Immersive Health: Are we ready?

That's the question that I've been reflecting upon over the last 12 months. Some of you may have noticed that in 2016, there is much more news, discussion and excitement with regard to Virtual Reality (VR) technology. Every other day there is some new announcement, and more and more people are believing that this could play a greater role in our future. Google has recently extended its foray into mobile VR beyond their Cardboard initiative with the announcement of their new Daydream platform. VR itself has been around for a while now, and I remember reading about the concept of VR when I took my first Computer Science class 29 years ago! 

Life is in 360, so why shouldn't our experiences be in 360 too? What really caught my attention in 2015 was a tweet by Susannah Fox when she was at TED 2015 after she had watched Chris Milk's talk "How Virtual Reality can create the ultimate empathy machine" and reading how it had impressed her. This really piqued my curiosity with respect to VR and its applications, as when we think of VR, we often associate it with computer games simply for entertainment. I was skeptical that putting on a VR headset could generate empathy for others. In his TED talk, Milk showed the 'Clouds over Sidra' VR experience he created, and after viewing it in VR, I was very surprised at how it made me feel. 

I was also inspired when attending the Body Computing Conference last autumn at USC, where Dr Leslie Saxon announced their new Virtual Care Clinic as well as announcing the winners of their VR Medical Hackathon. In fact, USC's Institute for Creative Technologies is one of the original pioneers when it comes to VR in healthcare as you can see in this short video.

In my quest to understand the future, I started to purchase many of these new devices as soon as they came onto the market. I believe it's important to try new hardware and software for more than a day or two in order to determine what it's like to live with the technology. I purchased a Samsung Gear VR, and ended up using it to demo VR experiences at the world's 1st Pop-Up Museum of Happiness in London at the start of 2016. I offered attendees the chance to experience guided meditation at the beach, snowboarding or diving in the ocean with the whales.

With Sam Cookney, we helped people attending the pop up Museum of Happiness in London, experience Virtual Reality. This man tried a 360 video using a Samsung Gear VR, which took him on a helicopter ride in the mountains, followed by snowboarding Hear his immediate reaction to the experience.

It was fascinating to see the range of reactions to the Gear VR, some thought it was terrible, and others enjoyed meditating on the beach so much, they didn't want to take the headset off and come back to the real world. Seeing some people smiling and laughing after a few minutes with a headset with a smartphone inside of it compelled me to keep exploring the potential uses of this technology. For example, given aging populations, how do we immerse ourselves in the world of someone aged 85, who lives alone and has multiple long term conditions? In Australia, a Virtual Dementia Experience has been developed, which "is an immersive, interactive virtual reality experience that invades the senses and takes people into the world of a person living with dementia, simulating thoughts, fears and challenges." That's already here today, so what might we do in the future?

It's not just about consuming VR content but creating it too. It's now possible to buy a 360 camera, record your own 360 video, and upload it to YouTube & Facebook which both support 360 videos. You can then share the video, and whoever views it can watch it on their computer, their smartphone or even using a VR headset. Personally, I suggest using a smartphone whilst connected to wifi or a VR headset if you have access to one. Dr Shafi Ahmed recently made history by performing a cancer surgery in London, live streamed using 360 cameras located in the operating theatre, which allowed people around the globe to watch the surgery up close and personal in Virtual Reality. 

Sometimes, there are unexpected findings associated with the use of emerging technology such as a 360 camera. Many of us might dismiss it as a gimmick for every day use. We can't assume how this tech will or will not impact lives. We often just have to get out there and try something new, even if we don't know what to expect. Our sense of wonder and curiosity takes us towards new horizons. I was delighted to read Molly Watt's post on how using a 360 camera has helped her see the world differently by taking 360 images, despite losing her peripheral vision a few years ago. If you haven't done so already, do read my last post which was an interview with Molly on how she is putting Usher Syndrome on the map. If you ask me for a list of the top 10 people that influence my thinking about the future of technology, Molly would definitely be in that list. I firmly believe that citizens should have the freedom to find or even make their own solutions. Couple that mindset with advances in technology available to consumers, and we are heading for a world where our children will attend school and assume that 'invention literacy' was always part of the curriculum. 

This year, I've used telemedicine services in the UK where I had a video call with a doctor using my tablet. Will my telemedicine visit with the doctor in 2020 be in Virtual Reality? What if the doctor could visit me virtually in my own home, and by seeing my home environment in 360 degrees, be able to pick up social and environmental cues that could help them make a more accurate diagnosis? Or what if taking a selfie with a 360 camera allowed researchers looking at smoking cessation programs to understand smoking triggers in someone's social and physical environment with one 360 image? That's a core element of a pitch from a team I was part of at a recent Cancer Research UK Innovation Workshop that led to us winning an award for funding to conduct a pilot study. The 360 image you see embedded below was taken moments after we won. You can move around the entire image and immerse yourself in that moment, much more than a regular image. 

Our team just got awarded funding at @crukresearch #innovation workshop #cancerprevention - Spherical Image - RICOH THETA

I recently gave a talk at Health 2.0 Amsterdam, called 'Immersive Health: Are we ready?' and I used my Ricoh Theta S 360 camera to record my talk. The resolution of the video could be better, which is why I've also gone out and also purchased 4K 360 cameras such as the Insta360 and the Kodak PixPro SP360. Our existing infrastructure is usually not quite ready to cope with these new technologies. For example, I tried embedding the 360 video in this post, but it didn't display as a 360 video, just a regular one. Hence, I had to insert links to my 360 videos throughout this post, which require you to click on, and then it launches YouTube where you can have the full 360 video experience. Now, when you watch the 360 video of my talk in Amsterdam on your phone, move the phone around and you'll change the position of the video! 

2016 has also seen the launch of two long awaited VR headsets, one called the Oculus Rift and the other is the HTC Vive. These are the most advanced products consumers can buy today, and I've bought both of them. Whilst they deliver an immersive experience that is unparalleled by any other technology available to consumers, there are a few drawbacks. The first of which is price. I paid almost £800 for the HTC Vive, and I needed to buy a rather high end gaming PC to use it, which was another £1,400. The Oculus Rift was cheaper at £529, and I've opted to get a VR ready laptop for use with the Rift, which is an eye watering £2,200. So, this level of VR tech is not affordable to the masses yet, but neither were the original mobile phones when they were first launched.

You may wonder, when it comes to making us healthier and happier, where is the value in these expensive VR systems? Well, hospitals are starting to experiment with these advanced products. For example, C.S Mott. Children's hospital in the USA, has been using the Oculus Rift with sick children who were stuck in a hospital ward for a length of time.

There is a compelling read on Reddit, entitled "Oculus Rift saved my sanity while stuck in the hospital, Thanks!" This story was written by a patient in the USA, who upon facing being stuck on the top floor of the hospital for treatment decided to bring in his own system to the hospital. The part that stood out to me the most is "All from my top floor prison of a floor I couldn't leave. This was my getaway, for the rest of the stay. Teleporting me away from the sterile, dry and bland existence that was my hospital room. I was playing my flight simulators and space simulators, racing cars and playing FPS. Life was good again." Granted, this isn't a clinical trial, but it's a positive outcome, their own success story, and a brilliant example of patients as innovators. 

Researchers have been testing VR for some time now, most of the proven use cases seem to be with exposure therapy. For example, 12 years ago, this study looked at the use of VR and computer games as exposure therapy for people with a fear of driving after a car accident. In this study from 16 years ago, researchers looked at the use of VR to overcome fear of flying. What else could we achieve now given the VR technology has evolved and we now have an array of VR products from cheap to expensive, available in the consumer market? There is also the expected array of hype with VR that we have to navigate, just like the hype that still surrounds wearables, big data and AI etc. Finding the signal within the noise won't be easy. We can't just jump into working with this technology because it's new and shiny, we all have to operate with finite resources, no matter how big an organisation we work in.

There are so many questions to answer before we can even begin to explore this arena. What can VR replace or augment? What can we do with VR that we never thought was possible before? Will we be prescribed a VR experience by our doctor alongside our medication so we can better understand the benefits of adhering to our treatment plan? What does the ongoing refinement of VR tech mean for medical education? What are the long term risks of using these headsets for extended periods of time? Is the use of VR going to isolate us or immerse us? Who can actually afford to use VR?

That's why I decided to launch my VR for Health & Social Care workshop in London. Since I've invested in many of the latest devices, tested them myself, have been reviewing the scientific literature to understand what's been studied so far, researched future trends in VR and thought of how they might be used across Health & Social Care, why not blend that all together into an interactive learning experience for people who want to be able to make informed decisions about VR. These devices whether they be the headsets or the cameras are best experienced with your own eyes. In my workshop, one of the things you'll be learning is how to take take, process and upload 360 videos, and then viewing the content you create, in Virtual Reality! Unlocking creativity is key, and I really do believe that the creative industries will have a much larger role to play when it comes to improving our health in the future. There is a deficit of imagination when it comes to new ideas and inventions today, and collectively we must be bolder in imagining the world we want to create for our children, and our grandchildren. 

For some of you, VR may turn out to be something you want to utilise immediately, for others it may still have too many limitations to be of value until the technology and related services evolve. To that end, I've worked with experts such as Dr Keith Grimes for clinical input and Shirley Ayres for her depth of experience in the social sector, when designing the workshop to ensure that you'll walk away with knowledge that you can apply immediately in your own work. 

The workshops are 4 hours in duration, and are held on selected Mondays, Wednesdays and Fridays in London during June and July. I've deliberately limited each workshop to 4 attendees, as I want to maximise the learning opportunity for each of you. I've been to conferences where there are long lines just to try out the latest VR systems for a couple of minutes, and if you have an unexpected reaction to VR, you're in a public place where everyone to see. 

