 5.25-inch floppy disks, and send them to a line printer that yammered like a set of prank-shop chatter teeth, but, by the time the last perforated page coiled out of it, the equipment whose functions those manuals explained had been discontinued. We’d work a month here, a week there. There wasn’t much to do. Mainly, we sat at our desks and wrote wishy-washy poems on keyboards manufactured by Digital Equipment Corporation, left one another sly messages on pink While You Were Out sticky notes, swapped paperback novels—Kurt Vonnegut, Margaret Atwood, Gabriel García Márquez, that kind of thing—and, during lunch hour, had assignations in empty, unlocked offices. At Polaroid, I once found a Bantam Books edition of “Steppenwolf” in a clogged sink in an employees’ bathroom, floating like a raft. “In his heart he was not a man, but a wolf of the steppes,” it said on the bloated cover. The rest was unreadable.
Things you own or use that are now considered to be the product of disruptive
Qualcomm Incorporated, through its Qualcomm® Wireless Reach™ initiative, and Trice Imaging, a mobile medical imaging business announces the results of their collaborative, 3G “Mobile Ultrasound Patrol” project.
Every day, around the world, approximately 800 women die from preventable causes related to pregnancy and childbirth. Of those deaths, 40 percent are due to injuries or conditions related to placenta complications. The only way of detecting abnormal placenta challenges is through an ultrasound. Ultrasound medicine is experiencing drastic changes, resulting in a veritable paradigm shift. New technology is disrupting how ultrasound imaging is currently executed by whom and at what cost. Technology creates additional access, reduces costs, which is driving accessibility and paves the way for new, sustainable models of healthcare economics.
Inspired by the UN initiatives and the knowledge that their combined strengths could truly impact the health of women across the globe and specifically in Morocco, a group of companies combined resources, talent, and passion for mobile healthcare to create something extraordinary: the Mobile Ultrasound Patrol Project.
The Mobile Ultrasound Patrol is a project that seeks to improve care for women in developing countries through early detection and treatment of major causes of maternal mortality. The medical examinations took place in three villages in Morocco — Oulmes, Boulemane and Ribat el Kheir — with reading physicians providing diagnoses in city centers in Morocco and France. Done in conjunction with Fujifilm SonoSite, an ultrasound systems provider and Sony Mobile, the Xperia smartphone division of Sony Corporation; this project used portable ultrasound units, 3G-enabled smartphones and phablets, remote diagnostic software and 3G connectivity to improve care for women in developing countries through early detection and treatment of major causes of maternal mortality.
The key goal was to validate how advanced wireless technologies and connected portable ultrasound devices can provide access to state-of-the-art imaging diagnostics in places it has never been available before at a significantly lower cost. Medical professionals provided proper care to patients in remote areas using encrypted mobile devices that were connected to a 3G/4G network and a sharing platform that enabled experts to perform remote diagnoses. The time and cost efficiencies gained, without any compromise in quality improved the likelihood for early detection and treatment of the major causes of maternal morbidity/mortality, which could ultimately reduce the number of maternal and child deaths.
- 575 exams were wirelessly transmitted to clinicians
- 94 exams exposed potential at-risk pregnancies
- 158 patients were flagged for a second opinion
- Use of advanced wireless technologies led to:
o Shortened diagnostic review or second opinion time from two weeks to less than a day
o Reduced ultrasound costs from US$80 to US$2 per patient
o Shortened the delivery of medical data for review from four days to two seconds
o Shortened the time the patient had to wait for a medical opinion from two weeks to less than 24 hours
o Increased local medical practitioners’ skills in delivering ultrasound images from 20 percent sufficient for diagnostic purposes to 92 percent sufficient for diagnostic purposes
o Participating physicians reported an increased number of patients seeking care at health houses after the trial. The number of deliveries in these facilities increased, which is an important step in reducing the number of dangerous at home births.
For more information:
- See case study
- See full report
New projections put forward last week by Lux Research suggest that the mobile health devices market is set for explosive growth through 2023.
The prevalence of clinical devices will be driven by the adoption of vital signs monitoring and in vitro diagnostic (IVD) devices. Consequently, the mobile health market will grow eight-fold from $5.1B in 2013 to $41.8B in 2023.
