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]

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Sensors: What value do they add?

That was the underlying question throughout the Body Computing conference (BCC) last Friday in Los Angeles. The conversation in Digital Health is maturing, and the question facing all parties is, what's in it for me? Investors want to know if there are significant returns to be made, entrepreneurs want to know if they will be rewarded for taking risks, physicians want to know if clinical decision support will be helped or hindered, and consumers want to know if they can prevent disease or better manage an existing disease. That's just a few of the interested parties. Many more are curious about the potential value of sensors that could collect data about each of us in real-time. 

I really enjoyed listening to the talk by Dr David Beiser during the session on virtual visits. When we think about sensors and the type of data we might be able to collect on people and how frequently, he really made me stop and think with this one question.

Do we need to be collecting more data on people? Even though we have lots of data already, it's sometimes not enough to answer questions that arise in pharmaceutical research. For example, I regularly use a database with the health insurance claims for 100+ million Americans. It sounds like a huge database, right? Well, if I have to answer a question which involves a rare disease and/or a rare event, even this seemingly giant database sometimes doesn't have enough patients available to analyse. Could we one day have a database which captures health data in real-time on the health of not just an entire country, but multiple countries? Is that going to be the made possible by existing organisations? Or will be it be done by new organisations that bypass traditional infrastructures and develop new methods of both collecting, sharing and making sense of these data? New organisations such as British startup, uMotif, whose founder & CEO, Bruce Hellman spoke at BCC and announced their plans to create the world's largest health self-management dataset. 

As mentioned in my last blog post, my slot to speak at the conference was on Consumer Wants & Needs, and I shared the results of my survey. Over the course of 4 days, 886 people had opened the survey, but only 86 had responded, giving me a response rate of 9.7%. Not bad for an impromptu survey over a couple of days. The slides below reflect responses one week after the conference, now with 94 responses. Looking at the geodemographics of responders.

  • 62% were outside the USA
  • 60% were men
  • 92% were between 25-55

I acknowledge the results are not representative of the population as a whole, given that I didn't get anyone aged 65 or older responding (and that group is likely to contain the heaviest users of health & social care). 

I asked 7 questions about sensors, and the answers to these 4 questions in particular were of most interest to me.

  • Would you wear a smartwatch if it could improve your health? 81% said Yes
  • Would you considering implanting a sensor under your skin if it could improve your health? 49% said Yes
  • Would you want a smartphone to diagnose illness without having to visit a doctor? 74% said Yes 
  • Would you share data from your body if you got paid to share the data? 57% said Yes

I deliberately allowed only an answer of Yes or No to my questions when designing the survey. As it turns out, I received feedback from people who told me they didn't respond to the survey, as there wasn't an option to answer 'Maybe' or 'It depends'. Especially regarding the question on sharing data from your body if you were paid for that data. For example, their answer might change depending upon whether it's Google vs their hospital wanting to buy their data. Including a 'Maybe' option in future surveys is something I will definitely do, I wonder how many of the people who answered 'No' in my survey were actually 'Maybe'. Some people even emailed me to request that there be a option to answer each question with free text, as they had many questions and concerns that they wanted to share. This experience only serves to remind me that understanding the wants & needs of consumers is not cut & dried. 

I was surprised at how many people said Yes for the smartwatch question, given that the smartwatches already in the market are not particularly good, and it's such a new market too. I know of organisations developing sensors that would be implanted underneath our skin, and I'm also surprised to see almost half of people would consider the implanted sensor. When it comes to the idea of a smartphone diagnosing illness without having to visit a doctor, I'm not surprised at all. Using the healthcare system can often be 'disruptive' to your life. Making an appointment, waiting a week or more for the appointment, taking time off work for the appointment, and so on. When it comes to being paid to share data from your body, I wonder if I had made that a two part question, with the second part of the question asking which organisation you would be most willing to share your data with for payment. 

As I said before. this survey was an experiment, and the combination of user feedback and the initial results compel me to undertake more surveys in the future. It appears to me that consumers may be more open to sensors than we think. I'd also like to drill down deeper over time to ask how people feel about sensors in particular settings or scenarios. Interestingly, the questions I asked relate to future of medicine as envisioned by Dr Eric Topol, whose recent talk at AHIMA centred around the 'rebooting' of medicine, in which he sees access and ownership of medical data shifting from physicians to consumers through the proliferation of smartphones and health apps. I love this powerful statement from Topol's talk, "You are your data but more importantly each individual needs to own their data. That’s where we need to be."