The workshop has the same content, experience and devices across the 23 dates, so you can simply choose a date that's convenient for you. I've already received requests to run the workshops in other parts of the UK, if that's something you'd like, please contact me to discuss.

You can read more about the workshop and book your ticket here. 

Finally, I've made another 360 video when I was preparing for the workshop yesterday at the venue. You can take a look around the classroom as well as see the devices you'll be getting to use during the workshop. 

[Disclosure: I have no commercial ties with the individuals or organisations mentioned above, apart from Dr Keith Grimes and Shirley Ayres who I have hired to consult on the design of my workshop]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

An interview with Molly Watt: Putting Usher Syndrome on the map

For this post, I wanted to share Molly Watt’s story. I first came across Molly in 2015, after I read her Apple Watch post. I had also just received my Apple Watch and was curious about other people’s experiences. What’s different about Molly, is that she has Usher syndrome, which is a rare genetic disorder caused by a mutation in any one of at least 11 genes resulting in a combination of hearing loss and visual impairment, and is a leading cause of deafblindness. Usher syndrome is the most common cause of congenital deafblindness (the elderly is the biggest group). Usher syndrome is incurable at present. Usher syndrome hasn’t held Molly back, she’s even set up her own charity, the Molly Watt Trust and much more. When reading each of her subsequent blog posts. her writing was creative, courageous and candid, and that resonated with me. In fact, it resonated so strongly with me, I decided to visit Molly in her home town of Maidenhead, England to interview her. It’s a longer interview than what I would normally post, but we have so much to learn from Molly (and others like her), that I was compelled to include as much as possible from her answers. Listening to Molly was also a powerful reminder, that we often focus so much on ‘empowering’ or ‘activating’ or ‘engaging’ patients themselves, that we ignore the patient’s family and friends who play a very critical role. I feel there are so many voices currently not heard, do we need to change the way we listen?

The image below is a 360 image from my interview with Molly. 

Post from RICOH THETA. - Spherical Image - RICOH THETA

1. You were recently had a meeting at Apple's HQ in America to share your views on accessibility. Can you tell us more about how you ended up there?
The main thing was the Apple watch blog post that I wrote, and through the charity, I discuss how we can access things through tech. I have been an Apple user since my diagnosis 10 years ago, I had a Mac eventually in education to access exam papers. So when the Apple watch came out, I was unsure what it could offer, and I bought one out of curiosity, and thought I would probably return it. Accessibility has been at the cornerstone of my life since the diagnosis, and we got my website set up after Xmas 2014, and my mum encouraged me to blog, so I did.

This was the first personal blog post wrote. I think the timing of it was shortly after the launch of the Apple watch, there was a lot of bad press saying it was a toy, but I found from the perspective of sensory impairment, it opened a lot of doors for me to be more independent, I never missed a phone call because of the prominent haptics, the digital touch features were really beneficial socially when out with friends, maps was a big feature for me, navigating from A to B with the watch. When I’m out I’d rather have my phone in my bag, as it’s much safer for me, and the watch enables me to do that. My post generated quite a lot of positive reviews about the Apple watch. All of that is how after a few months, Philip W. Schiller, the senior vice president of worldwide marketing at Apple retweeted me and my website crashed due to so many hits. From there onwards, a lot of people contacted the trust. We have to remember that a lot of people can’t afford the watch, many with Usher syndrome are shuffling between jobs.

Apple had reached out to the trust to speak with me, and since we were going on a family holiday to California, they said, well come and visit us. They were genuinely interested in hearing my story, and to understand how technology can enable accessibility much more in the future. As a family, we travel as much as possible, because my sight may completely go at any time. I wrote a post about my trip to California.

2. Many people laugh at products such as the Apple watch calling it a toy or not seeing any value in using it, but it has been of value in your life. What can be done to get people looking at all possible uses of new technology?
I wasn't sure about the Apple watch, I couldn't really understand what it would do for me over the iPhone that I have relied on for years. My decision to purchase it was last minute really as a couple of my friends were getting one. It's great my friends did as I might not have got one myself as we were able to explore the features of the watch together. However, for me after a little fiddling around with my insight into my real need for accessibility I was able to really put it to the test. I believe people give the Apple watch a bit of a hard time because they don't use it in the way somebody like myself does. I have learnt how to use it to make a real difference to my life, and it’s a brilliant piece of equipment I have come to rely on. I guess because I rely on technology I have become an expert in my own way of accessing it!

3. You've got your own charity and you've spoken at places such as the Houses of Parliament and Harvard Medical School. When you were younger, did you envisage you would reach these heights?
I had no idea. I think my own struggles have made me feel passionate about making a difference, to raise awareness of ability as much as disability, share my experiences good and bad and demonstrate the importance of accessible, assistive technology. I am definitely not the person I was since being diagnosed with Usher syndrome.  

Being deaf is very different, it is not rare.  It is however challenging and there needs to be support and assistive technology.  In the area I live, support of the deaf was excellent. Usher Syndrome diagnosis brought confusion and inexperience of supporting somebody with the condition particularly in school - my education became a nightmare as I couldn't access the curriculum without modification and nobody knew what they were doing.

At my real time of need the only people I could rely on were my parents who continued to battle for me even though they also did not really understand what I was going through. I definitely get my determination and drive from them.

I've been speaking since I was 14 and making awareness videos.  It was my way of telling people what I was going through, how I felt and what I felt I needed by way of support. That's how it all began and as the years have gone by I have found my work public speaking a very useful skill and a way of reaching the larger audience with the many messages I have.

4. When it comes to accessibility and new technology, what's missing? What are the 3 top inventions that you'd like to see come in the next few years?
This is a hard question as I'm not an expert on what is possible. I believe people in design, design of everything can be improved by the inclusion of accessibility from day one. The obvious things like all websites need to be completely accessible. I rely on this sort of thing, picking up a book isn't an option. Things like hotels often terrible design, decor, carpets & wallpapers clashing and the poorest lighting. Most public places are difficult.

I cannot wait for the driverless car to be available to people like me, I'm sad I'll never experience driving but excited to think this technology is on the horizon.

5. For those living with Usher Syndrome, do they feel like their wants & needs are being heard. If not, what could we do to be better listeners?
Definitely not, there is a lack of understanding and awareness.  Usher syndrome is the most common cause of congenital deafblindness and few are experienced in dealing with it hence few get what they need. Life is a constant battle.

I'm sad that people with Usher Syndrome struggle to be understood and often live isolated lives.
Many do not work, do not socialise, and do not have access to enabling technology to allow them access to social media and if they did, they need help in learning to how to use the technology. Some use sign language which again can be isolating and can cause difficulty getting employment as communication support is often needed and hard to access as cuts to Access to Work continue. I think professionals should encourage people like myself to be vocal about their needs and to listen and take onboard their thoughts and feelings. All too often people tried to speak for me and it is not acceptable. Encouragement from the point of diagnosis is important.  

I'm fortunate my parents have always encouraged me to speak up.

6. I understand you've faced many challenges when dealing with the NHS, schools and charities/support groups, can you tell us a bit more about what happened? 
I'll answer this one at a time:

The NHS were good with my deafness diagnosis when I was little and up to my Usher diagnosis, thereafter it has been a different story. Sadly, audiologists who are often the first point of contact either know of the condition but have not treated anybody with it or worse, know nothing about it. Either way it is not helpful to the patient and needs to change. It is the same with ophthalmologists, who know about eye conditions but not much about deafblindness.  Whilst conditions are rare, there has to be professionalism in dealing with all conditions. An example of not having a decent understanding is my NHS audiologist who has known me since I was very young and has monitored my hearing with regular tests the results of which are followed up in writing. It would be great if I could read those results, which were completely inaccessible until I pointed it out that they were completely unaware of my accessibility issues. Not a thought about how I am able to access information in font 10/12 on white paper and black text!

Equally I have sat at Moorfields Eye Hospital and during the appointment, was spoken to whilst a Professor looked at his computer screen - everybody knows deaf people need to see faces to lipread and for facial expressions, even those of us with very little sight. These things should be obvious!

My experience of a mainstream school was excellent whilst I was deaf, there was great support.
Again after my Usher Syndrome diagnosis there was a lot of confusion, I was given the support of a VI teacher as well as my teacher of the deaf, and neither had supported somebody like myself.
A multi sensory teacher had to be "bought" in from a charity and yes she understood the condition but with one visit a term to educate those supporting me and myself things did not go the way they should have. This resulted in me struggling to deal with what was happening to me, I felt a burden and looked to move schools, my biggest mistake ever.

I thought going to a private school for the deaf, who were familiar with my condition I'd be with people like myself! I couldn't have been more wrong. The deaf kids were cruel, questioned my deafness as I have good speech, questioned my blindness as I appeared to see. The staff were just as bad. I boarded initially and spent hours in my dorm as I physically couldn't get from dorm to dining hall in the dark, nobody noticed or cared. Teachers didn't modify my reading material and if they did it would be on A3 paper making me feel very different. I struggled for 2 years trying to deal with my failing sight, being in denial as it often seemed easier to be that way surrounded by deaf kids telling me I was fine - it was hell.

It was made worse when I got my guidedog who did enable me to get from A to B safely then I was denied access to all social areas as my need to get from A to B was not as important as the need for a younger boy with a dog allergy to move freely around the school. 

I left with depression and a nervous breakdown at 17 years old.

That school knew all there was about Usher syndrome - they knew little, I was treated very badly.