Lux Research estimates that clinical mHealth devices will soar past consumer-focused counterparts after a slow start due to regulatory approval barriers and slower integration into physicians’ workflows.
For instance, clinical vital signs monitoring devices will grow from $372M in 2013 to $16B in 2023, a compound annual growth rate (CAGR) of 46%, while consumer applications will grow from $2.5B to $7B, an 11% CAGR.
“Consumer devices have seen a lot of hype but clinical devices will surpass their consumer counterparts in revenues by 2020, helped by value-added software services and generally larger revenue streams,” said Nick Kurkjy, Lux Research Associate.
“Clinical markets will be able to pay much more for comparable services, especially if a device is able to reduce patient recovery times or readmission rates, which can lead to outsized cost savings for the health care provider,” he added.
Android will soon have the ability to share data amongst health apps and devices on the new Google Fit platform, announced at the Google I/O developer conference keynote in San Francisco. The platform will allow apps to not only draw data from various devices — such as Polar and Nike+ wearable trackers — but also allow apps to access on-phone sensor devices, edit the user’s fitness history, and add data to their fitness history.
This, combined with Google’s Android ecosystem, the recently-announced Android Wear smartwatch platform, and new Google Play Games services with quests, saved games, and game profiles, could usher in new concepts for health-related games and apps.
Conspicuously absent during the keynote were mentions of medical or healthcare industry data, such as that from electronic medical records. Epic, which runs the United States’s most widely-used electronic medical record system, has indicated that Epic Systems will work more extensively with Android later in 2014, but has not indicated whether it would integrate with Google Fit.
While not an application itself, the Google Fit platform is comparable to Validic, a platform launched by a North Carolina Research Triangle-based startup that standardizes data from numerous disparate fitness devices into one single accessible data programming interface. The story of Google Fit comes shortly after Apple’s own Healthkit platform was announced, which incorporates not just fitness data, but also health and medical data with integration into Epic’s medical record system — a potential game-changer for physicians — and advisory content from Mayo Clinic.
Also notable is Apple’s inclusion of a user-facing Health app that provides users with a dashboard-like overview of data such as diagnostics, calories burned, calories eaten, sleep hours, vital signs, and even lab results. No such app has been announced with Google Fit.
Although Google shut down its Google Health personal health record project in 2011, Google has continued work in other healthcare-related initiatives. In 2013, it launchedCalico, a start-up that focuses on solving age-related illnesses. Google Glass is used inmedical diagnostics research, surgery, emergency departments, and medical education. And Google Helpouts, its fee-for-service HIPAA-compliant videoconferencing platform, has given users access to physicians, nutritionists, fitness experts, and mental health providers from mobile devices and the web.
The Google Fit software development kit (SDK) will be available to developers to use in fall 2014.
Technology can make a significant impact in healthcare and, the GSMA announced a new ecosystem to drive mobile technologies to drive health in Sub-Saharan Africa.
Valeria Duflot's insight:
Health tech partnership targets UN MDGs #development #healthcare #mhealth
Halle Tecco, co-founder and CEO of healthcare accelerator Rock Health, shares how technologists, designers and other professionals can play a role in bringing innovation to the healthcare industry. Tecco identifies systemic challenges facing healthcare in America and shares examples of companies working to address these opportunities for change.
The health care IT space is possibly the most exciting and dynamic industry in the United States right now. Health care is going through a total transformation driven by massive regulatory change, the consumerization of health care and the important shift from a system that manages sickness to a system that manages health.
Underlying all of this change is the software that runs large health care organizations: specifically, the big EMR systems. Given all of the rapid change in health care, the EMR industry — and the dominant players that lead it — are ripe for disruption. It’s not unlikely that there’ll be some big names dropping out of the race over the next several years.
With that in mind, here are 4 things I think the large EMR players should do to remain competitive amidst all of this change.
1. Move to the cloud. Health care IT is all about big data. And the large EMR companies host loads of it. In the traditional database space, Oracle and SAP waited much too long to move their data to the cloud. And it seems that some of the big EMR companies appear to be waiting too long as well (though, it’s possible they could be making this transformation behind the scenes).