What do you think of the results of my survey? What question(s) do YOU think I should be asking next time?

Big Pharma & Sensors

The pharmaceutical industry is often one of the most risk averse groups in healthcare. However, I found a talk (video is below) given in April 2014 by Professor Patrick Vallance, President of R&D at GSK to be very illuminating. The talk was about looking ahead to 2025. Now, when Vallance talks about monitoring of patients in clinical trials, he believes the future will be "Invisible, wearable devices with real-time data collection."  At BCC, Stuart Karten's session was on "Design: The Future is Not Wearable…It’s Invisible" with a great recap of Karten's session here

When Vallance speaks about patients, he remarks that "patient influence will become much more evident". Mentioning sensors in the context of drug safety, Vallance also talks about a future which involves, "Instant feedback in terms of surveillance of medicines post-launch, with various sensing devices/monitors, and listening to patients in real-time, much more than we are able to do at the moment". Why would the President of R&D at the world's 4th largest pharmaceutical company be talking this way publicly if sensors have limited value both now and in the future? Perhaps it's the work that GSK has been doing with McLaren Applied Technologies that is behind these perspectives on the future?

Moving forwards

This coming week, there are two events which are relevant to this conversation. Kaiser Permanente, is hosting an event in Washington, DC where they discussing a future where we could receive care anywhere. The event looks at both current & emerging technologies. 

The second event is Cisco's Internet of Things World Forum in Chicago. I attended last year, and found it useful to understand what Cisco and their partners are doing in this space. 

It really is incredible to see how sensor technology is evolving, and to see organisations working towards a future where billions of devices might be connected together. These converging forces could potentially impact health & social care. However, there are barriers to unlocking this value, and one of the biggest is standards (or lack of them). Today, within health & social care, we already suffer from systems that don't talk to one another, even in the same building. It's extremely frustrating for everyone involved. Then we hear about these new sensors, new devices and new software interfaces and we wonder, where are the standards? How will all these different devices talk to one another? Will I be forced to be buy all my products from one vendor in order for everything to work seamlessly? Actually, there are multiple standards emerging. A great article from Joe McKendrick highlights these different standards being proposed for the Internet of Things. It's early days and it's not clear which will become the preferred standard. 

With the consumerisation of health & social care, who will be the organisations that will serve our needs over the next decade and beyond? Will it be the existing players in health & social care, or will it be the 'interlopers' as Don Jones (who helped conceive the Qualcomm Tricorder XPRIZE) mentioned in his talk at BCC on 'The bleeding edge of mobile'? Or will it be a combination of these different types of organisations working together? Will this shift happen primarily in the USA or will it take place in other countries too? Which country will lead the world with research and development of sensor technology? Will it be a different nation that leads the world in the deployment of these sensors in real-life settings?

We are all hopeful of what sensors might do for us, but ultimately, like so many new technologies in health & social care, we're going to need to see evidence of it's value, as well as finding someone willing to pay for this innovation. This is likely to be easier in some markets than others, given the impact of austerity measures on budgets across Europe. Your appetite for risk as well as how much trust you have built with consumers could determine whether you're part of the future or left behind in the past. The choice is yours. 

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

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Will the home of the future improve our health?

According to BK Yoon, that would be one of the benefits in their vision of the 'home of the future'. Who is BK Yoon? He's President and CEO of Samsung Electronics. Last Friday, I listened as he delivered the opening keynote of IFA 2014, which is the largest consumer electronics and home appliance show in Europe.

Whilst many talk of bringing healthcare out of the hospital/doctor's office into the home, Samsung, in theory, have the resources and vision to make this a reality at a global level. Samsung Group, of which Samsung Electronics is the biggest subsidiary, have just invested $2 billion in setting up a biopharmaceuticals unit. Christopher Hansung Ko, CEO at the Samsung Bioepis unit. said in an earlier interview, “We are a Samsung company. Our mandate is to become No. 1 in everything we enter into, so our long-term goal is to become a leading pharmaceutical company in the world.” 

