I am writing this from the Apple Worldwide Developer Conference (WWDC) here in San Francisco, where I got to substitute for John Halamka at the Keynote (now I keep having urges to raise Alpacas); John missed the most amazing seats [front row center!].
There were many, many, many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for healthcare.
If you remember the state of digital music, prior to the introduction of the iPod and iTunes music store, that is where I feel the current state of the healthcare app industry is at; there is no common infrastructure between any of the offerings, and consumers have been somewhat ambivalent towards them as everything is a data island; switching apps causes data loss and is not a pleasant experience for patients.
Amazingly there are 40,000+ apps on the App store at Apple alone, showing huge demand from users, but probably a handful can talk to each other in a meaningful way; this is both on the consumer and professional side of healthcare.
Individual vendors such as Withings have made impressive strides towards data consolidation on the platform, but these are not baked into the OS, so will always have a lower adoption rate. If we take the music industry example further, Apple entering a market with a full push of an ecosystem at their scale, legitimizes the technology in ways that other vendors simply can’t match.
Continue reading “Apple Enters the Healthcare Software Ecosystem”
Filed Under: Tech, THCB
Tagged: Apple, Apps, consumer driven health, digital health, HealthKit, Henry Feldman, Tech, WWDC 2014
Jun 3, 2014
When it comes to discussing exercise with friends, family and patients, it seems that many of us are at a loss for words. What kind of exercise should we recommend? How much exercise is enough? How much is too much? How do I know that my patient is actually exercising? How do I prescribe exercise?
According to the U.S. Department of Health and Human Services, U.S. adults should engage in moderately intense physical activity for a minimum of 150 minutes each week; this is equivalent to 30 minutes a day, 5 days per week . While it is relatively easy to keep track of the duration and frequency of exercise, it is much more difficult to quantify the intensity of an activity, let alone ensure that the activity is “moderate” for the entire 30 minutes.
In fact, in a 2008 study of women’s understanding of “moderate-intensity” of physical activity as presented in the popular media, the authors found it is not enough to simply hear and read a description of physical activity, but that it requires practice .
So, what are we to do? Should we have our patients log their daily activities? Should we have our patients show us sign-in sheets from the local gym?
It turns out that the dilemma of how to quantify physical activity has been a hot topic for more than 50 years. In 1965, a Japanese inventor developed the first pedometer to give people the opportunity to meet measurable goals and, thus, increase their physical activity. The device was called the Manpo-Kei (meaning “10,000 steps meter”) and it was based on research by Dr. Yoshiro Hatano that demonstrated that 10,000 steps per day allowed for a proper balance between the traditional Japanese caloric intake and the activity-based caloric expenditure of walking approximately five miles per day (the average person’s stride length is approximately 2.5 feet long, therefore 2,000 steps/mile) .
Continue reading “Download Two of These And Call Me In the Morning”
Filed Under: THCB
Tagged: American Resident Project, Apps, Brian Levine, Fitbone, FutureMed, Jawbone Up, Manpo-Kei, Nike+Running App, Prescribing apps, RunKeeper, Tech
May 28, 2014
Last week’s news that Doximity has raised another $54 million got me thinking ..
On one hand, I’m glad to see these guys continue to raise money and continue their development.
On the other hand, I’m disappointed that we don’t have a better physician-centric social network. While they have been successful at signing up doctors, it seems (at least anecdotally) few are engaging with the network. I have connected with many of my classmates and some physicians I know on the network. I have never interacted with any of them through Doximity.
The article quotes LinkedIn co-founder and Doximity board member , Konstantin Guericke:
I think a lot of doctors will have a LinkedIn profile and Doximity profile. But the key is which part is really going to get ingrained in their lives.
The key question is—what value does Doximity provide over other, non-physician centric social networks? More plainly, what is going to make me open up Doximity on my iPhone instead of my favorite Twitter client?
The current answer to that question is: nothing.
In their smartphone app, the news feed features medical journal articles from the likes of NEJM, JAMA, Lancet, etc. It is unclear exactly how these are selected, but quite clear they are not tailored to my interests. Twitter, on the other hand, provides a constant stream of thoughts and articles related to my interests because of the people I’ve chosen to follow.