Regardless, the fact is that health information is going to have to live on the cloud in the long-term. There is no way around this. Patients are going to demand interoperability of data between their primary care doctor and their gastroenterologist and their dermatologist and their dentist. And there is no way that all of those providers are going to be running the same EMR — the space is way too fragmented. I’d argue that not moving to the cloud is a bigger risk for EMR companies now than it was to the large database companies ten years ago. Patient advocates and regulators are simply not going to allow a big EMR vendor to keep their data in house. Larry Ellison said it took 7 years of development to get Oracle on the cloud. EMRs vendors can’t continue to put this off.
2. Open up platform APIs (I mean, really open up platform APIs). I’ve used the BlackBerry versus Apple’s iOS example in the past when discussing this topic. Apple opened up its app store early (effectively employing hundreds of thousands of app developers) and as a result made the iPhone 1,000 times more valuable. Meanwhile, BlackBerry dragged their feet and eventually ended up near bankruptcy. There are a number of reasons why the analogy isn’t perfect (EMRs aren’t consumer products, there are HIPAA restrictions around exposing personal health information, etc.) but EMRs should take a close look at what caused BlackBerry’s demise. Part of the reason they dragged their feet on opening up was that their corporate customers were hesitant to allow their employees to download apps. They let their own customers slow down their development. Now some will tell you that the EMRs have created APIs and are adding services on top of their products all the time. This is not true. Even the most open EMRs are tightly policing the products that plug-in to their platform. The first EMR that takes a true “app store” approach will have a massive advantage. There are a ton of well-funded developers building amazing things that these EMRs can tap into if they open up.
3. Focus on usability. I’m not a doctor and I don’t work in a doctor’s office. But I’ve seen enough of these systems and I’ve heard enough complaints from users of them to know that the usability of most EMRs is not up to par with high quality B2B software tools. This is the classic case of B2B software being bad because it can. These companies have high talent sales teams that only need to sell a handful of executives and the rest of the health system is forced to use it and deal with the usability problems. With the emergence of B2E2B (business to employee to business) sales strategies a lot of this is changing. Staff members expect B2B software to work the same way their consumer tools work (Facebook, Gmail, Amazon, etc.). Granted, due to high switching costs, the big EMRs can get away with poor usability for a while — it’ll be a long time before EMR software is sold the way Yammer is sold but when big contracts come due in a few years, usability will be a massive competitive advantage.
4. Get out of the B2C business. Many big EMRs are rapidly creating direct to consumer products, mostly in the form of a patient portal. This is being driven by:
Take a look at the app store ratings of many of the big health IT apps — consumer expectations of what makes a good app are much too high for an enterprise-focused vendor to meet at this point. To compete in the consumer space you have to be totally focused on the consumer. It has to be an obsession. Take a look at a company like Oscar Health that has built their entire business around consumer experience. This isn’t a criticism of the EMRs, they do lots and lots of things really well. The point is that they should focus on those things and double down on them. Moving to the consumer space is too hard and too competitive and too much of a distraction. The better approach is to buy or partner with an organization that is built around the consumer.
In our inaugural article together, we take a 30,000ft view on the pulse of digital health today, with a keen eye on the future... and this is only the beginning...posted: Thursday 5th of June 2014 by Paul Sonnier and John Nosta
Digital Health. Two simple words. Apart, they define the essential realities of many aspects of our lives. From the magic of the computer and smart phone to the tribulations of health, a day doesn’t pass without some aspect of these ideas and concepts touching our lives. Then, there’s the convergence of these two words—digital and health. It’s an expression that conjures a host of emotions, from excitement to confusion. For many years, we have both been active participants in this important evolution and shared—and perhaps even created—many of these emotions.
Our task, with the help of our team at nuviun, is to advance the story of digital health. We don’t expect to end the debate but, to the contrary, we look to catalyze and invigorate the discussion. Our goal is to be the “First Word in Digital Health.”
Let’s focus where necessary. Let’s stir the pot as appropriate. And let’s ask the tough questions and seek out the even tougher answers.
So, with that backdrop in place, let’s take a view from 30,000 feet—from our two perspectives. For this, our inaugural post, we’d like to take the pulse of digital health as we see it today and with a keen eye on the future.