Is South Korea innovative?

My views on Samsung (and South Korea overall), changed when I visited Seoul, the capital of South Korea during my round the world trip in 2010. I had only scheduled a 3 day stopover, but ended up staying over 3 weeks. I was impressed by their ambitions, their attitude towards new technology and their commitment to education. Their journey over the last half century is truly amazing. "Fifty years ago, the country was poorer than Bolivia and Mozambique; today, it is richer than New Zealand and Spain." Bloomberg released their Global Innovation Index at the start of this year. Guess which country was top of the list? Yup, South Korea. The UK was ranked a lowly 16th.

After my visit, I left South Korea with a different perspective, and have been paying close attention to developments there ever since. I believe many people in the West underestimate the long term ambitions of a company like Samsung. Those wishing to understand the future, would be wise to monitor not just what's happening in Silicon Valley, but also in South Korea. 

Aging populations worry policy makers in many advanced economies. Interestingly, recent data shows that South Korea's population is aging the fastest out of all OECD countries. Maybe that's one of the drivers behind Samsung's strategy of developing technology that could one day help older people live independently. 

We've been hearing about smart and connected homes for many years, and one wonders how this technology would be integrate with our lives. How easy would it be to set up and use? How reliable would it be? Would I have to figure out what to do with all these data streams from the different devices? I used to believe that Apple was unique in really understanding the needs and wants of the consumer, but it seems Samsung have been taking notes. They have conducted lifestyle research with 30,000 people around the world. The results of that research were shared after they keynote. Whilst reading the reports, one feels like Samsung Electronics is now trying to position itself as a lifestyle company, not a technology company. Whether it's one of the opening statements, "The home of the future is about more than technology and gadgets. It's about people." It's about responsive homes that adapt to our needs, homes that protect us, homes that are empathetic. How much is all of this going to cost us, right? Is it only going to be for the rich? Is it only going to work with new homes, or can we retrofit the technology?

Data driven homes - is that what we truly want?

Their research also says, "Technology will promote eating and living right. Devices around the home will inspire us to make decisions that are right for our bodies, taking an active role in helping us achieve better health by turning goals into habits." So in Samsung's vision, the fridge of the future will inform you that some of the food inside has expired and needs to be thrown away. Where do we draw the line? What if you come home from work hoping to grab a beer from the fridge, but the fridge door is locked, because the home of the future knows you've already consumed more than your daily allowance of calories?

Do we actually want to live in data driven homes? Our homes are often an analogue refuge in an increasing digital & connected world. We have the choice to disconnect and switch off our devices and just 'be'. What if part of our contract with our energy provider or home insurer is having smart home technology installed?

In a recent survey of Americans aged 18+ for Lowe's, 70% of smartphone/tablet owners want to control something inside their home from their bed via their mobile. Obesity is already a public health issue not just in the USA, but in many nations. Will being able to switch on the coffee pot, adjust the thermostat and switch on the lights by speaking into your smartphone whilst lying in bed lead to humans leading even more sedentary lives in the future? 

However, there is a flip side. Rather than just dismiss this emerging technology as silly or promoting inactivity, these advancements may be of immense benefit to certain groups of people. For example, would the home of the future enable someone who is blind, disabled or with learning difficulties a greater chance to live independently? Would the technology be useful when you're discharged from hospital after surgery?

Is it just about the data?

One of the byproducts of these new technologies for our homes, are data. Sensors and devices which track everything we do in the home are going to be collecting and processing data about us, our behaviour and our habits. Samsung to mention in their research "Our home will develop digital boundaries that keep networks separate & secure, protecting us from data breaches, and ensuring that family members cannot intrude on each other's data." It all sounds great in a grand vision, but turning that into reality is much harder than it appears.

We expect to hear about Apple's HealthKit later today. Who will you trust with the data from your home in the future? Apple, an American corporation or Samsung, a South Korean corporation? Or neither of them? Is the strategy of connecting our homes to the internet simply a ploy to grab even more data about us? Who will own and control the data from our homes? Where will it be stored? 

Despite the optimism and hope in BK Yoon's keynote, I can't help wonder about the risks of your home's data feed getting hacked, and what it means for criminals such as burglars, or even terrorists. Do we want machines storing data on the movements of each family member within our own home? Or will tracking of family members who are very young or very old, in and around the home, give families peace of mind and reassurance?

