That was the underlying question throughout the Body Computing conference (BCC) last Friday in Los Angeles. The conversation in Digital Health is maturing, and the question facing all parties is, what's in it for me? Investors want to know if there are significant returns to be made, entrepreneurs want to know if they will be rewarded for taking risks, physicians want to know if clinical decision support will be helped or hindered, and consumers want to know if they can prevent disease or better manage an existing disease. That's just a few of the interested parties. Many more are curious about the potential value of sensors that could collect data about each of us in real-time.
I really enjoyed listening to the talk by Dr David Beiser during the session on virtual visits. When we think about sensors and the type of data we might be able to collect on people and how frequently, he really made me stop and think with this one question.
Do we need to be collecting more data on people? Even though we have lots of data already, it's sometimes not enough to answer questions that arise in pharmaceutical research. For example, I regularly use a database with the health insurance claims for 100+ million Americans. It sounds like a huge database, right? Well, if I have to answer a question which involves a rare disease and/or a rare event, even this seemingly giant database sometimes doesn't have enough patients available to analyse. Could we one day have a database which captures health data in real-time on the health of not just an entire country, but multiple countries? Is that going to be the made possible by existing organisations? Or will be it be done by new organisations that bypass traditional infrastructures and develop new methods of both collecting, sharing and making sense of these data? New organisations such as British startup, uMotif, whose founder & CEO, Bruce Hellman spoke at BCC and announced their plans to create the world's largest health self-management dataset.
As mentioned in my last blog post, my slot to speak at the conference was on Consumer Wants & Needs, and I shared the results of my survey. Over the course of 4 days, 886 people had opened the survey, but only 86 had responded, giving me a response rate of 9.7%. Not bad for an impromptu survey over a couple of days. The slides below reflect responses one week after the conference, now with 94 responses. Looking at the geodemographics of responders.
- 62% were outside the USA
- 60% were men
- 92% were between 25-55
I acknowledge the results are not representative of the population as a whole, given that I didn't get anyone aged 65 or older responding (and that group is likely to contain the heaviest users of health & social care).
I asked 7 questions about sensors, and the answers to these 4 questions in particular were of most interest to me.
- Would you wear a smartwatch if it could improve your health? 81% said Yes
- Would you considering implanting a sensor under your skin if it could improve your health? 49% said Yes
- Would you want a smartphone to diagnose illness without having to visit a doctor? 74% said Yes
- Would you share data from your body if you got paid to share the data? 57% said Yes
I deliberately allowed only an answer of Yes or No to my questions when designing the survey. As it turns out, I received feedback from people who told me they didn't respond to the survey, as there wasn't an option to answer 'Maybe' or 'It depends'. Especially regarding the question on sharing data from your body if you were paid for that data. For example, their answer might change depending upon whether it's Google vs their hospital wanting to buy their data. Including a 'Maybe' option in future surveys is something I will definitely do, I wonder how many of the people who answered 'No' in my survey were actually 'Maybe'. Some people even emailed me to request that there be a option to answer each question with free text, as they had many questions and concerns that they wanted to share. This experience only serves to remind me that understanding the wants & needs of consumers is not cut & dried.
I was surprised at how many people said Yes for the smartwatch question, given that the smartwatches already in the market are not particularly good, and it's such a new market too. I know of organisations developing sensors that would be implanted underneath our skin, and I'm also surprised to see almost half of people would consider the implanted sensor. When it comes to the idea of a smartphone diagnosing illness without having to visit a doctor, I'm not surprised at all. Using the healthcare system can often be 'disruptive' to your life. Making an appointment, waiting a week or more for the appointment, taking time off work for the appointment, and so on. When it comes to being paid to share data from your body, I wonder if I had made that a two part question, with the second part of the question asking which organisation you would be most willing to share your data with for payment.
As I said before. this survey was an experiment, and the combination of user feedback and the initial results compel me to undertake more surveys in the future. It appears to me that consumers may be more open to sensors than we think. I'd also like to drill down deeper over time to ask how people feel about sensors in particular settings or scenarios. Interestingly, the questions I asked relate to future of medicine as envisioned by Dr Eric Topol, whose recent talk at AHIMA centred around the 'rebooting' of medicine, in which he sees access and ownership of medical data shifting from physicians to consumers through the proliferation of smartphones and health apps. I love this powerful statement from Topol's talk, "You are your data but more importantly each individual needs to own their data. That’s where we need to be."
What do you think of the results of my survey? What question(s) do YOU think I should be asking next time?
Big Pharma & Sensors
The pharmaceutical industry is often one of the most risk averse groups in healthcare. However, I found a talk (video is below) given in April 2014 by Professor Patrick Vallance, President of R&D at GSK to be very illuminating. The talk was about looking ahead to 2025. Now, when Vallance talks about monitoring of patients in clinical trials, he believes the future will be "Invisible, wearable devices with real-time data collection." At BCC, Stuart Karten's session was on "Design: The Future is Not Wearable…It’s Invisible" with a great recap of Karten's session here.
When Vallance speaks about patients, he remarks that "patient influence will become much more evident". Mentioning sensors in the context of drug safety, Vallance also talks about a future which involves, "Instant feedback in terms of surveillance of medicines post-launch, with various sensing devices/monitors, and listening to patients in real-time, much more than we are able to do at the moment". Why would the President of R&D at the world's 4th largest pharmaceutical company be talking this way publicly if sensors have limited value both now and in the future? Perhaps it's the work that GSK has been doing with McLaren Applied Technologies that is behind these perspectives on the future?
This coming week, there are two events which are relevant to this conversation. Kaiser Permanente, is hosting an event in Washington, DC where they discussing a future where we could receive care anywhere. The event looks at both current & emerging technologies.
It really is incredible to see how sensor technology is evolving, and to see organisations working towards a future where billions of devices might be connected together. These converging forces could potentially impact health & social care. However, there are barriers to unlocking this value, and one of the biggest is standards (or lack of them). Today, within health & social care, we already suffer from systems that don't talk to one another, even in the same building. It's extremely frustrating for everyone involved. Then we hear about these new sensors, new devices and new software interfaces and we wonder, where are the standards? How will all these different devices talk to one another? Will I be forced to be buy all my products from one vendor in order for everything to work seamlessly? Actually, there are multiple standards emerging. A great article from Joe McKendrick highlights these different standards being proposed for the Internet of Things. It's early days and it's not clear which will become the preferred standard.
With the consumerisation of health & social care, who will be the organisations that will serve our needs over the next decade and beyond? Will it be the existing players in health & social care, or will it be the 'interlopers' as Don Jones (who helped conceive the Qualcomm Tricorder XPRIZE) mentioned in his talk at BCC on 'The bleeding edge of mobile'? Or will it be a combination of these different types of organisations working together? Will this shift happen primarily in the USA or will it take place in other countries too? Which country will lead the world with research and development of sensor technology? Will it be a different nation that leads the world in the deployment of these sensors in real-life settings?
We are all hopeful of what sensors might do for us, but ultimately, like so many new technologies in health & social care, we're going to need to see evidence of it's value, as well as finding someone willing to pay for this innovation. This is likely to be easier in some markets than others, given the impact of austerity measures on budgets across Europe. Your appetite for risk as well as how much trust you have built with consumers could determine whether you're part of the future or left behind in the past. The choice is yours.
[Disclosure: I have no commercial ties to any of the individuals or organisations mentioned in the post]