Continue reading “Doximity Raises $54 Million. But What Value Will They Add?”
Filed Under: THCB
Tagged: Apps, Doximity, Halo Effect, Josh Herigon, messaging, Social networking
May 4, 2014
At the first White House public workshop on Big Data, Latanya Sweeney, a leading privacy researcher at Carnegie Mellon and Harvard who is now the chief technologist for the Federal Trade Commission, was quoted as asking about privacy and big data, “computer science got us into this mess; can computer science get us out of it?”
There is a lot computer science and other technology can do to help consumers in this area. Some examples:
• The same predictive analytics and machine learning used to understand and manage preferences for products or content and improve user experience can be applied to privacy preferences. This would take some of the burden off individuals to manage their privacy preferences actively and enable providers to adjust disclosures and consent for differing contexts that raise different privacy sensitivities.
Computer science has done a lot to improve user interfaces and user experience by making them context-sensitive, and the same can be done to improve users’ privacy experience.
• Tagging and tracking privacy metadata would strengthen accountability by making it easier to ensure that use, retention, and sharing of data is consistent with expectations when the data was first provided.
• Developing features and platforms that enable consumers to see what data is collected about them, employ visualizations to increase interpretability of data, and make data about consumers more available to them in ways that will allow consumers to get more of the benefit of data that they themselves generate would provide much more dynamic and meaningful transparency than static privacy policies that few consumers read and only experts can interpret usefully.
In a recent speech to MIT’s industrial partners, I presented examples of research on privacy-protecting technologies.
Continue reading “Using Technology to Better Inform Consumers about Privacy Decisions”
Filed Under: Uncategorized
Tagged: Apps, Big Data, Brookings Institution, Cameron Kerry, Consumer Protection, Design, Privacy
Apr 30, 2014
Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps:
I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at hand in sensible increments.)
You may think I’m being too picky, but I really think our ability to leverage technology will hinge in part on these apps and devices being very usable.
And that usability has to be considered for everyone involved: patients, caregivers, and clinicians.
Why am I looking at an app to enter blood pressure?
Let me start by saying that ideally nobody should be entering vitals data manually. (Not me, not the patient, not the caregivers, not the assisted-living facility staff.)
Instead, we should all be surrounded by BP machines that easily send their data to some computerized system, and said system should then be able to display and share the data without too much hassle.
But, we don’t yet live in this world, to my frequent mild sorrow. This means that it’s still a major hassle to have regular people track what is probably the number one most useful data for us in internal medicine and geriatrics: blood pressure (BP) & pulse.
Why is BP and pulse data so useful, so often?
To begin with, we need this data when people are feeling unwell, as it helps us assess how serious things might be.
And of course, even when people aren’t acutely ill, we often need this data. That’s because most of our patients are either:
- Taking medication that affects BP and pulse (like cardiovascular meds, but many others affect as well)
- Living with a chronic condition that can affect BP and pulse (such as a-fib)
- All the above
As we know, the occasional office-based measurement is a lousy way to ascertain usual BP (which is relevant for chronic meds), and may not capture episodic disturbances.
Continue reading “An Example of Bad Design: This App’s Interface for Entering Blood Pressure”
Filed Under: THCB
Tagged: Apps, Blood Pressure, Caregiving, Geriatrics, Leslie Kernisan, Tech, Telemonitoring, Wellness
Apr 14, 2014
Apple transformed portable music players. It redefined what we expect from cell phones. It brought tablet computing to the masses.
Is the company planning to do the same for mobile health?
Some industry watchers think so.
This isn’t a small venture. Apple executives suggest that Healthbook is being positioned as perhaps the key selling point when the company releases its next operating system for iPhone, likely later this year. And the app also may pair with a new “iWatch” that’s under development and will contain biometric sensors.
In his lengthy post, Gurman further details how Healthbook is expected to work. Its interface is ”largely inspired” by an existing iPhone application called Passbook, which is intended to centralize a user’s boarding passes, loyalty coupons, and so on in one place. Beyond fitness and diet, the app also has sections devoted to tracking physical activity, our sleeping habits, and hydration.