Charities:  
Sense is the main deafblind charity, they cover/support all types of deafblindness, including deafblind with additional issues from the very young to the very old and everything in between and they are great at campaigning however I do feel people with Usher Syndrome often miss out and that’s why we set up the Molly Watt Trust.

My family travel to the USA to find out information about Usher Syndrome, there has not in the 10 years I have been diagnosed an Usher specific conference yet several for other types of deafblindness even though Usher Syndrome is the most common cause of congenital deafblindness.
Sense does a great job but there is little for those with Usher syndrome. Being an ambassador I'm always happy to help/work alongside them on any Usher projects. I am an Ambassador for Sense and happy to do what I can when I can to promote awareness of Usher syndrome, something I do as part of the work I do with the companies I have worked with. I have spoken for several charities including RP Fighting Blindness and also Berkshire Vision. I often feel on the outside looking in, I don't fit in the deaf community or the blind community and yet I feel I'm a part of both along with the Usher community and society in general.

Belonging somewhere is important to us all.

7. You wanted genetic testing, but encountered resistance from the system. Why did they think it was a bad idea for you to have genetic testing?
I wanted genetic testing when I was 15 years old, back in 2009. I had studied genetics a little at school and I wanted to know exactly who I am. My parents asked at Moorfields Eye Hospital in London the next time we were there and we were told ‘NO’ because of funding and because there is no cure for my condition. I remember feeling very upset and my parents following up the request for genetic testing with my GP.  Thankfully he understood the need and arranged for me to see a geneticist from John Radcliffe hospital in Oxford. My geneticist was brilliant (Edward Blair), he explained things in full and even provided a history lesson on where Usher syndrome came from. Some 6 months later I was told I have Usher syndrome type 2a. The importance of knowing is essential should the chance to trial anything become an option in the future. If there is any clinical testing of that gene in the future I can decide if I'd like to be involved. Being told ‘NO’ makes you feel you are a lost cause which just escalates the isolation this condition brings. Everything is a battle with this condition.

Something else to be considered is the benefits system. I have been assessed more times than I can say. Sadly people think deafblind, no hearing, no sight and no speech.  When they see me they are often very shocked and then don't believe I have any disability. On one occasion I arrived for an assessment (ATOS) and was told by the doctor he had googled Usher syndrome the night before!  He did not have a clue what I deal with on a daily basis.

8. When it comes to innovation in technology, and in particular around accessibility, what is your long term dream? 
I'd like people with disabilities to be considered from day one.  I'd like those with rare disabilities like mine to have access to all equipment they need and to be taught how to use it. I’d like them to have access to transport and benefits to enable them to work.

I think developers of everything need to understand the unique needs of all. For them to realise disabilities are not black and white. Sensory impairments are not two colours. Some with Usher are profoundly deaf (usually type 1's), the older generation might not have used any hearing aids so rely on sign language (BSL) and later tactile signing as their vision deteriorates - their communication skills and needs differ to the younger generation who have (parents chose) cochlear implants hence access to sound young and oral. My generation in the main, wear hearing aids and are oral. This is in my opinion a huge positive to accessing our world. However those who sign must always be considered regarding accessibility. And being blind is extremely rarely total darkness. There are many grey areas that are not often considered. 

In an ideal world I'd like to work/consult with developers around the world working on accessibility for all.  I'd like to be a part of moving forward with assistive technology. I believe if technology works for people like myself it will work for the older generation who's eyes and ears start to fail them as they grow older and this is very important with our ageing population.

9. Do you think there are other people like yourself around the world? Have you built your own network or is that something still to come?
I know of a few people doing similar to what I do. I have built a network which continues to grow, I am quite well known for my work around the world something I have been doing since I was 15. There is definitely more work to do and lots more to come. I hope that one day having Usher syndrome can just open up unique doors for every individual, rather than the progressive isolation and depression lack of access and awareness can give.

10. Who has inspired you the most in your life, and why?
My parents, particularly my mum and my grandparents.  They have always encouraged, supported and fought for me and I have learnt so much from them.
My mum always told my brothers and my younger sister we could be anything we wanted.  At that time she didn't realise what was around the corner for me but she still believed I would make some-thing of myself and I will, one way or another!
Before I could speak (at age 6), my Nannie, Pat, would sit me down and we'd make cards, paint and create for hours. We'd do jigsaw puzzles and watch Disney videos. My creative streaks definitely arose from those days. I was born creative and to this day use those skills. My children's books have frog characters, my Nan loved frogs. She inspired me.

11. If people want to work with you, what would they need to be offering to get your attention?
Opportunities to speak, to motivate, to innovate, to consult, to make a difference, to be heard.
My passion is accessible assistive technology and educating others.

12. If others wanted to follow in your footsteps, what would your advice be to them?
I'd encourage others to think about what is important to them, how to use their unique skill set to make a difference. Work hard and be passionate about your cause. Plus of course, never be afraid to speak up. Find ways to express yourself, in that process you eventually find yourself and also the confidence to help others.

[Disclosure: I have no commercial ties with the individuals or organisations mentioned above]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

Shifting to a world of prevention: A GP's story

For this post, I caught up with Dr Manpinder Sahota, a GP in Britain's NHS. We first interacted over Twitter, where we met on the topic of shifting healthcare to a world of prevention. Dr Sahota said he had a vision for building a GP practice with a focus on wellness and prevention of disease, and was curious if technology could play a role in that. So I hopped on a train to see him, and what follows is the interview at his practice, in Gravesend. For those who have never visited, Gravesend is an ancient town in north west Kent, England, situated 21 miles east south-east of Charing Cross, London on the south bank of the Thames estuary. Gravesend has one of the oldest surviving markets in the country, its earliest charter dates from 1268. For my American readers, Gravesend is where Princess Pocahontas is buried, having died there almost 400 years ago, on a ship bound for the Commonwealth of Virginia. Back to the present day, Gravesend [and the borough of Gravesham that it falls under] faces the challenge of childhood obesity, with 38.9% of 10 to 11-year-olds resident in Gravesham being overweight or obese. Demographics are changing, with 17% of the population of the borough of Gravesham having been born outside of the UK. 

Hearing about new models of care with Dr Manpinder Sahota at his GP practice

Hearing about new models of care with Dr Manpinder Sahota at his GP practice

1. What is your role & responsibilities?
I've been at the Pelham medical practice since 1999. We have 7 GPs, over 2 sites and almost 14,000 patients. I'm the Diabetes lead and a GP trainer as well. I also provide free acupuncture to some of my patients. 

2. What are the key challenges you're facing in the year ahead? 
In a place like Gravesend, where 50% of patients are not tech savvy, getting reminders on their mobile phone or 'choose and book' [Note: Choose and Book is a national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic] doesn’t mean anything to them. Furthermore,  many can just about get to the local hospital on the cheapest bus, and often they can't afford a taxi to a hospital that is further away, so services such as 'choose and book' are of no use to them.  I'm seeing the local population getting sicker and sicker, and although some of my patients are living longer due to being on 9 or 10 drugs, they usually have very little quality of life. 

My main challenge is educating people in lifestyle changes, especially those from the lower social classes. I've found that if I can give them a practical bit of advice or even encouragement, it does lead to lower blood pressure and loss of weight.  

Patients only seem to listen when they are about to have ill health, many times there is no motivation to change behaviour, diet and exercise, especially given education levels can be quite low. 

I'm interested in pre-Diabetes and screening for pre-Diabetes, that is where the biggest change can happen. Usually, my patients know a bit about Diabetes from someone in the family, so there is some emotional trigger, which can help in our conversations. 

3. What is your big vision for moving to a world with a focus on prevention of disease?
My overall big vision is to get away from prescribing drugs, there are dangers of polypharmacy and I want to get people to rely upon themselves, and use lifestyle medicine as the first discussion point, before we go down the path of handing out tablets. I'm also thinking about depression, back pain, obesity related diseases, and am keen to provide Tai Chi classes, Yoga classes and Meditation classes at this new centre.

4. Tell us more about your new centre
My new centre is not replacing the existing GP surgery. It would be a new GP practice with a preventative component, One idea is to have a gym at the top of the surgery where Tai Chi classes could take place. I want to be able to prescribe patients a 12 week course on diet and nutrition with a personal trainer. There is a national program where certain courses for diabetes prevention can be done. No current funding, but in the future, there should be money coming from it. If the NHS wont fund my ideas, I will go to the British Heart Foundation or National Lottery. 

5. Switching over to technology, there is much talk about giving patients online access to their medical records, in the hope that it will improve the quality of care, shared decision making as well as patient outcomes. How often do patients come in and ask for a paper copy of their medical records?
Very rarely, it does happen though.

6. If today, your practice was able to offer online access to medical records for your patients, as an estimate, how many would use it?
I estimate 25% would use it. The remaining 75% aren't that educated and/or don't have computers. In fact, 10% of the patients visiting our practice need an interpreter during the visit, as they don't speak English, or don't speak it well enough. 

Our other practice is in a deprived area. Over there, the patients tend to believe the doctor knows best, and they don't want to be involved in their treatment decision, patients actually want a paternalistic healthcare system. Quite a lot of my Indian patients, believe that the doctor is God, and if you give them management options, they are not interested.

7. We hear so much about how wearable technology is changing healthcare. How many of your patients are coming in and showing you apps or wearables with respect to behaviour change (such as using a FitBit as a tool in increasing physical activity)?
Hardly any patients are showing up at appointments with this kind of technology.

8. What are your thoughts when you hear the term 'Big Data' in healthcare? How does it make you feel as a GP?
We are already overloaded with information, letters from hospitals, from agencies, if we have to look at even more information, that would be too much for us. We are doing too much administration work already, any new information would have to be controlled very well. We are literally drowning in information, as everything in the NHS gets sent to a patient's GP.