Digital Health: Delineated and DefinedPaul Sonnier
First off, let me start by saying that I’m delighted to be working with nuviun, collaborating with John Nosta, and sharing our unique perspectives to help determine where digital health is now in its evolution, adoption, and provision of benefits to our health and our economies. I work with many companies and initiatives, both within specific markets and on a global scale because I believe that by working together we can accelerate the development and application of digital health. One thing I’ve noticed over the past few years of curating the Digital Health group on LinkedIn, facilitating dialogue on the many issues, and constantly surveying the global, evolving ecosystem, is that we all have unique perspectives which have been molded by years of experience and the development of expertise in diverse settings. And when we leverage this expertise in a collaborative fashion, we can do much more together than we can ever do alone.
That being said, I am often taken aback when I hear that “digital health” hasn’t arrived yet. Certainly, there are many challenges and hurdles still being overcome, but who of us hasn’t utilized a digital tool or solution for health-related purposes; be it Googling a condition, talking with a family member on a mobile phone, sharing a personal health issue or news article on Facebook? There’s also been a massive influx of information technology into healthcare systems around the world. Sure, there are challenges there (e.g. interoperability, user experience and workflow, status quo resistance), but over time, we’ll see many improvements that resolve issues or sometimes totally disrupt the current way of doing things.
Digital health is already here and in widespread use. But, as novelist William Gibson famously stated, “The future is already here — it's just not very evenly distributed.” The same holds true for digital health. Manufacturing systems, for example, were not digitized overnight, but over decades—an analogy that’s apropos for many segments of digital health as well.
While the term “digital health” has actually been around for many years prior to my founding the Digital Health group, it was lacking one fundamental component: genetics and genomics. When I founded my group in 2009, I called it “Wireless Health.” It rapidly became a respected forum and source of news for this important area of technology convergence. Shortly thereafter, I renamed the group and put forth the modern definition for “digital health” on Wikipedia. I also set about inculcating others as to precisely what digital health is and the significance it holds for revolutionizing human health and the delivery of healthcare. With diligent effort and input from stakeholders and other key influencers, the digital health meme has permeated the global dialogue on health innovation and even crossed over into coverage by the mainstream media. I consider this a major measure of success.
My inspiration for this modern definition of digital health came from Dr. Eric Topol’s book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. It was there that I noted a succinct enumeration of all of the digital innovations I had been seeing converge with health and healthcare: wireless devices and networks, microprocessors, information technology, social networking, the internet, and biometric sensors; plus genetics and genomics—the latter being associated with J. Craig Venter’s comments on the digital nature of the molecule. All of these enabling digital technologies are presented in a beautiful graphical format by nuviun, in the Venn diagram they created to describe the digital health landscape. These can also be seen in my video, “The Story of Digital Health – Part 1.”
While all of this progress is great, and the definition is foundational to our understanding of what digital health is, there’s still much to be done. Confusion, conflation, and misuse of sub-terms is ongoing. Moreover, I often see headlines proclaiming that digital health is this or that, and still needs much development. But these headlines are almost always inaccurate, simply because digital health is not a monolithic industry or segment. As outlined above, it’s more of an amorphous conglomeration of powerful digital technologies which are converging with health and healthcare. This simple and broad definition is not intended to facilitate sweeping or hyperbolic statements about what’s happening, but to be straightforward and accurate. Consequently, it’s also easily understood. It’s from this foundation that the details, measures, and benefits of digital health can be parsed to convey precisely what’s happening throughout a variety of segments.
To find evidence of the depth and breadth of digital health, just visit my crowdsourced Digital Health solutions list, currently over 500 and ever-growing. The 130+ descriptive tags I created there have come to represent a digital health taxonomy, albeit unintentionally. I’m excited about this, because I feel it helps to further inculcate stakeholders regarding what digital health is, thereby increasing the awareness of its potential applications and overall impact.