And Healthbook will offer blood monitoring features—”perhaps the most unique and important elements of the application,” Gurman writes—although it’s unclear exactly what it will track beyond oxygen saturation and glucose levels.
App’s appearance not unexpected
The long-awaited screenshots of Healthbook follow months of reports that Apple’s readying a push into the health care space. While the company’s interest in the sector is nothing new—my team has spent years covering its health-related innovations—Apple’s recent focus has been much more discrete.
Continue reading “The Apple Has Landed”
Filed Under: Uncategorized
Tagged: Apple, Apps, Dan Diamond, digital health, fitness tracking, Mobile health, Telemonitoring
Mar 19, 2014
Hello. I am Mike Painter, and I track. I don’t necessarily have a compelling reason to track health parameters such as exercise patterns, heart rate, weight, diet and the occasional blood pressure. Yet I do. I do most of my tracking with several small devices, simple sensors and software applications. My tracking is also pretty social—meaning I share much of my data widely and daily. You’re welcome to see it—most of it is on Strava. Admittedly, I still keep some data daily on a paper calendar, and I do monitor diet and sleep in my head—i.e., nobody needs to remind me about my food splurge days. The local bakery is intimately aware of that data point as the employees witness me charge in, wild-eyed and drooling for a giant cinnamon roll every Thursday morning—almost without fail.
It all feels pretty normal to me.
Here’s the rest of the story: I track to enhance athletic performance rather than monitor my health, per se, or even really my wellness. I am an avid cyclist and have tracked miles, location, accumulated elevation, heart rate and power readings and other data for years. I share that information with both cyclist colleagues I know and don’t know on Strava. That site eagerly ingests my data—and among other things, plops it into riding (and running) segment leader boards, riding heat maps—and, most importantly, in training, trend graphs like the attached. All that data is incredibly helpful to me—it empowers me by making me face the numbers—it makes my training data- and reality-based. I don’t have to guess to maximize my fitness and minimize my fatigue level in anticipation of a big event. I follow the numbers.
Is all that bad? To me, my obsession with tracking my athletic performance seems like an extension of observing data for health and wellness.
Continue reading “Confessions of a Self-Tracker”
Filed Under: Tech, THCB
Tagged: Apps, Health 2.0, Health 2.0 Fall 2013 Conference, mHealth, Michael Painter, Quantified Self, Stanford Medicine X, Strava, Wellness
Oct 11, 2013
Having been supported by several small business grants from the National Cancer Institute to create online interventions for cancer patients, I have been learning gradually about commercialization models to get our work out to the public. I am dismayed about the major disconnect between eHealth entrepreneurs and eHealth intervention researchers (my personal reference group).
Last year I attended Stanford Medicine X and last week I did a demo of one of our web sites at Health 2.0 in Santa Clara. Both times, I was struck by the assumption in the IT developer and consumer community that giving people realtime feedback about their health will automatically result in major positive changes in behavior, not to mention cost savings for insurers.
The Connected Patient movement seems particularly naïve to me. Psychologists have been using self-monitoring, i.e. recording behaviors such as smoking, eating, and exercise, for at least 30 years to promote behavior change. First we used paper-and-pencil diaries, but researchers like Saul Schiffman quickly adapted the first handheld computers to prompt people to record their behaviors in realtime, greatly increasing the accuracy and power of self-monitoring.
As technology has advanced, so have our means of self-monitoring. Overall, however, the technology matters far less than the procedure itself. For most people, tracking their smoking, calories, mood, or steps does change unhealthy behaviors somewhat, for a limited period of time. A small group of highly educated, motivated people is more successful in using self-monitoring to make larger, more lasting changes.
I was reminded of this last year in a seminar on tracking at Stanford Medicine X, when a concierge physician from San Francisco and several of his patients talked about being empowered to change their health by using feedback from various types of sensors. One had paid out of pocket for a continuous blood glucose monitor since his insurance would not cover the costs to use it for his Type II diabetes.
Another doggedly demanded access to the data from his cardiac defibrillator. They believed their experiences heralded a sea change in health care in the United States. I am all for empowering patients with knowledge, tracking tools, and social support.