9. How might 'smarter homes'  in the future help you as a GP in terms of prevention?
Technology that could help spot rises in blood sugar, oxygen, pulse rates. Patients are already bringing in paper to their appointments showing their rising Blood Pressure levels. For current hypertensives, I'd like to see a patient's BP readings at home on my computer screen prior to the patient's visit. Patients could save admin time if they could pre-enter this information for me to see. What if we could get food diaries into patient's medical records, that would be great for preventing Diabetes. To be able to understand what they are eating on a daily or weekly basis, the carbohydrate content etc. 

10. Who influences you?
I follow Dr Aseem Malhotra and Jamie Oliver, they are both leading a national conversation. I hope to see celebrities and sports starts taking up the baton in health prevention and get involved in their local areas. What if we had footballers like David Beckham or Wayne Rooney helping to spread this message? Kids would listen to those people, rather than us. 

[Disclosure: I have no commercial ties with the individuals or organisations mentioned above]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

Developing a wearable biosensor: A doctor's story

For this post, I caught up with Dr Brennan Spiegel, to hear in more detail about his journey to get a wearable biosensor from concept to clinic. In the interview, we discuss how an idea for a sensor was borne out of an unmet clinical need, how the sensor was prototyped, tested, and subjected to clinical research, and how it was finally FDA approved in December of 2015. Throughout, we learn about the challenges of developing a wearable biosensor, the importance of working with patients, doctors, and nurses to get it right, and how to conduct rigorous research to justify regulatory approval of a device. The interview ends with seven suggestions from Dr. Spiegel for other inventors seeking to develop wearable biosensors.

1. What is AbStats?
AbStats is wearable sensor that non-invasively measures your intestinal activity – it's like a gut speedometer. The sensor is disposable, about the size of a large coin, sticks on the external abdominal wall, and has a small microphone inside that dutifully listens to your bowel churn away as it digests food. A specialized computer analyzes the results and presents a value we call the "intestinal rate," which is like a new vital sign for the gut.  We've all heard of the heart rate or respiratory rate; AbStats measures the intestinal rate.  The sensor tells the patient and doctor how much the intestines are moving, measured in "events per minute."  If the intestinal rate is very high, like 30 or 40 events per minute, then it means the gut is revved up and active.  If it's very low, like 1 or 2 per minute, then it means the gut is asleep or, possibly, even dysfunctional depending on the clinical situation.

2. What existing problem(s) does it solve?
AbStats was specifically designed, from the start, to solve for a real problem we face in the clinical trenches.  

We focused first on patients undergoing surgery.  Almost everyone has at least temporary bowel paralysis after an operation.  When your body undergoes an operation, whether on your intestines or on your toe (or anywhere in-between), it's under a great deal of stress and tends to shut down non-vital systems.  The gastrointestinal (GI) tract is one of those systems – it can take a hit and shut down for a while.  Normally, the GI system wakes up quickly.  But in some cases the GI tract is slow to come back online.  This is a condition we call postoperative ileus, or POI, which occurs in up to 25% of patients undergoing abdominal surgeries.  

The issue is that it's hard to know when to confidently feed patients after surgery.  Surgeons are under great pressure by administrators to feed their patients quickly and discharge them as soon as possible. But feeding too soon can cause serious problems, from nausea and vomiting, to aspiration, pneumonia, or even death.  On the other hand, feeding too late can lead to infections, prolong length of stay, and cost money.  As a whole, POI costs the US healthcare system around $1.5 billion because of uncertainties about whether and when to feed patients.  It's a very practical and unglamorous problem – exactly the type of issue doctors, nurses, and patients care about. 

Now, you might ask how we currently decide when to feed patients.  Here's the state of the art: we ask patients if they've farted or not. We literally ask them, practically all day long, "have you passed gas yet?"  No joke.  Or, we'll look at their belly and determine if it looks overly distended.  We might use our stethoscope to listen to the bowels for 15 seconds at a time, and then make a call about whether to feed.  It's nonsense.  Data reveals that we do a bad job of determining whether someone is fit to eat.  We blow it in both directions – sometimes we overcall, and sometimes we under call.  We figured, in this fantastical age of digital health, there had to be a better way than asking people about their flatus!  So we invented AbStats. 

3. What prompted you to embark upon this journey?
One day, about 4 years ago, I was watching Eric Topol give a TED talk about wearable biosensors and the "future of medicine." As I watched the video, I noticed that virtually very part of the human body had a corresponding wearable, from the heart, to the lungs, to the brain, and so forth.  But, sitting there in the middle was this entire body cavity – the abdominal cavity – that had absolutely zero sensor solutions.  As a gastroenterologist, I thought this must be an oversight.  We have all manner of medieval devices to get inside the GI system, and I'm skilled at inserting those things to investigate GI problems.  But typical procedures like colonoscopies, enteroscopies, capsule endoscopies, and motility catheters are all invasive, expensive, and carry risks.  There had to be a way to non-inavsively monitor the digestive engine.  So, I thought, what do we have available to us as doctors?  That's easy: bowel sounds.  We listen to bowel sounds all the time with a stethoscope, but it's highly inefficient and inaccurate.  It makes no sense to sit there with a stethoscope for 20 minutes at a time, much less even 1 whole minute.  But the GI system is not like the heart, where we can make accurate diagnoses in short order, over seconds of listening.  The GI system is slow, plodding, and somewhat erratic.  We needed something that can stand guard, vigilantly, and literally detect signal in the noise.  That's when AbStats was borne.  It was an idea in my head, and then, about 4 years later, became an FDA-approved device.  

4. What was the journey like from initial idea to FDA approval? 
When I first invented AbStats, I wasn't thinking about FDA approval.  I knew virtually nothing about FDA approval of biomedical devices.  I just wanted the thing built, as fast as possible, and rigorously tested in patients.  As a research scientists and professor of medicine and public health, this is all I know.  I need to see proof – evidence – that something works.  AbStats would be no different. 

I was on staff at UCLA Medical Center when I first invented the idea for AbStats. I told our office of intellectual property about the idea, and they suggested I speak with Professor William Kaiser at the UCLA Wireless Health Institute.  So, I gave him a call.  

Dr. Kaiser got his start working for General Motors, where he contributed to inventing the automotive cruise control system.  Later, he went to work for the Jet Propulsion Laboratory, where he worked on the Mars Rover project.  Then, he came to UCLA and founded the Wireless Health Institute.  He is fond of saying that of all the things he's done in his career, from automotive research to spaceships, he believes the largest impact on humanity he's had is in the realm of digital health.  He is a real optimist.  

So, when I told Professor Kaiser about my idea for AbStats, he immediately got it.  He got to work on building the sensor and developed important innovations to enhance the system.  For example, he developed a clever way to ensure the device is attached to the body and not pulled off.  This is really important, because if AbStats reports that a patient's intestinal rate is zero, then it might mean severe POI, or it might mean the device fell off.  AbStats can tell the difference thanks to Professor Kaiser's engineering ingenuity.  

Once we developed a minimal viable product, we worked like crazy to test it in the clinics, write papers, and publish our work.  At the same time, UCLA licensed the IP to a startup company, called GI Logic, that worked with our teams to submit the FDA documentation.  Professor Kaiser's team did the heavy lifting on the engineering and safety side, and we focused on the clinical side.  It was a great example of stem-to-stern teamwork, ranging from in-house engineering expertise, to clinical expertise, to regulatory expertise.  It all came together very fast.  

Importantly, it was my sister who came up with the name "AbStats."  I always remember to credit her with that part of the journey!

5. What role did patients play in the design of AbStats? 
Patients were critical to our design process.  We went through a series of form factors before settling on the current version of AbStats.  At first, the system resembled a belt with embedded sensors. Patients told us they hated the belt.  They explained that, after undergoing an abdominal surgery, the last thing they wanted was a belt on their abdomen.  We tweaked and tweaked, and eventually developed two small sensors that adhere to the abdomen with Tegaderm.  Even those are not perfect – it hurts to pull Tegaderm off of skin, for example.  And the sensors are high profile, so they are not entirely unobtrusive.  We're working on that, too.  But patient feedback was key and remains vital to our current and future success with AbStats.  

6. How did patients & physicians respond to AbStats during research & development?
It was gratifying that virtually every surgeon, nurse, and patient we spoke with about AbStats immediately "got it."  This is not a hard concept to sell.  Your bowels make sound.  The sound matters. And AbStats can listen to those sounds, make sense of them, and provide feedback to doctors and nurses to drive decisions.  The "so what" question was answered.  If your belly isn't moving, then we shouldn't feed you.  If it's moving a little, we should feed a little.  And if it's moving a lot, then we should feed a lot.  The surgeons called this the AbStats "stoplight", as in "red light," "yellow light," and "green light."  Each is mapped to a very specific action plan.  It's not complicated.  

We were especially surprised by the engagement of nurses in this process.  Nurses are the heart and soul of patient care, especially in surgery.  Our nursing colleagues told us that feeding decisions come up in nearly every discussion with post-operative patients.  They said they have virtually no objective parameter to follow, and saw AbStats as a way to engage patients in ways they previously could not. This was surprising.  For example, the nurses pointed out that many patients are on narcotics for pain control, and that can slow their bowels even further. By having an objective parameter, the nurses can now use AbStats to make conversations more objective and actionable.  For example, they can show that every time a patient uses a dose of narcotics, it paralyzes the bowels further.  Knowing that, some patients might be willing to reduce their medications, if only by a little, to help expedite feeding decisions.  AbStats enables that conversation.  It's really gratifying to see how a device can alter the very process of care, to the point of impacting the nature of conversations between patients and their providers.  Almost uniformly, the patients in our trials felt the sensors provided value, and so did their nurses. 

