An interview with Jo Aggarwal: Building a safe chatbot for mental health

We can now converse with machines in the form of chatbots. Some of you might have used a chatbot when visiting a company’s website. They have even entered the world of healthcare. I note that the pharmaceutical company, Lupin, has rolled out Anya, India’s first chatbot for disease awareness, in this case, for Diabetes. Even for mental health, chatbots have recently been developed, such as Woebot, Wysa and Youper. It’s an interesting concept and given the unmet need around the world, these could be an additional tool that might help make a difference in someone’s life. However, there was a recent BBC article highlighting how two of the most well known chatbots (Woebot and Wysa) don’t always perform well when children use the service. I’ve performed my own real world testing of these chatbots in the past, and gotten to know the people who have created these products. So after the BBC article got published, Jo Aggarwal, CEO and co-founder of Touchkin, the company that has made Wysa, got back in touch with me to discuss trust and safety when using chatbots. It was such an insightful conversation, I offered to interview her for this blog post as I think the story of how a chatbot for mental health is developed, deployed and maintained is a complex and fascinating journey.

1. How safe is Wysa, from your perspective?
Given all the attention this topic typically receives, and its own importance to us, I think it is really important to understand first what we mean by safety. For us, Wysa being safe means having comfort around three questions. First, is it doing what it is designed to do, well enough, for the audience it’s been designed for? Second, how have users been involved in Wysa’s design and how are their interests safeguarded? And third, how do we identify and handle ‘edge cases’ where Wysa might need to serve a user - even if it’s not meant to be used as such?

Let’s start with the first question. Wysa is an interactive journal, focused on emotional wellbeing, that lets people talk about their mood, and talk through their worries or negative thoughts. It has been designed and tested for a 13+ audience, where for instance, it asks users to take parental consent as a part of its terms and conditions for users under 18. It cannot, and should not, be used for crisis support, or by users who are children - those who are less than 12 years old. This distinction is important, because it directs product design in terms of the choice of content as well as the kind of things Wysa would listen for. For its intended audience and expected use in self-help, Wysa provides an interactive experience that is far superior to current alternatives: worksheets, writing in journals, or reading educational material. We’re also gradually building an evidence base here on how well it works, through independent research.

The answer to the second question needs a bit more description of how Wysa is actually built. Here, we follow a user-centred design process that is underpinned by a strong, recognised clinical safety standard.

When we launched Wysa, it was for a 13+ audience, and we tested it with an adolescent user group as a co-design effort. For each new pathway and every model added in Wysa, we continue to test the safety against a defined risk matrix developed as a part of our clinical safety process. This is aligned to the DCB 0129 and DCB 0160 standards of clinical safety, which are recommended for use by NHS Digital.

As a result of this process, we developed some pretty stringent safety-related design and testing steps during product design:

At the time of writing a Wysa conversation or tool concept, the first script is reviewed by a clinician to identify safety issues, specifically - any times when this could be contra-indicated, or be a trigger, and alternative pathways for such conditions.

When a development version of a new Wysa conversation is produced, the clinicians review it again specifically from an adherence to clinical process and potential safety issues as per our risk matrix.

Each aspect of the risk matrix has test cases. For instance, if the risk is that using Wysa may increase the risk of self harm in a person, we run two test cases - one where a person is intending self harm but it has not been detected as such (normal statements) and one where self-harm statements detected from the past are run through the Wysa conversation, at every Wysa node or ‘question id’. This is typically done on a training set of a few thousand user statements. A team then tags the response for appropriateness. A 90% appropriateness level is considered adequate for the next step of review.

The inappropriate statements (typically less than 10%) are then reviewed for safety, where the question asked is - will this inappropriate statement increase the risk of the user indulging in harmful behavior? If there is even one such case, the Wysa conversation pathway is redesigned to prevent this and the process is repeated.

The output of this process is shared with a psychologist and any contentious issues are escalated to our Clinical Safety Officer.

Equally important for safety, of course, is the third question. How do we handle ‘out of scope’ user input, for example, if the user talks about suicidal thoughts, self-harm, or abuse? What can we do if Wysa isn’t able to catch this well enough?