Digital health is seeing a Cambrian explosion of solutions, with diversity and overlap in the functionalities they enable, the markets they serve, and the varied benefits they provide. A useful gauge of this evolutionary progression—at least for some areas of digital health—can be gleaned from Gartner’s Hype Cycle for emerging technologies, published August 9, 2013. Their most recent version includes digital health elements such as Biochips, Big Data, Gamification, Mobile User Interfaces, and Mobile Health Monitoring. In their chart, we can see the “when” of some aspects of digital health, and an obvious visual representation that digital health is not monolithic, but a set of pieces with endless combinations and possibilities all driving (at varying speed) towards technological maturity and market adoption.
An oft-featured aspect of digital health relates to measuring investments in startups, exits (IPOs, M&A), and market share. But again, digital health does not ideally lend itself to this generalized form of analysis. For one, it’s difficult and confusing to include genetics and genomics without skewing the data. Hence, what we often see are analyses that exclude the biggest news in those segments, which typically are captured in business analyses of life sciences. Moreover, as Nobel Laureate Joseph Stiglitz recently stated, "The profitability of an innovation may not be a good measure of its net contribution to our standard of living." In the “Innovation Enigma”, Stiglitz proposed that the traditional measure of GDP can’t be relied upon to capture the improved standards of living that technology provides. This translates well to digital health, since the inability to directly or easily measure health benefits or economic profitability (of some aspects of digital health) doesn’t mean that it’s not already providing great value to society. When it comes to digital health, it’s not always about building a multi-million or billion dollar business, but realizing that small, diverse solutions and the benefits they provide are, in aggregate, beneficial at a population level, even if we can’t track them as we’d like to.
In the final analysis, digital health is already empowering us in innumerable ways to manage and improve our own health. It’s also transforming and disrupting our healthcare systems and how we receive health care. New market entrants are helping to improve access, reduce costs, increase quality, and make medicine more personalized and precise. Digital health is pervasive and doing enormous good already. And the greatest thing of all is that we’re just getting started!
Digital Health: Capturing Innovation in a Simple and Memorable WayJohn Nosta
When I think of digital health, I almost immediately sense a duality between the vast complexities of science and innovation with the utter simplicity of a simple device that can potentially save someone’s life. These are two poles of tremendous accomplishment. Yet my intellectual journey doesn’t reside on either side. I, like many, tend to shift around defining digital health in the context of a discussion and driven more by the audience than a fixed perspective. Could there be an “uncertainty principle” to digital health similar to Heisenberg’s? Can we fix on a position; yet fail to accurately measure momentum and direction?
The comprehensive list that Paul has created captures everything in digital health—from genomics to disease prevention and is very powerful. One glance and you can see the vast range of potential applications and real-life solutions for health issues. For the educated and informed, this glance is a quick reminder and a great touch-point for discussion. But for many—from clinicians to consumers—the definition may pose both a solution and a problem. Simply stated, does the attempt to try to be “all things to all people end up being nothing to anyone”?
Now, let’s take step back from the informed clinician and the empowered patient and take a look at the rank and file population. You know the type very well—the overweight, hypertensive couch potato. It’s this person that will help establish the proverbial “democratization” of health that pundits (like me) banter about as a central driving force behind digital health. But to get that individual’s attention, I’m not sure the rich diversity and complexity of digital health will get him up and off that couch. In fact, it may just add to the confusion of health and wellness and drive him away.
What this audience needs is a Volvo.
Yes, a Volvo. But it’s less about the car and more about the single-minded definition that Volvo owns. And it can be reduced to one word—safety. The challenge is finding a way to focus digital health in a similar way that will make it memorable yet doesn’t reduce it to irrelevance. Volvo knows that its customers are less interested in logistics than outcomes, which is why it has drilled into this cornerstone of marketing strategy: focus on benefits, not attributes. It has wrapped all of the diverse details into a neat, yet powerful package that the consumer not only understands, but remembers and wants. If we’re ever going to roust the Potatoes from their nests, it’s what digital health must do as well.
So, let’s take a step back and consider some of the core issues for digital health. Technology will empower all to take steps up the clinical continuum from disease detection to diagnosis to management to prediction and ultimately to prevention. That’s a powerful ladder of benefits. And the top rung of prevention takes us to a highly desired place. My friend Paul has teamed up with MISFIT Wearables to create a wonderful infographic that portrays this continuum, based on the work of Dr. Eric Topol.
But can we push harder and up to one final rung in our health quest? Can we move past the “What” of digital health and move to the more emotionally resonant question of “Why”?