7. Would you approach the problem differently if you had to do this again?
Not really.  Considering that in 4 years we invented a sensor, iteratively improved its form factor, conducted and published two peer-reviewed clinical trials, submitted an FDA application, and received clearance for the device, it's hard to second guess the approach.

8. What other problems would you like to solve with the use of wearable technology in the future?
AbStats has many other applications beyond POI.  We are currently studying its use in an expanding array of applications, including acute pancreatitis, bowel obstructions, irritable bowel syndrome, inflammatory bowel disease, obesity management, and so on.  There are more opportunities than there are hours in the day, so we're trying to remain strategic about how best to proceed.  Thankfully, we are well aligned with the startup, GI Logic, to move things forward.  I am also fortunate to be at Cedars-Sinai Medical Center, my home institution since moving from UCLA, where most of the clinical research on AbStats was conducted.  Cedars-Sinai has been extremely supportive of AbStats and our work in digital health.  We couldn't do our research without our medical center, patients, administrative support, and technology transfer office. I am immensely grateful to Cedars-Sinai.  

More generally, wearable technology and digital health still have a long way to go, in my opinion.  I've written about that before, here. AbStats is an example of a now FDA-approved sensor supported by peer-reviewed research.  I'd like to see a similar focus on other wearables.  There are good examples, like AliveCor for heart arrhythmias, and now Proteus, which is an "ingestible."  But, for many applications in healthcare, there is still too little data about how to use wearables.  

I believe that digital health, in general, is more of a social and behavioral science than a computer or engineering science.  Truth be told, most of the sensors are now trivial.  Our sensor is a small microphone in a plastic cap.  The real "secret sauce" is in the software, how the results are generated and visualized, how they are formed into predictive algorithms, and, most importantly, how those algorithms change behavior and decision making.  Finally, there is the issue of cost and value of care. There are so many hurdles to cross, one wonders whether many sensors will run the gauntlet. AbStats, for example, may be FDA approved, but that doesn't mean we're ready to save money using the device.  We need to prove that.  We need data.  FDA approval is a regulatory hurdle, but it doesn't guarantee a device will save lives, reduce costs, reduce disability, or anything close to it.  That only comes from hard-fought science.  

9. Are clinically proven medical applications of wearable technology likely to grow in years to come?
Almost certainly, although my caveats, above, indicate this may be slower and more deliberate than some are suggesting in the digital health echo chambers.

10. For those wishing to follow in your footsteps, what would you words of wisdom be?
First, start by addressing an unmet need. Clinical need should drive technology development, not the other way around.  

Second, if you're working on patient-facing devices, then I believe you should really have first hand experience with literally putting those devices on patients.  If you're not a healthcare provider, then you should at least visit the clinical trenches and watch what happens when sensors go on patients. What happens next can be unexpected and undermine your presuppositions, as I've written about here and here.  I do not believe one can truly be a wearable expert without having literally worked with wearables.  That's like a pharmacist who has never filled a prescription, or, a cartographer who has never drawn a map.  Digital health is, by definition, about healthcare. It's about patients, about their illness and disease, and about figuring out how to insert technology into a complex workflow.  The clinical trenches are messy, gray, indistinct, dynamic, and emotional — injecting technology into that environment is exceptionally difficult and requires first-hand experience.  Digital health is a hands-on science, so look to the clinical trenches to find the unmet needs, and start working on it, step-by-step, in direct partnership with patients and their providers.

Third, make sure your device provides actionable data.  Data should guide specific clinical decisions based on valid and reliable sensor indicators.  We're trying to do that with AbStats. 

Fourth, make sure your device provides timely data. Data should be delivered at the right time, right place, and with the right visualizations.  We spent days just trying to figure out how best to visualize the data from AbStats.  And I'm still not sure we've got it right.  This stuff takes so much work. 

Fifth, if your'e making a device, make sure it's easy to use and has a favorable form factor.  It should be simple to hook up the device, it should be unobtrusive, non-invasive, with zero infection risk, comfortable, safe, and preferably disposable.  We believe that AbStats meets those standards, although there is always more work to be done.

Sixth, the wearable must be evidence-based.  A valuable sensor should be able to replace or supplement gold standard metrics, when relevant, and be supported by well designed, properly powered clinical trials.  

Finally, and most importantly, the sensor should provide health economic value to health systems.  It should be cost-effective compared to usual care.  That is the tallest yet most important hurdle to cross.  We're working on that now with AbStats.  We think it can save money by shaving time off the hospital stay and reducing readmissions.  But we need to prove it.  

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

My review of the first Scripps Health Digital Medicine conference

In this post, I'm going to be sharing my thoughts regarding the first Scripps Health Digital Medicine event hosted by Scripps Translational Science Institute (STSI) that I attended a few months ago. What was excellent, and still rare to see in many Digital Health events across the globe is that both days started with patients sharing their stories on stage, and not just a few minutes, but 30 minutes for each patient story. These were really powerful reminders of why we were gathered there. 

I wasn't enamored by the first two talks on Day 1. I still remain skeptical of Deepak Chopra's work, even after listening to his talk on the 'Future of Wellbeing'. I found Paul DePodesta's talk on 'Moneyball for Healthcare' to be quite dry and didn't engage with me at all. Thankfully, Anna McCollisterSlip's talk followed on patient centered healthcare which was a highlight and I'm looking forward to the future launch of Vitalcrowd, which aims to crowdsource the design of clinical trials and involve patients. 

Talking to other attendees in the breaks got me thinking, where is everyone? Whilst the speakers were from different parts of the USA, almost every attendee I spoke to was local to the San Diego area (Note: I did meet 3 people who had travelled from Europe) This was the first event of its kind by Dr Eric Topol and Dr Steve Steinhubl by STSI, and when registering, I imagined people would be attending from around the world. Especially given how influential Topol's work has become in recent years, I find it surprising that nobody from the UK's NHS was there. After all, UK Health Secretary, Jeremy Hunt, cited Dr Topol's book, 'The patient will see you now' in his annual HSJ lecture in October 2015.

One of the most energetic talks during the entire event was delivered by Dr Henry Wei, and really hit home for me because he actually talked about the challenges of evidence generation in Digital Health, and he shared Aetna's experience from piloting health apps. 

Adam Pellegrini, from Walgreens, shared that they had seen improved outcomes as a result of patients using wearable devices, in terms of medication adherence and the results were unexpected. They seem to have big plans for incorporating digital technologies in their offerings, so it will be worth keeping an eye on what they do next. 

What was interesting was that the second half of Day 1 had 5 talks on the theme of 'What the patient wants and needs.' Walter de Brouwer from Scanadu, made some bold predictions including that within 2-3 years there will be a lab in every bathroom. His talks are always very engaging, as he is definitely focused on the patient first. He also made a point that consumers will have agents like Siri, Artificial Intelligence like Watson, and so what will happen to doctors? 

All this talk about transforming medicine, and it made me aware of my own health. Sadly, this event seemed to suffer from the same issues I have observed at similar events around the world. To be fair, someone must have listened, because on Day 2, fruit was available in every break. 

John Sculley, the former CEO of Pepsi & Apple, pointed out that the American Medical Association says that 70% of procedures could be done remotely, in his talk, on 'Telehealth Care to Just Health Care.' I do think more people need to consider virtual doctor visits, and whether in some areas, it becomes the default method for interacting with a healthcare provider. I was intrigued to hear Babak Parviz speak, (who invented Google Glass) but has moved to Amazon, where they are exploring new spaces including healthcare. I wonder, what if our experience of healthcare were as efficient as our experience of using Amazon? 

Since the event was located in California, which is considered by many to be the most progressive and forward thinking state in the USA, I was surprised to see find that the panel discussion at the end of Day 1 was absent of women. On top of that, out of 11 formal talks on Day 1, just 2 were delivered by women. 

What I found particularly valuable was the chance to network and spend time with people who are normally really difficult to get hold of. After the talks had finished on Day 1, I remember having a wonderful extended conversation with Professor Rosalind Picard, who is at the MIT Media Lab, and I got the chance to have a look at the wearable technology she is currently developing. One of the benefits of having a relatively small event in a compact venue. I went to the mHealth Summit in Washington, DC a few years ago, and felt like I was in a small town, since 4,500 attendees were there. 

Whilst I'm on the topic of the venue, the location, which was the Scripps Institution of Oceanography in La Jolla is the best setting for a conference that I've ever attended. Having flown 11 hours to attend, and then driving 2 hours from Los Angeles in rush hour, I suspect the ocean views and laid back atmosphere had an impact in reducing the effects of my jet lag during the 2 days. 

This was the view of the Pacific Ocean from the venue when we had breaks

This was the view of the Pacific Ocean from the venue when we had breaks

Day 2 opened strongly, with D.A Wallach speaking about the need to create a company that is the Apple of healthcare, a one stop shop for consumers. Dr Jess Mega from Google Life Sciences [now known as Verily] gave a insightful talk on the technology that Google is pursuing in healthcare, including the contact lens that aims to monitor glucose levels in people living with Diabetes. Their vision she shared on the 'machine intelligent' landscape in healthcare has convinced me to pay much more attention to technology trends such as machine learning. Professor Picard's talk on what wristband sensors can tell us about brain health also gave tremendous insights into the future, asking how could we use sensors to predict seizures in those living with Epilepsy. She also asked us to work together to use tech to save lives. One of the metrics I use to judge if a speaker has made the audience think is how many queue up to ask questions once the talks are over. 