To deal with this question, we did a lot of work to extend the scope of Wysa so that it does listen for self-harm and suicidal thoughts, as well as abuse in general. On recognising this kind of input, Wysa gives an empathetic response, clarifies that it is a bot and unable to deal with such serious situations, and signpost to external helplines. It’s important to note that this is not Wysa’s core purpose - and it will probably never be able to detect all crisis situations 100% - neither can Siri or Google Assistant or any other Artificial Intelligence (AI) solution. That doesn’t make these solutions unsafe, for their expected use. But even here, our clinical safety standard would mean that even if the technology fails, we need to ensure it does not cause cause harm - or in our case, increase the risk of harmful behavior. Hence, all Wysa’s statements and content modules are tested against safety cases to ensure that they do not increase risk of harmful behavior even if the AI fails.

We watch this very closely, and add content or listening models where we feel coverage is not enough, and Wysa needs to extend. This was the case specifically with the BBC article, where we will now relax our stand that we will never take personally identifiable data from users, explicitly listen (and check) for age, and if under 12 direct them out of Wysa towards specialist services.

So how safe is Wysa? It is safe within its expected use, and the design process follows a defined safety standard to minimize risk on an ongoing basis. In case more serious issues are identified, Wysa directs users to more appropriate services - and makes sure at the very least it does not increase the risk of harmful behaviour.

2. In plain English, what can Wysa do today and what can’t it do?
Wysa is a journal married to a self-help workbook, with a conversational interface. It is a more user friendly version of a worksheet - asking mostly the same questions with added models to provide different paths if, for instance, a person is anxious about exams or grieving for a dog that died.

It is an easy way to learn and practice self help techniques - to vent and observe our thoughts, practice gratitude or mindfulness, learn to accept your emotions as valid and find the positive intent in the most negative thoughts.

Wysa doesn’t always understand context - it definitely will not pass the Turing test for ‘appearing to be completely human’. That is definitely not its intended purpose, and we’re careful in telling users that they’re talking to a bot (or as they often tell us, a penguin).

Secondly, Wysa is definitely not intended for crisis support. A small percentage of people do talk to Wysa about self harm or suicidal thoughts, who are given an empathetic response and directed to helplines.

Beyond self harm, detecting sexual and physical abuse statements is a hard AI problem - there are no models globally that do this well. For instance ‘My boyfriend hurts me’ may be emotional, physical, or sexual. Also, most abuse statements that people share with Wysa tend to be in the past: ‘I was abused when I was 12’ needs a very different response from ‘I was abused and I am 12’. Our response here is currently to appreciate the courage it takes to share something like this, ask a user if they are in crisis, and if yes, say that as a bot Wysa is not suited for a crisis and offer a list of helplines.

3. Has Wysa been developed specifically for children? How have children been involved in the development of the product?
No, Wysa hasn’t been developed specifically for children.

However, as I mentioned earlier, we have co-designed with a range of users, including adolescents.

4. What exactly have you done when you’ve designed Wysa with users?
For us, the biggest risk was that someone’s data may be leaked and therefore cause them harm. To deal with this, we took the hard decision of not taking any personally identifiable data at all from users, because of which they also started trusting Wysa. This meant that we had to compromise on certain parts of the product design, but we felt it was a tradeoff well worth making.

After launch, for the first few months, Wysa was an invite-only app, where a number of these features were tested first from a safety perspective. For example, SOS detection and pathways to helplines were a part of the first release of Wysa, which our clinical team saw as a prerequisite for launch.

Since then, design continues to be led by users. For the first million conversations, Wysa stayed a beta product, as we didn’t have enough of a response base to test new pathways. There is no one ‘launch’ of Wysa - it is continuously being developed and improved based on what people talk to it. For instance, the initial version of Wysa did not handle abuse (physical or sexual) at all as it was not expected that people would talk to it about these things. When they began to, we created pathways to deal with these in consultation with experts.

An example of a co-design initiative with adolescents was a study with Safe Lab at Columbia University to understand how at-risk youth would interact with Wysa and the different nuances of language used by these youth.

4. Can a user of Wysa really trust it in a crisis? What happens when Wysa makes a mistake and doesn’t provide an appropriate response?
People should not use Wysa in a crisis - it is not intended for this purpose. We keep reinforcing this message across various channels: on the website, the app descriptions on Google Play or the iTunes App Store, even responses to user reviews or on Twitter.