Ultimately, who is going to pay for all of this innovation? Even today, when I talk to ordinary hard working families about new technologies, such as sleep tracking, I'm conscious it's out of the reach of many. For example, the recently launched Withings Aura system allows you to track and improve your sleep. It's priced at $299.95/£249.95. If given the choice, how many ordinary families would invest in the Withings Aura to improve their sleep vs buying a new bed from Ikea for the same price?

The video below was played during the keynote, and gave me a glimpse into Samsung's vision of the home of the future. BK Yoon claimed that the future is coming faster than we think. He seemed pretty confident. Only time will tell. 

How does this video make you feel? Does Samsung's vision make you excited and hopeful, or does it frighten you? Do you look forward to a home that aims  to protect you and cares for your family? How comfortable do you feel with your home potentially knowing more about your health than you or your doctor? How will the data about our health collected by our home integrate with the health & social care system? Will the company that is most successful in smart homes be the one that consumers trust the most?

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

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Day 2 - Health 2.0 Silicon Valley

The lure of events in Silicon Valley

The amazing David Ewing Duncan

The amazing David Ewing Duncan

One of the reasons I love coming to Silicon Valley for events is just how progressive and laid back people are. They are very much focused on business like other parts of the world but Health 2.0 conferences are always informal and friendly. It's one of the few events where I can walk around wearing a Hawaii shirt and potential clients are not expecting you to be wearing a shirt and tie! I remember meeting a CEO of a tech company in a coffee shop in Silicon Valley last year so he could demo his software. Despite being very successful, he attended the meeting wearing a t-shirt, shorts and sandals. It's a small point, but again, it's very different from the traditional attitudes found on the East Coast of the USA and in Europe where where your parent's occupations and where you went to college can often dictate what opportunities come your way. 

Xprize Nokia Sensing Challenge

I'm passionate about the potential of sensors, and meeting the teams from Xprize's Nokia sensing challenge alone was worth flying 6,000 miles for. Many observers are critical that Health Technology is largely developed by the 'worried well' for the 'worried well'. There is an element of truth in that. However, meeting the teams from around the world, it became clear very quickly that each team had designed their solution with the mindset of wanting to impact the health of 7 billion people. For those that haven't heard of the challenge, this infographic does a good job of explaining why the competition was set up. 

Let's meet the teams

First of all I met Silicon BioDevices, who have developed handheld, disposable device that takes measurements from a drop of blod and instantly transfers the results to a mobile phone. And it costs $1 to make!   

Next I met Apollo, who have developed a nano spectrometer-on-a-chip. This tiny chip offers the same functionality as a $10,000 machine and can be embedded into wearable technology.   

Wandered over to i-calQ, who have developed technology that turns your smartphone into a portable laboratory and medical specialist. In addition, they developed a decision support system that interprets the results and then suggests how much medicine should be given to treat the patient.  

InSilixa have developed a CMOS chip specifically for biosensing. Nobody else does that!  

ABUS-urodynamics have developed a wearable device that measures urinary flow, anywhere, anytime in an easy and natural manner. Currently patients have to use toilet-borne equipment in hospitals to do this test. Fascinating stuff!  

Onto Quasar, who have developed a chair pad with embedded sensors that work through clothes to monitor the heart's activity, known as an ECG. Think of the applications for older people. Now, that's the unobtrusive monitoring that I want to see more of in the future.  

The programmable-Bio-Nano-Chip  technology offers the ability to determine if a patient has had a heart attack, whilst they are waiting in the Emergecy Room of the hospital!  

Unfortunately, the battery on my phone died before I managed to meet all of the teams. The other teams are: 

Elfi-Tech - a sensor that can detect blood flow waveform. The sensor could even be incorporated into a watch!

Holomic - Handheld, Quantitative, Point-of-Care, Rapid Diagnostic Test Reader

Mobosens - a smartphone based sensor, provides accurate nitrate concentration measurements. Allows citizens to collect and share environmental data.

Nanobiosym Health RADAR - One drop of blood or saliva can be used to detect presence (or absence) of a disease's pathogen in real-time with gold standard accuracy.  