Virtual Reality is tipped to be an area of increasing interest in 2016 with the launch of new consumer headsets. We might think it's brand new technology but Brenda Wiederhold from the Virtual Reality Medical Center, highlighted how the evaluation of virtual reality as a form of therapy has been around for some time. 

I enjoyed listening to Donna Spruijt-Metz from the USC mHealth Collaboatory share some of her research in Obesity, and made me think about the 'just-in-time' interventions we may be receiving in the future.

Dr Zubin Damania from Turntable Health, delivered a very entertaining talk which tackled a very serious topic about reforming primary care, including his vision for the future, where instead of evidence enslaved medicine, we have evidence informed medicine. He also gave the audience a preview of his latest video, EHR State of Mind, which the audience loved so much, he received a standing ovation. As I too stood up, smiling and clapping, it hit me how humour can be utilised to get an entire group of people thinking hard about something that bothers many in healthcare today. 

Wendy Nilsen, from the National Science Foundation, spoke about Precision Medicine as a National Initiative: The Role of mHealth. I've admired her efforts for many years, and it was great to get to hear her speak in person. 

In the final session on Day 2, the theme was 'Individualizing care via Big Data', which is a growing area of interest right now. This was the first time I'd seen a talk about the newly formed Watson Health, and Robert Merkel, certainly shared a bold vision for what they hope to use their technology for. 
 

It was unfortunate that at the end of Day 2, the panel discussion was devoid of women, again. 

After the event formally concluded at the end of Day 2, there was a long queue of people patiently waiting to speak to Merkel about Watson Health. I reckon that given their strengths in big data and their bold visions for future, competition between interlopers such as Watson Health and Google Life Sciences may lead to a paradigm shift in the application of data in our everyday life to optimise our health. 

It was my first time hearing in person about MD2K, which aims to lay the scientific foundations for turning the wealth of mobile sensor data available through new and rapidly evolving wearable sensors into reliable and actionable health information, and contribute to the vision of predictive, preventive, personalized, participatory, and precision (P5) medicine.  However, the speaker, Santosh Kumar, spoke far too fast, and I had trouble keeping up with the pace of the presentation. It was enlightening to learn about their mHealth Training Institute (applications open Jan 15th 2016)

There was also a small marquee outside of the auditorium where breakfast, lunch & breaks took place, which also had a very small selection of exhibitors. That was a good decision. Sometimes, there can be so many exhibitors that you use most of your breaks visiting booths, which makes the day quite hectic. 

I left the event feeling somewhat confused. The cost of registration was $345, which is less than the price of some of the latest smartwatches, so a veritable bargain, in my opinion. STSI did a great job bringing some brilliant speakers together in one place. However, they need to work out exactly what this event is about in order for it to justify a place in the increasingly crowded space of Digital Health events. It has the potential to be a brilliant event, but because it didn't deliver content that consistently met the objectives stated in the brochure, it's a major failing in my eyes. I expressed this view in my earlier post. Neither the low cost of admission or the beautiful location can offset that. The brochure opened with this statement under course description, "A thoughtful exploration of the clinical evidence necessary to drive the widespread uptake of mobile health solutions will be the focus of the first Scripps Health Digital Medicine conference", and whilst there were elements during some of the talks with this explicit focus, by and large it felt like existing events I've been to which discuss in general terms, the future of emerging technologies that are hoping to transform medicine.

The brochure also stated it would be an interactive conference. Sorry chaps, but a conventional format where in each session, the audience sits and passively receives information from 3 talks over 90 minutes followed by a panel discussion, and Q&A time with the audience doesn't count as interactive for me. Fewer talks, more audience participation/practical workshops would be a step towards being able to describe it as interactive. The brochure also listed, "After attending this activity, participants should be able to: Identify global needs for mobile health and potential technologies to address those needs." Sadly, this didn't actually translate into reality, since the speakers including the patients were all from the US, and most of the examples cited in talks were in reference to the American healthcare system or research initiatives set in the US. .

I'm not sure that having a theme of mHealth is the best thing for the future. We assume that smartphones are cutting edge and with us for some time. However, a recent survey by Ericsson Consumer Labs found that 50% of smartphone users believe that smartphones will disappear within 5 years [Note: they surveyed urban smartphone users in 13 major cities around the world]. 

To conclude, I see that STSI are now showing online that the event will repeat in 2016. I also note that the overview and conference objectives for 2016 are identical to 2015. I sincerely hope that they will make changes to the structure, content and format of the next event. Artificial Intelligence and the Internet of Things are likely to be two buzzwords that are thrown around in 2016 from many claiming to have solutions that might impact the lives of many people around the globe. "There is a clear need for a forum to present, discuss and debate clinical trial evidence and how to best obtain it in order to accelerate change" states this conference brochure. Moving forwards, I believe this need will become even more acute, let's hope this annual event can become the forum that the everyone eager to change healthcare is awaiting.

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

Unexpected findings

It's fascinating to meet people in healthcare and hear them dismiss the potential value of a tool like Twitter. Despite an increasing amount of noise, I do find it a great place to listen and learn. For me personally, it's been a very powerful tool, and has taken me to places I've never imagined. One of those places is Cedars-Sinai Medical Center in Los Angeles, California. By chance, I'd come across Dr Brennan Spiegel on Twitter earlier this year, and through our online interactions, discovered that we had common interests in Digital Health, especially in the context of understanding whether these new digital tools and services being developed are actually having an impact in healthcare.

Dr Spiegel is Director of Health Services Research at Cedars-Sinai Health System, Director of the Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), and Professor of Medicine and Public Health in Residence at UCLA. I was particularly intrigued by the work he does at CS-CORE, where he oversees a team that investigates how Digital Health technologies, including wearable biosensors, smartphone applications, and social media, can be used to strengthen the patient-doctor bond, improve outcomes, and save money. So whilst I was out in California, I popped into Cedars-Sinai Medical Center to spend some time with him and his team to understand their journey so far in Digital Health.

With Dr Spiegel and the CS-CORE team - the picture was taken remotely using Dr Spiegel's Apple watch! 

With Dr Spiegel and the CS-CORE team - the picture was taken remotely using Dr Spiegel's Apple watch! 

To give you some context, Cedars-Sinai Medical Center is a non-profit, has 958 beds, over 2,000 doctors and 10,000 employees. It's also ranked among the top 15 hospitals in the United States, and is ranked first in Los Angeles by US News and World report. In addition to Dr Spiegel, I met with Dr Christopher Almario, Garth Fuller, and Bibiana Martinez. 

What follows is a summary of the Q&A that took place during my visit. 

1. What is the big vision for your team?
"The big vision is value of care. Value is our true north. It puts patients first while also reminding us to be judicious about the healthcare resources we use. Take Cedars-Sinai, a traditional volume based center of excellence. How do we transform our hospital, that has excelled in the fee-for-service healthcare environment for so long, and transform it into a value-based innovation center while maintain our top-notch quality of care? It seems like a magic trick to transform from volume to value in healthcare. How do we do it at scale, and how do we keep people out of hospitals when healthcare systems have  been designed to take people in? Our mission is to figure out how to do that. This could be a blueprint for how other health systems could do this and which doctors could do this. How do we align incentives? How do we create a Digital Health strategy that works within the existing clinical workflow? How might we use an E-coordination hub? These are all open questions ready for rigorous research. 

What does innovation mean at Cedars-Sinai? We see ourselves as a hub of innovation and are now developing a new 'Value Collaboratory' under the guidance of our visionary leader, Scott Weingarten, who directs Clinical Transformation at Cedars-Sinai. We offer a set of tools to help value-based innovators make a difference. We're going to be doing a lot over the next 5 years. Digital Health is just one small part of that. The Value Collaboratory will be the centre for ideas within Cedars. For example, if innovators seek internal funding for a project, then they can work with the collaboratory to refine their idea, evaluate its health economic potential, and create a formal case for its support."

2. Tell me more about the team, what types of people work in CS-CORE
"There are 12 of us in CS-CORE, and we have a combination of health system and statistical expertise. We have social scientists, behavioural scientists, mobile health experts and more. It's a multi-disciplinary team. For example, Dr Almario is a gastroenterologist, who has always been interested in health services research, and was awarded a career development award from the American College of Gastroenterology, which is very rare, in Digital Health to pursue research. Garth Fuller with a background in health policy and management has been working with us for the last 5 years and has a strong interest in medication adherence, and conducts research to understand how we can show that 'Beyond the Pill' strategies in the pharma industry are working. Bibiana Martinez with her background in Public Health is hands on, and works with our patients. Bibiana helps filter the real world barriers faced in Digital Health research and bring them back to our team. We have an all-hands-on-deck research crew."

3. What has surprised you during your research in Digital Health?
"We've had some unexpected findings. For example, we had a patient who reported less pain, and our original expectation was that the data from her wearable would report that she had been walking more, as the pain was subsiding. However, that wasn't the case, as her pain decreased, she was walking less. It turns out the patient was an author, and being free of pain meant she could sit for hours on end and finish writing her book. Completing the book was the outcome that mattered to the patient. What should we do when a patient's steps fall from 1,500 a day to almost 0? Do we give them a call, simply because we perceive it as unhealthy? How often does your doctor ask you what your goal is for your visit? I show these charts of pain vs steps when I teach my health analytics class at UCLA, to challenge how my students think."

4. How else have your assumptions about how patients use Digital Health tools been challenged?
"In healthcare, we often make a lot of assumptions about the needs and wants of patients. We have been fitting Virtual Reality goggles with hospital patients, so that we can transport them from their hospital bed to far away places such as Iceland. One patient asked if we could transport him somewhere more tropical, as the hospital is cold, and having a VR experience in Iceland made him feel even colder. 

