Finding a signal within the noise

Apple's new iPhones and their new watch. That's what dominated the technology headlines last week. More firms are planning to enter the smartwatch space. In health & social care, what value do these smart watches actually add? The Apple watch claims to be able to track our activity levels, with new fitness and workout apps. Sounds great for those who want to monitor their activity or monitor their workouts in the gym or whilst jogging. I wasn't blown away by the keynote and I began to wonder how useful are these health & fitness features for someone whose job involves sitting for the entire working day? Bus drivers, taxi drivers, truck drivers? How useful is the Apple watch for someone confined to a wheelchair? Add a price of $349 for the watch and that you need your iPhone nearby the watch to use all the functions, and I wouldn't blame you for concluding that the reality of the Apple watch doesn't match the hype. Has it been designed by the 'worried well' for the 'worried well'? Are the primary beneficiaries those of us with above average income/education, who are digital savvy and already engaged with our own health? What value Apple's watch will add to health & social care? Only time will tell. 

Technology for Parkinson's disease

For me, what's remarkable, is that last week, there were three advancements in the development of technology for Parkinson's disease (PD) that didn't grab the headlines the way the Apple watch did. The main symptoms of PD are tremor, rigidity and slowness of movement, and it's estimated that between 7-10 million people around the world are living with PD. There are no lab tests to diagnose PD, no cure, and we don't know what causes PD. 

The first advancement was at the British Science Festival, where Dr Max Little gave an update on his work for the Parkinsons Voice Initiative. He'd already developed the technology to test for symptoms using voice recordings alone, more in his TED talk. He's gone one step further now, by using smartphones to track how the disease progresses in those that have PD, collecting data on voice, location & movement every 20 microseconds. He is now conducting larger trials to evaluate the technology, and he has said, "This new kind of remote data analysis will help patients monitor their conditions on a minute-by-minute basis from the comfort of their own homes".

We often hear talk about bringing the hospital into the home, and it's encouraging to see someone actively working on that. What I find particularly fascinating is Dr Little is interested in developing a tool "that could potentially provide specific feedback to people on symptoms that matter to them". The research has been going on for 8 years, and it reminds me that every problem in health & social care can't be solved with a weekend hackathon.

The second advancement is an activity tracker from Australia called the Parkinson's KinetiGraph Data Logger that allows automated reporting of a PD patient's movements. It's just been approved by the FDA in the USA. The device is prescribed to a patient, who wears it on their wrist, and it can collect data for 10 days, after which it's downloaded by the physician. This wearable technology offers physicians the ability to know much more about changes in a PD patient's movements outside of the doctor's office. The device even vibrates and reminds patients to take their Levodopa medication, and records data on when the patient took the medication. Remember that in my testing of the new Android Wear smart watches, an app already exists that allows me to get medication reminders on the watch, and to record when I have taken or skipped my dose. For many in the world of health, wearable technology is just a buzzword with little or no value, and I can understand their perspective. It's easy to dismiss this emerging area of computing, but dismissing it entirely might be foolish.

The third advancement was that Google X bought Lift Labs, joining the Life Science division. What do Lift Labs make? Their product, Liftware, is a spoon that vibrates to stablise tremors, which makes it much easier for people with PD to eat. The founder of Lift Labs, Anupam Pathak, "sees the technology being extended to other everyday objects, as well as extending the diagnostic capabilities to be able to monitor tremors over time." Google X is the part of Google that runs their most ambitious projects. Many of the people I meet who are experimenting with new technology in health & social care, are driven because of personal experience or a family member's experience. The mother of Sergey Brin (one of Google's co-founders) has PD, so I find this acquisition of Lift Labs most fascinating. Once again, time will tell what they bring out in the future. You can see more in the video below.

Finding the signal

Finding the signal within the noise of Digital Health is increasingly a challenge. The three advancements I listed above could both improve the quality of life for PD patients as well as enable a deeper understanding of this disease. They are not just cool technologies, but designed to solve real problems associated with different aspects of PD. 

Now, Apple's watch might offer extra features once it's launched, but for now, it's health features leave people wondering, "Is that it?". What problems does it solve that existing technology does not? 

How do we evaluate and test emerging technologies in Digital Health? This fledgling industry is evolving so rapidly that many organisations I speak to are struggling to keep up with the pace of change. How do we determine what offers sustainable value? One of the steps that seems to be missed is about understanding needs. Do we truly understand what doctors, nurses and other frontline staff want? Do we truly understand what patients want? Do we truly understand what the ordinary consumer wants?

Is the Digital Health industry at times trapped in the dogmatic perspective that the system is always wrong, and startups are always right? 

On top of that, do we actually have a genuine understanding of the underlying problems facing us in health & social care? I meet so many organisations that believe by making services 'Digital', everything will be transformed. I challenge that mindset. Have you stopped to examine whether the underlying process or service is flawed? Merely 'digitising' an existing process or service isn't going to help in the long term. It makes your process looks shiny and modern, but it's fundamentally still a flawed process. 

This week, it was announced that two US hospitals are working with Apple to trial the use of the new HealthKit platform with patients that have diabetes and other chronic diseases. Apple have built up amazing levels of trust with consumers around the globe by delivering a simple but great user experience. Could they do the same with health & social care? Many of us are excited by the possibility that companies with no track record in health, such as Apple, could transform aspects of healthcare delivery, but it's too early to tell. As Dan Diamond points out, an unsustainable hype cycle built up for the Apple watch, and another is building up in advance of the iPhone 6 release this Friday with regard to what the new iPhone can do for our health. 

In a thought provoking article by Darius Tahrir, which questioned the benefits of Digital Health, Julia Adler-Milstein, a professor in the School of Information at the University of Michigan said “There’s a risk of backlash against the technology: we were promised all these benefits, and we’re not seeing them”.

Evidence based medicine is the bedrock of modern healthcare systems, so how can we practice evidence based Digital Health? What evidence do we need to help us find the signal within the noise? Is the health of the Digital Health industry at risk if we don't take steps to generate, evaluate and share the evidence?

[Disclosure: I have no commercial ties with the individuals and organisations mentioned in this post]

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