However, if knowledge and feedback was all it took to change unhealthy behaviors, psychologists would be superfluous in the world.
Continue reading “Healthcare’s Tech Disconnect: Why Aren’t We Building the Products Patients Really Need?”
Filed Under: Tech, THCB
Tagged: Apps, behavioral psychology, Health 2.0, HIT, Leslie R. Schover, mHealth, Patients, Population Health, Stanford Medicine X, Wellness
Oct 11, 2013
The developers of the app Pain Care, the winner of the Robert Wood Johnson Foundation’s Project Health Design challenge two years ago, have this to say about THCB contributing writer Dr. Leslie Kernisan’s recent post wondering why the winning entries of development challenges have a habit of disappearing and never being heard from again:
We are the app developer. We are also disappointed with the outcome of the app. But I think we also learned valuable lessons here.
One of the challenges small business facing is the need to rapid prototype and test the market, and then move on to another idea when the previous idea fails to gain traction. That is especially true with grant funded projects — they need to “make money” after the grant ends in order to justify continued development effort.
Pain Care was developed in the early days of mHealth, and it was indeed very physician focused — the reason is that we believe we must engage physicians to look at the data. We still hold that belief. It is a learning process for us. We put in our own money to develop the app, and fortunately, won the developer challenge.
We made the app public after the challenge to “test the market” — so to speak. But, as you know, essentially *none* of the pure app-based “patient journal” has turned out to be a success (let alone a financial success). Our app is no exception. It is enormously costly keep the app updated for all those iPhone, iPad, iOS released every year, as well as thousands of Android devices released since then.
So, the app becomes one of those “outdated” apps in the app store, and I think it is quite obvious to users as well. However, I think the app did contribute significantly to the “science” of mHealth. We now understand much more what works and what not in “patient engagement”. Many other “pain management” apps have since emerged, and many have done a better job than ours. I think that was what RWJF wanted when they challenged developers back then.
Today, we do things a lot differently. We no longer release research grant-funded apps to the public. Instead, we run clinical studies to test them in much smaller / controlled groups. We do not attempt to tackle vague “big problems” like general pain management any more — instead, we are much more focused on managing specific diseases that include pain. We are also moving beyond “pure software” and “simple reminders” to engage people in multiple modalities.
All of these would not be possible without the generous award RWJF gave us in picking Pain Care as the winner of one of the first developer challenges.
Filed Under: Tech, THCB
Tagged: Apps, Commentology, Leslie Kernisan, mHealth, Pain Care, RWJF
Sep 24, 2013
Health care providers and consumers are increasingly using mobile technology to exchange information. Many health IT providers readily acknowledge that some level of oversight is required to ensure patient safety and privacy protections, but many providers question whether the FDA is the right agency for the job and want to see the FDASIA recommendations.
Can the FDA, with its already limited resources and lengthy review cycles, regulate the fast-moving health IT industry? Should it? Health IT is fundamentally different from a medical device in many ways. For oversight purposes, the key differentiator between the two is the opportunity for clinical intervention in the use of health IT. Many medical devices interact directly with the patient (such as an infusion pump or pacemaker). Most health IT, on the other hand, merely provides information to clinicians, who ultimately make independent, experienced care decisions. Physicians are informed, but not controlled, by the information. This leads to a vast difference in the patient risk proposition and rigid regulatory oversight is not appropriate.
Advocates of a broad health IT oversight framework – which encompasses mobile health IT – are urging the FDA to delay release of its final guidance, particularly in light of a July 2012 Congressional mandate for the creation of a comprehensive oversight framework that avoids regulatory duplication.
But some mobile medical application developers are pressing the FDA to move forward immediately, believing its guidance will reduce the regulatory uncertainty that they believe is stifling innovation and investment in some aspects of mHealth.
Continue reading “Regulating Health IT: When, Who, and How?”
Filed Under: Tech, THCB
Tagged: Apps, athenahealth, Dan Haley, Epocrates, Esq., FDA, HIT, mHealth, Rebecca L. Jewell, Regulation
Sep 10, 2013