We had an instance where a patient wasn't able to charge her Fitbit. We tried to explain over the phone, but it actually required a house visit in order for this patient to understand how to charge the device. We thought we could put sensors around the ankle joint of patients to measure steps, and some patients felt like they were under house arrest when wearing our sensor on their ankle."

5. What are some of the most exciting projects you're working on today?
"Well, we create our own technologies and sensors. We find out soon if our first sensor is approved by the FDA. Also, with the vision of our hospital Enteprise Information Services (EIS) team, our hospital's EHR is now connected to Apple's HealthKit, it's a great achievement, we now have 750 people pouring in real-time sensor data into our EPIC Electronic Health Record. We've also developed My GI Health, a patient provider portal which by gathering information on symptoms in advance of a visit to the doctor, helps us learn more about a patient's GI symptoms. The computer doesn't forget to ask questions, but sometimes the doctor forgets to ask questions. Although much of our research is in GI, we are working across healthcare. We are now building a version of My GI Health for rheumatology, for example. We are also interested in testing whether the first visit to a specialist doctor should be virtual or in person? What would patients & doctors actually want? We are putting a study design together now that will compare both types of visits."

6. What are some of the challenges you face in your research?
"The research we do is often challenging for the IRB because it’s so different.  We work closely with our IRB to explain the nature of our work. As more academic groups conduct Digital Health research, it will be important that medical centers develop regulatory expertise around this type of work.

There is also an urgency to test quickly, fail quickly and succeed quickly. What we need is a high level discussion to understand what risk means in the context of Digital Health research. Can we generate evidence faster?"

7. What are you doing to help ensure that no patient gets left behind in Digital Health?
"We are soon going to start a community-based study in partnership with African American churches in Los Angeles. We will work with these 'mega churches,' which have up to 10,000 congregants, and will distribute healthy living experiences delivered by Virtual Reality goggles using Google Cardboard.  We will also use an app for obesity and diabetes management. We observe that many families from minority backgrounds are mobile first, and we see that the next digital divide is opening up over mobile. Healthcare isn't built for mobile. We are also researching the mobile usability of hospital websites across America."

8. What message would you like to share with others also on the same journey as you?
"Listen to the patients, get used to Digital Health being dirty and difficult, it may be harder than you think. We can say that with some authority now, that it can sound easy, but in reality it's been very hard. Our team has developed devices and applied them directly to patients; what happens next is often unexpected and challenges our assumptions. Digital Health is really hard to do. We have to focus on the how of Digital Health. We understand why it's valuable, but not as much about how we will be doing it. Value is another big theme - we need to improve outcomes and reduce costs of care. It takes time to do it right. We also try to never forget the end user, both the physician and the patient. 

This work is 90% perspiration, and 10% inspiration. You need to have a sense of humor to do this because, you’re going to get a lot of unexpected bumps and failures. It’s a team sport to figure it out. Defining the problem in terms of the health outcomes and costs is the key, and generating a solution that has value to patient and providers is paramount.. 

Finally, the 'cool test' is so seductive. Don’t been fooled by the 'cool test' in Digital Health. What may be cool to us may not be cool to the patient. Don’t be seduced by the 'cool test' in healthcare."

I really enjoyed my time with Dr Spiegel and his team, not only because of the types of research they are doing, but also because of their vision, values and valor. Their unexpected findings after putting new devices on patients has subsequently made me think at length about health outcomes. I was reminded about the human factors in healthcare, and that both patients and doctors don't always do what we expect them to do. I'm glad CS-CORE are not just thinking from the perspective of medicine, but through the lens of public health too, and how to ensure that no patient is left behind. I'm not the only one who is admires their work. David Shaywitz, has recently written a post about the research conducted by CS-CORE, and mentions, "they are the early adopters, the folks actually in the arena, figuring out how to use the new technology to improve the lives of patients." 

Dr Spiegel did admit they've been under the radar so far, focusing on putting “one foot in front of the other” in research mode while working with a wide variety of partners from industry and academia. The team is also looking for collaborators who want to road test their digital health solutions in a “real world” laboratory of a large health system. Their team is equipped to conduct stem-to-stern evaluations with an eye to rigorous research and peer-reviewed publications. I see that Dr Spiegel is one of the speakers at the Connected Health Symposium later this week, as part of a panel discussion on Measuring Digital Health Impact & Outcomes. I won't be there but I hope to be part of the live Twitter discussion. 

Since my visit, I note that Cedars-Sinai and Techstars have partnered to launch a Digital Health focused accelerator. What does this accelerator aim to do? The website states, "We are looking for companies transforming health and healthcare.  Companies that are creating hardware, software, devices and/or services that empower the patient or healthcare professional to better track, manage, and improve health and healthcare delivery are eligible to apply." Techstars is one of the world's most highly rated startup accelerator programs, the other being Y Combinator. It's fascinating to see the marriage of two very different worlds, and who knows what unexpected findings will result from this partnership. In the 21st century, when we think of radically different models of care, startups and emerging technologies, large traditional hospital systems are not the first place we think of looking for them. Maybe the lesson here for large healthcare institutions is to "disrupt or be disrupted?"

In the world of Digital Health, the trend of moving healthcare out of the hospital into the home, virtual visits and telemedicine may be causing concern to hospital executives. If all of these converging technologies (often coming from startups) really are effective and become widely adopted, then surely we will need smaller hospitals, or perhaps in certain scenarios, we may one day not need to have that many hospitals at all? Perhaps the hospitals that survive and thrive in the 21st century will be the ones that boldly explore the unknown in Digital Health, rather than the ones that hide and hope that the world of Digital Health will just be a passing fad? 

“It is the tension between creativity and skepticism that has produced the stunning and unexpected findings of science.” - Carl Sagan

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

Promise doesn't equal proof

I've just returned from California, where I attended these 3 conferences;

For this post, I'm going to focus on what I observed at these events regarding the quest for evidence in Digital Health. I'll be writing separate blog posts in the future relating to my overall experience at each of these events.

Starting with the first event which was hosted by Scripps Translational Science Institute, I was excited about the event. The opening sentence in the brochure said, "A thoughtful exploration of the clinical evidence necessary to drive the widespread uptake of mobile health solutions will be the focus of the first Scripps Health Digital Medicine conference." When booking my place, Three of the educational objectives of the event which sounded tremendously useful to me as a participant were;

  • "Assess the quality of clinical trials of mobile health in terms of providing the evidence necessary to support implementation"

  • "Discuss the implementation of mobile health technologies into clinical practice based on clinical trial evidence"

  • "Identify innovative trial methodologies for use in digital medicine"

Having attended, I don't really feel those three objectives were met. Whilst some of the sessions were very interesting and thought provoking, it wasn't because the speakers were discussing evidence generation or clinical trials in this arena. Often they were talking about the future of Digital Health, and where we are heading. I walked away feeling confused and disappointed. Only on the second day, when Jeff Shuren, Director of the Center for Devices and Radiological Health at the FDA spoke, did I see a session which specifically related to the objectives listed above.

So onto Health 2.0, where I was expecting validation and evidence to be discussed at two sessions. The first was "Validating Performance in Healthcare and Turning the Dial on Credibility" and the second was "Arc Fusion: Getting real about the convergence of health IT and biomedicine." In the first session, Vik Khanna from Quizzify made a number of good points.

I didn't manage to attend the second session, but the talk was captured on video, and can be found here. Having watched the 40 minute video, there wasn't much exploration of evidence or validation.

However, before either of those two sessions took place, it was useful to hear about validation at the session on "Health Data Exploration Project-Personal Data for the Public Good." It's good that they are pursuing this research, and I look forward to seeing what they discover.

I also noticed this tweet during Health 2.0, but I can't find a link on the web that shows what the American Medical Association is doing here.

At Body Computing, there was a panel discussion on "Building a virtual healthcare system" and I asked the panel about whether we need some kind of new institute that can validate & certify these new digital interventions. Andy Thompson, the CEO of Proteus Digital Health replied, and said that we don't need new institutions, and that industry needs to collaborate with regulators to improve regulatory science, as the regulators can't do it alone. At some level, I think he has a good point, and later in this post, I'll explain why we might actually need a new institute.

I've tried a lot of wearable technology, especially smart watches, and there still isn't any real evidence showing that these are making an impact on our health. Whilst a watch that can remind you to walk more or workout at the gym in the best heart rate zone is of some use, many who work with patients every day, are asking, "What's the medical benefit?" There is a huge unmet need out there for wearable technology developed with medical grade sensors that doctors and patients can trust and use with confidence.

At Body Computing, I witnessed the first public viewing of the AliveCor ECG for the Apple watch. You can see a demo by Dr Dave Albert, founder & CMO of AliveCor, in my video below.

I must mention that this new AliveCor product is a prototype and has not been FDA cleared yet. I personally expect it to be a roaring success when it is launched. I note that at the Scripps conference, when both patients and doctors were commenting on what Digital Health product had impacted their life, AliveCor was cited nearly every time. The fact that the AliveCor app on the watch records the patient's voice, links it to the location, takes us a step forward on the path to a single patient view, the marriage of hard and soft data. We need more of this science driven innovation in Digital Health, where gathering of evidence is not an afterthought, and where the product/service has a clearly defined medical benefit. 

I am witnessing increasing use of algorithms in healthcare, especially since we're collecting more data than we ever have before. Algorithms are like the invisible hand that guides many of our decisions, and since they are programmed by humans, how do we know what bias is incorporated into them? The recent scandal which involved Volkswagen's cars and an algorithm that was cheating the system makes me think about the need for greater transparency in healthcare.