The “what” is factual. From genomics to disease detection and prevention, these concepts are all part of the essential laundry list of facts and figures. But let’s go back to our friend sitting on the couch and see what might be driving his behavior. Exactly what would make him pry himself from his comfort and participate in some form of digital health? Or, more clearly, “What’s his Why?”
I believe that the sum total of health initiatives offered up by digital health push beyond prevention (the What) and move towards the simple idea of adding years to your life (the Why). Some of our best democratizing agents in this effort will be the baby boomers—prime subscribers of digital health because they place such a high priority on living well and living longer. Here, we’re seeing a simple and focused Volvo beginning to emerge:
L o n g e v i t y.
It’s a powerful word that excites our rational “thinking man’s” neocortex with practical solutions around health and wellness. But it also strikes a chord in our primitive brain—a brain that is more visceral and reacts in a way that is unencumbered by cognition. It moves us beyond the simplistic “longevity” into the context of survival as related to our “fight or flight” response that defines our limbic system. At our very core, I believe we want to move to the next rung on the ladder, living not only better—but longer. And I’m not alone, since it’s a concept that corporate ventures have already tapped into—like Google Calico and Human Longevity, Inc., which is comprised of a team of leading experts, such as Robert Hariri, MD, PhD, J. Craig Venter, PhD, Peter H. Diamandis, MD. Whilst writing this article, I asked Dr. Hariri to give me his perspective on the role of digital health to enhance longevity. This is what he had to say:
To carry this thought even farther along this continuum, longevity and survival may even have the potential to become moot. As the promise of digital health pushes us into unchartered territories, life extension and Ray Kurzweil’s Singularity may evolve into a practical discussion of immortality. It’s a concept that’s graced the pages of Time magazine and actually has a predicted date—2045. However, as interesting as it may be, immortality in the human sense still lies on a distant horizon. But it’s these ideas that move us forward, sometimes effortlessly and sometimes dragging and screaming.
Distilling digital health down to a single word can certainly be a dangerous exercise. The compromises necessary may exclude key points and make for an abstract promise. But if we truly strive to democratize healthcare and empower the patient, we need to do this type of exercise—to define, refine, focus and even dream. And while we many not capture the totality of digital health for some, we may do something much more important. We may avoid the pitfalls and complexities that can obscure the magic and innovation of digital health. And in the process, define an idea that single-mindedly captures our hearts and our minds and our lives forever.
So there you have it. The view from 30,000 feet as we see it. Our attempt to describe the “What” and the “Why” of this exciting, fascinating and ever-evolving story—the lists, the ladder, and the Volvo. The story that we’re all writing together.
It’s why we need each other in the global community, and why we’re both excited to be part of the nuviun team. Here, we seek to attract thought leaders to engage, to challenge, to dream and to create in a manner beyond anything we could accomplish in isolation. And in so doing, we’ll all be able to come together respectfully, without the need to agree, but with the ability to learn from each other—sharing knowledge and perspectives and passion. The outcome will be that digital health will be catalyzed globally in a manner that moves beyond vision to implementation in a perpetual and fluid cycle of progress.
It’s up to all of us to take a hard look at digital health together. To ask the difficult questions. To dream its dreams and yet challenge each other to better and more clear solutions. To create a world in which digital health is both understood and optimized—while simultaneously supporting the exponential expansion of its future into realms that lack boundaries, are little understood, and sometimes even scary.
In so doing, we’ll be able to offer our individual passions and expertise to something so big that it requires our collaborative efforts in order to capture the innovation within to write the Story of Digital Health that belongs to us all.
We hope you’ll join us.
This is an unsurprising release for Google, which continues to emphasize its commitment to design in the face of perfectionist competitors like Apple.
The new design language, which will be used throughout the next version of Google’s mobile OS, Android L, has strong echoes of the designs recently adopted by Apple — and especially Microsoft.
Material looks a lot like Microsoft’s Windows 8 and Windows Phone 8 design (formerly known as “Metro) in its reliance on large squares and rectangles with full-bleed images (images that go right up to the edges of the squares, without any “chrome” or window borders). Instead of icons and windows, it’s all big, bold squares.