However, anyone who receives information about a crisis has a responsibility to do the most that they can to signpost the user to those who can help. Most of the time, Wysa will do this appropriately - we measure how well each month, and keep working to improve this. The important thing is that Wysa should not make things worse even when it misdetects, so users should not be unsafe ie. we should not increase the risk of harmful behaviour.

One of the things we are adding based on suggestions from clinicians is a direct SOS button to helplines so users have another path when they recognise they are in crisis, so the dependency on Wysa to recognise a crisis in conversation is lower. This is being co-designed with adolescents and clinicians to ensure that it is visible, but so that the presence of such a button does not act as a trigger.

For inappropriate responses, we constantly improve and also handle cases where the if user shares that Wysa’s response was wrong, respond in a way that places the onus entirely on Wysa. If a user objects to a path Wysa is taking, saying this is not helpful or this is making me feel worse, immediately change the path; emphasise that it is Wysa’s, not the user’s mistake; and that Wysa is a bot that is still learning. We closely track where and when this happens, and any responses that meet our criteria for a safety hazard are immediately raised to our clinical safety process which includes review with children’s mental health professionals.

We constantly strive to improve our detection, and are also starting to collaborate with other people dealing with similar issues and create a common pool of resources.

5. I understand that Wysa uses AI. I also note that there are so many discussions around the world relating to trust (or lack of it) in products and services that use AI. A user wants to trust a product, and if it’s health related, then trust becomes even more critical. What have you done as a company to ensure that Wysa (and the AI behind the scenes) can be trusted?
You’re so right about all so many discussions about AI, how this data is used, and how it can be misused. We explicitly tell users that their chats stays private (not just anonymous), that this will never be shared with third parties. In line with GDPR, we also give users the right to ask for their data to be deleted.

After downloading, there is no sign-in. We don’t collect any personally identifiable data about the user: you just give yourself a nickname and start chatting with Wysa. The first conversation reinforces this message, and this really helps in building trust as well as engagement.

AI of the generative variety will not be ready for products like Wysa for a long time - perhaps never. They have in the past turned racist or worse. The use of AI in applications like Wysa is limited to detection and classification of user free text, not generating ‘advice’. So the AI here is auditable, testable, quantifiable - not something that may suddenly learn to go rogue. We feel that trust is based on honesty, so we do our best to be honest about the technical limitations of Wysa.

Every Wysa response and question goes through a clinical safety process, and is designed and reviewed by a clinical psychologist. For example, we place links to journal articles in each tool and technique that we share with the user.

6. What could you and your peers who make products like this do to foster greater trust in these products?
As a field, the use of conversational AI agents in mental health is very new, and growing fast. There is great concern around privacy, so anonymity and security of data is key.

After that, it is important to conduct rigorous independent trials of the product and share data openly. A peer reviewed mixed method study of Wysa’s efficacy has been recently published in JMIR, for this reason, and we working with universities to further develop these. It’s important that advancements in this field are science-driven.

Lastly, we need to be very transparent about the limitations of these products - clear on what they can and cannot do. These products are not a replacement for professional mental health support - they are more of a gym, where people learn and practice proven, effective techniques to cope with distress.

7. What could regulators to foster an environment where we as a user feel reassured that these chatbots are going to work as we expect them to?
Leading from your question above, there is a big opportunity to come together and share standards, tools, models and resources.

For example, if a user enters a search term around suicide in Google, or posts about self-harm on Instagram, maybe we can have a common library of Natural Language Processing (NLP) models to recognise and provide an appropriate response?

Going further, maybe we can provide this as an open-source to resource to anyone building a chatbot that children might use? Could this be a public project, funded and sponsored by government agencies, or a regulator?

In addition, there are several other roles a regulator could play. They could fund research that proves efficacy, defines standards and outlines the proof required (the NICE guidelines recently released are a great example), or even a regulatory sandbox where technology providers, health institutions and public agencies come together and experiment before coming to a view.

8. Your website mentions that “Wysa is... your 4 am friend, For when you have no one to talk to..” – Shouldn’t we be working in society to provide more human support for people who have no one to talk to? Surely, everyone would prefer to deal with a human than a bot? Is there really a need for something like Wysa?
We believed the same to be true. Wysa was not born of a hypothesis that a bot could help - it was an accidental discovery.