I appreciate that in the modern era, algorithms are closely guarded secrets by companies just like Kentucky Fried Chicken guards its secret recipe. I'm not saying that private corporations should make their algorithms open source and lose their competitive advantage, but maybe we need an independent body that can be monitoring these algorithms in healthcare, not just once when the product is approved, but all year round, so that we can feel protected? I found a fascinating post by Jason Bloomberg, who in response to the VW emissions scandal, asks if this is the death knell for the Internet of Things?  Bloomberg cites 'calibration attacks' as the possible cause of the VW scandal, and goes on to highlight how this may impact healthcare too. In my opinion, each of the three conferences I attended should have had a session where we could have a healthy debate about algorithms. I keep hearing about how artificial intelligence, big data and algorithms will lead to so many amazing things, but I never hear anyone talking about calibration attacks, and how to prevent them. Zara Rahman closes her wonderful post on understanding algorithms with, "Though we can't monitor the steps of the process that humans decide upon to create an algorithm, we can - or should be able to - monitor and have oversight on the data that is provided as input for those algorithms."

I don't think it's alarmist to examine a range of different future scenarios and to consider updated regulatory frameworks to reflect threats that never existed before. It's wonderful to hear speakers at conferences show us how the future is going to be better due to technological advances, but we also need to hear about the side effects of those new technologies too.

I recognise that not every digital intervention will need clinical trials and a whole body of evidence before it can be approved, accredited and adopted. For example, medication reminder apps that are a twist on the standard reminder app. Or it could be argued that even these simple apps should be regulated too? What if the software developer makes a mistake in the code and when a patient actually uses the app, their medication reminders in the app are switched around, leading to patient harm? A recent article highlights research that showed that most of the NHS approved apps for depression are actually unproven. Another related post by Simon Leigh, points out, "are apps forthcoming with the information they provide? It's easy enough to say this app beats depression, but do they offer any proof to turn this from what is essentially marketing into evidence of clinical effectiveness?"

Many people are so angry with the state of healthcare that they want this digital revolution to disrupt healthcare as quickly as possible. Asking for evidence and proof is often seen as slowing down this revolution, a sign of resistance to change. Just because something is digital doesn't mean we can trust it implicitly from the moment it's developed. Hype, hope and hubris will not be enough to deliver the sustainable change in healthcare that we all want to see. We are at a crossroads in Digital Health, and we have to be very careful going forwards that the recipients of these digital interventions aren't led to believe that promise equals proof.

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner



The quest for evidence

There is an abundance of excitement and enthusiasm in the world of Digital Health. One example is the growth in venture funding, another is the announcement of new partnerships between incumbents and the technology companies, such as Astrazeneca's partnership with Adherium to develop a 'smart inhaler.' We see more accelerators, more incubators, and more hackathons. It really is an incredible era. One of the major challenges is that the world of healthcare requires more than excitement and enthusiasm, it requires evidence. Apps may be cool and fashionable in the modern age, but apps that are proven to save lives are what decision makers in healthcare are seeking. News articles may cite that 165,000 health apps now exist, but that’s a headline statistic, as it’s simply evidence of increased activity. If we don’t start seriously thinking about validating these new technologies, chances are that the industry will fail to make the impact it hopes to. Even worse, widespread use of digital interventions that have not been validated may cause unnecessary harm to patients.

Now, evidence means different things to different people. In the world of startups, evidence might be $1 million in seed funding and 5,000 active users of an app. In the world of healthcare, evidence might be a randomised clinical trial with results published in a peer reviewed journal. I have observed a gulf between these two worlds, and that's a problem. How many startups have evidence generation in their business plans given that half of Digital Health startups fail within 2 years? Generating evidence is expensive when you're trying to get your business off the ground. Omada Health is cited as one of the leading examples of a startup that has worked hard to generate evidence, and they state, "Omada’s commitment to generating, analyzing, and sharing clinical data is central to our identity."

What is evidence in the 21st century?  This is a critical question, and one not being asked enough. Maybe if healthcare systems eventually start collecting patient outcome data in real-time, evidence may be easier to obtain? Perhaps as we collect different types of data, the evidence that is gathered could change? The time and costs needed to gather evidence using traditional methods may not be suitable to enable the swift development of Digital Health. Even when we have schemes for validating Digital Health, it’s not always plain sailing. Take the NHS example, and the news that some accredited health apps were found to be putting users' privacy at risk. My fear is that traditional organisations, under pressure to be seen to ‘accelerating innovation’ or ‘transforming healthcare with digital’ act in haste with regard to these new tools, and throw caution to the wind. Changing the world of healthcare is going to be a relatively slow moving process when done properly, no matter what you hear about the next disruptive idea. Maybe we mistakenly assume that a digital intervention is always going to be brilliant, which is quite a dangerous assumption to be carrying around. Again, that’s where evidence is useful, as maybe the evidence will show that a particular digital intervention does not offer any additional benefit over existing non-digital interventions.  

There are people out there starting to look at validating new ideas in Digital Health. It's interesting to note how a new startup accelerator, Rockstart, from the Netherlands has quite a strong focus on validation and evidence generation, which is a step in the right direction. There is also Evidation Health, which has a focus on, "Defining and demonstrating value in Digital Health." Also, the Global Consortium for Digital Medicine has been established, with a focus on Evidence based Digital Health.

This is good news, and quite frankly, we need more people working on this. I am so curious about trends in generating evidence that I've flown out today to California to attend the inaugural Digital Medicine conference at Scripps, where the focus of the 2 day event will be, "A thoughtful exploration of the clinical evidence necessary to drive the widespread uptake of mobile health solutions." There seems to be a growing momentum for pushing this conversation forward. I note that the Hacking Medicine Institute will be hosting their first "Measuring Digital Health Outcomes Summit" next week. I'm excited that the Institute has the aim of "convening healthcare leaders around the world to accelerate data, evidence and adoption of effective new medical technologies." I suspect those organizations building Digital Health products that have not thought enough about evidence are likely to be viewed differently in 2016 and beyond.

The quest for evidence in Digital Health is underway, and hopefully, we'll soon be able to sort out the wheat from the chaff. 

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner

Painting a false picture of ourselves

In the quest for improving our health, we're on the path to capturing more data about us, and what we do, and what happens to us. It's no longer sufficient to capture data about our health when we visit the doctor. Sensors are popping up all over the place, even in pills that help others determine whether we are actually taking our medication. Today, the most prevalent sensors are the ones in those wristbands and smart watches that track how many steps we've taken and how much we've slept. We're likely to end up at some point in the future where many, if not all of us, will be monitored 24 hours a day. Recently, Target in the USA, announced it will be offering a Fitbit activity tracker to each of its 335,000 employees.

There are already insurers in the US & UK that are offering rewards if you share data from your wearable, and the data from the wearable proves you are being active enough. In Switzerland, a pilot project by health insurer, CSS, is monitoring how many steps customers are walking every day, with one implication being, "people who refuse to be monitored will be subject to higher premiums." In that same article, Peter Ohnemus of Dacadoo, believes "Eventually we will be implanted with a nano-chip which will constantly monitor us and transmit the data to a control centre."

Well, if pills with ingestible sensors are already here, then the vision of Ohnemus may not be that far fetched. En route to the nano-chip, I note that Samsung's new Sleepsense device that sits under your mattress and tracks your sleep (and analyses the quality of your sleep), offers a feature where a report about your sleep can be emailed daily to family members. You might use it to track how your elderly parents/grandparents/children are sleeping. At the 5th EAI International Conference on Wireless Mobile Communication and Healthcare in London next month, there is a keynote titled, "The car as a location for medical diagnosis." There is so much data about us that could be captured and shared with interested parties, it's an exciting new era for many of us. 

SLEEPsense was launched when I visited IFA earlier this month

SLEEPsense was launched when I visited IFA earlier this month

Not everyone is excited though. It's truly fascinating to observe how people might respond to the introduction of these new sensors in our lives. We're going to see many developments in 'smart home' technologies, and maybe Apple's HomeKit will be the catalyst for people to make their homes as smart as possible. Given aging populations, maybe older people, especially those living alone are the perfect candidates for these sensors and devices. Whilst their children, doctors and insurers may find the ability to 'remotely monitor' behaviour quite reassuring, what if the older person being monitored doesn't like being monitored? What strategies might they employ to hack the system? The short film below, 'Uninvited Guests' shows an elderly man and his smart home, and where the friction might occur. 

Then you have 'Unfit Bits' which pokes fun at the growing trend of linking data from your activity tracker with your insurance. "At Unfit Bits, we are investigating DIY fitness spoofing techniques to allow you to create walking datasets without actually having to share your personal data. These techniques help produce personal data to qualify you for insurance rewards even if you can't afford a high exercise lifestyle." Check out their video. 

These videos are food for thought. Our daily choices and behaviour are going to come under increased scrutiny, and just because it's technically possible, will it be socially desirable? Decisions are increasingly being made by algorithms, and algorithms need data. There is a call for healthcare to be more of a data driven culture, but how will we know if the data coming from outside the doctor's office can be trusted? There is huge concern regarding the risks of health data being stolen, but little concern regarding how health data may be falsified. 

In the case of employers tracking employees, "Instead of feeling like part of a team, surveilled workers may develop an us-versus-them mentality and look for opportunities to thwart the monitoring schemes of Big Boss", writes Lynn Parramore in her post examining the dystopia of workplace surveillance.  As these new 'monitoring' technologies and associated services emerge and grow, at the same time, will we also observe the emergence of technologies that will allow us to paint a false picture of ourselves?

[Disclosure: I have no commercial ties to any of the individuals or organisations mentioned in the post]

Enter your email address to get notified by email every time I publish a new post:

Delivered by FeedBurner