Owlstone - microchip spectrometer can be applied to smelling breath of bodily fluids for chemical markers of disease long before actual symptoms appear 


Winners to be announced today

I'm so inspired by the genuine innovation from each of the 12 teams. When we registered at the conference on Monday, we were each given a plastic tag to vote for our favourite team. At 9.45am Pacific Time on Wed Oct 2nd, at Health 2.0 Silicon Valley, one Grand Prize Winner and five Distinguished Award Winners will be honored by XPRIZE with cash prizes of more than $1 million. I wonder which team will win the Grand Prize! 



The future of sensors

My week is turning into a sensor fest, as after Health 2.0 Silicon Valley finishes, I'm off to Los Angeles to attend Body Computing 2013. Quoting from their website, "We pride ourselves on straight-forward and thought-provoking discussions (not marketing hype)", I attended last year, and the absence of hype was noticeable, which is refreshing. Another event worth flying 6,000 miles to attend.  

Innovation in sensor technology i something I deeply admire, but when I think of life back in England and around the world, one question springs to mind. Who is going to pay for all of this innovation in sensor technology? After all, many countries, especially the USA and those with aging populations very much want (and need) to reduce spend on healthcare. After all, money doesn't grow on trees. 


[Disclosure: I have no commercial ties with any of the companies mentioned in this post] 

I'm a geek, not a terrorist

So, I was travelling by 'tube' in London yesterday (subway for my American readers), and I was wearing a biosensor strapped to my forehead.  If you've been to London, you'll know that people shy away from making eye contact on the tube. As the doors to the carriage were closing, I heard the announcement over the PA system, something about 'report any signs of suspicious behaviour'.

It's then that I became aware that other passengers were looking at me with a mix of curiosity, apprehension and bewilderment. Now, for those in the Digital Health arena that know me well, me walking around with some kind of gadget strapped to my head is 'normal'. I certainly don't even think twice about it.

Wearing my  Truesense  biosensor

Wearing my Truesense biosensor

Wearing my  Neurosky Mindwave  headset

Wearing my Neurosky Mindwave headset

Fear of the Unknown

Maybe I need to do what photographers did a few years back and wear a t-shirt that says 'I'm a GEEK, not a terrorist"? Or should I be wearing my biosensor under a headband?

Misuse of 'wearable computing'?

In the future, what if technology such as Google Glass is 'misused' by someone who wishes to harm society? Will it cause the public to be suspicious of wearable computing? Will it lead to a knee jerk reaction from governments and legislators? What if manufacturers design products that integrate with how we currently dress?

Yesterday, I was also wearing a MeCam.

Taken with a pen to show you just how small the MeCam is

Taken with a pen to show you just how small the MeCam is

It was switched on, I simply wanted to see if anyone noticed that I was wearing a video camera capable of recording 2 hours of HD video. Not one person I met realised what it was. One person thought it was something to do with my headphones. They were surprised when I told them what it was. [Note: I deleted any footage I captured in this experiment]



How will society respond? 

Now I'm thinking, as these technologies become cheaper and potentially integrated into our everyday clothing, how will we know who is wearing a jacket that contains a wearable computer and who doesn't?

If someone is wearing a sensor that is monitoring their own body, could that sensor also monitor other people's bodies without their consent? Who owns that data? Do we get the chance to practice 'informed consent'? [Note: A video also counts as data] 

From a moral standpoint, should I be walking around with a note on my shirt saying, "Warning: You are being recorded on video"? 

However, it got me thinking, how do others (who are not in the Digital Health arena) perceive me?

It was a hot and humid day, a brown skinned man walks into the carriage, with what looks like a microchip on his forehead, and he's perspiring heavily [Note: the 'tube' in London has no air conditioning]. Would people stop to ask me, so "Recording your EEG brain waves again are you, mate?" or would they assume it's some kind of trigger for an explosive device, and possibly report me to the authorities as a potential terrorist?

Reflecting on the wider issue here, with the rise of wearable computing (not just in Digital Health), how will the general public perceive early adopters who are wearing all sorts of gadgets, sensors and devices? 

What are the implications for our security and privacy? 

[Disclosure: The author has no financial relationships with any of the companies mentioned in this blog post.] Thanks to Pritpal S Tamber for taking the picture of me and for taking part in my experiment.