We started our work in mental health to simply detect depression through AI and connect people to therapy. We did a trial in semi-rural India, and were able to use the way a person’s phone moved about to detect depression to a 90% accuracy. To get the sensor data from the phone, we needed an app, which we built as a simple mood-logging chatbot.

Three months in, we checked on the progress of the 30 people we had detected with moderate to severe depression and whose doctor had prescribed therapy. It turned out that only one of them took therapy. The rest were okay with being prescribed antidepressants but for different reasons, ranging from access to stigma, did not take therapy. All of them, however, continued to use the chatbot, and months later reported to feeling better.

This was the genesis of Wysa - we didn’t want to be the reason for a spurt in anti-depressant sales, so we bid farewell to the cool AI tech we were doing, and began to realise that it didn’t matter if people were clinically depressed - everyone has stressors, and we all need to develop our mental health skills.

Wysa has had 40 million conversations with about 800,000 people so far - growing entirely through word of mouth. We have understood some things about human support along the way.

For users ready to talk to another person about their inner experience, there is nothing as useful as a compassionate ear, the ability to share without being judged. Human interactions, however, seem fraught with opinions and judgements. When we struggle emotionally, it affects our self image - for some people, it is easier to talk to an anonymous AI interface, which is kind of an extension of ourselves, than another person. For example, this study found that US Veterans were three times as likely to reveal their PTSD to a bot as a human: But still human support is key - so we run weekly Ask Me Anything (AMA) sessions on the top topics that Wysa users propose, to discuss every week with a mental health professional. We had a recent AMA where over 500 teenagers shared their concerns about sharing their mental health issues or sexuality with their parents. Even within Wysa, we encourage users to create a support system outside.

Still, the most frequent user story for Wysa is someone troubled with worries or negative thoughts at 4 am, unable to sleep, not wanting to wake someone up, scrolling social media compulsively and feeling worse. People share how they now talk to Wysa to break the negative cycle and use the sleep meditations to drift off. That is why we call it your 4 am friend.

9. Do you think there is enough room in the market for multiple chatbots in mental health?
I think there is a need for multiple conversational interfaces, different styles and content. We have only scratched the surface, only just begun. Some of these issues that we are grappling with today are like the issues people used to grapple with in the early days of ecommerce - each company solving for ‘hygiene factors’ and safety through their own algorithms. I think over time many of the AI models will become standardised, and bots will work for different use cases - from building emotional resilience skills, to targeted support for substance abuse.

10. How do you see the future of support for mental health, in terms of technology, not just products like Wysa, but generally, what might the future look like in 2030?
The first thing that comes to mind is that we will need to turn the tide from the damage caused by technology on mental health. I think there will be a backlash against addictive technologies, I am seeing the tech giants becoming conscious of the mental health impact of making their products addictive, and facing the pressure to change.

I hope that by 2030, safeguarding mental health will become a part of the design ethos of a product, much as accessibility and privacy has become in the last 15 years. By 2030, human computer interfaces will look very different, and voice and language barriers will be fewer.

Whenever there is a trend, there is also a counter trend. So while technologies will play a central role in creating large scale early mental health support - especially crossing stigma, language and literacy barriers in countries like India and China, we will also see social prescribing gain ground. Walks in the park or art circles become prescriptions for better mental health, and people will have to be prescribed non-tech activities because so much of people’s lives are on their devices.

[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

AI in healthcare: Involving the public in the conversation

As we begin the 21st century, we are in an era of unprecedented innovation, where computers are becoming smarter, being used to deliver products and services powered by Artificial Intelligence (AI). I was fascinated how AI is being used in advertising, when I saw a TV advert this week from Microsoft where a musician was talking about the benefits of AI. Organisations in every sector, including healthcare, are having to think how they can harness the power of AI. I wrote a lot about my own experiences in 2017 using AI products for health in my last blog, You can’t care for patients, you’re not human!

Now when we think of AI in healthcare potentially replacing some of the tasks done by doctors, we think of it as a relatively recent concept. We forget that doctors themselves have been experimenting with technology for a long time. In this video from 1974 (44 years ago!), computers were being tested in the UK with patients to help optimise the time spent by the doctor during the consultation. What I find really interesting is that in the video, it’s mentioned that the computer never gets tired and some patients prefer dealing with the machine than the human doctor.

Fast forward to 2018, where it feels like technology is opening up new possibilities every day, and often from organisations that are not traditionally part of the healthcare system. We think of tech giants like Google and Facebook helping us send emails or share photos with our friends, but researchers at Google are working with AI on being able to improve detection of breast cancer and Facebook has rolled out an AI powered tool to automatically detect if a user’s post shows signs of suicidal ideation.

What about going to the doctor? I remember growing up in the UK that my family doctor would even come and visit me at home when I was not well. Those are simply memories for me, as it feels increasingly difficult to get an appointment to see the doctor in their office, let alone getting a housecall. Given many of us are using modern technology to do our banking and shopping online, without having to travel to a store or a bank and deal with a human being, what if that were possible in healthcare? Can we automate part (or even all) of the tasks done by human doctors? You may think this is a silly question, but we have to step back a second and reflect upon the fact that we have 7.5 billion people on Earth today and that is set to rise to an expected 11 billion by the end of this century. If we have a global shortage of doctors today, and since it’s predicted to get worse, surely the right thing to do is to leverage emerging technology like AI, 4G and smartphones to deliver healthcare anywhere, anytime to anyone?

We have the emergence of a new type of app known as Symptom Checkers, which provides anyone with the ability to enter symptoms on their phone and to be given a list of things that may be wrong with them. Note that at present, these apps cannot provide a medical diagnosis, they merely help you decide whether you should go to the hospital or whether you can self care.. However, the emergence of these apps and related services is proving controversial. It’s not just a question of accuracy, but there are huge questions about trust, accountability and power? In my opinion, the future isn’t about humans vs AI, which is the most frequent narrative being paraded in healthcare. The future is about how human healthcare professionals stay relevant to their patients.

It’s critical that in order to create the type of healthcare we want, we involve everyone in the discussion about AI, not just the privileged few. I’ve seen countless debates this past year about AI in healthcare, both in the UK and around the world, but it’s a tiny group of people at present who are contributing to (and steering) this conversation. I wonder how many of these new services are being designed with patients as partners? Many countries are releasing national AI strategies in a bid to signal to the world that they are at the forefront of innovation. I also wonder if the UK government is rushing into the implementation of AI in the NHS too quickly? Who stands to profit the most from this new world of AI powered healthcare? Is this wave of change really about putting the patient first? There are more questions than answers at this point of time, but those questions do need to be answered. Some may consider anyone asking difficult questions about AI in healthcare as standing in the way of progress, but I believe it’s healthy to have a dialogue where we can discuss our shared concerns in a scientific, rational and objective manner.

That’s why I’m excited that BBC Horizon is airing a documentary this week in the UK, entitled “Diagnosis on Demand? The Computer Will See You Now” – they had behind the scenes access to one of the most well known firms developing AI for healthcare, UK based Babylon Health, whose products are pushing boundaries and triggering controversy. I’m excited because I really do want the general public to understand the benefits and the risks of AI in healthcare so that they can be part of the conversation. The choices we make today could impact how healthcare evolves not just in the UK, but globally. Hence, it’s critical that we have more science based journalism which can help members of the public navigate the jargon and understand the facts so that informed choices can be made. The documentary will be airing in the UK on BBC Two at 9pm on Thursday 1st November 2018. I hope that this program acts as a catalyst for greater public involvement in the conversation about how we can use AI in healthcare in a transparent, ethical and responsible manner.

For my international audience, my understanding is that you can’t watch the program on BBC iPlayer, because at present, BBC shows can only be viewed from the UK.

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

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

Delivered by FeedBurner

Being Human

This is the most difficult blog post I’ve ever had to write. Almost 3 months ago, my sister passed away unexpectedly. It’s too painful to talk about the details. We were extremely close and because of that the loss is even harder to cope with. 

The story I want to tell you today is about what’s happened since that day and the impact it’s had on how I view the world. In my work, I spend considerable amounts of time with all sorts of technology, trying to understand what all these advances mean for our health. Looking back, from the start of this year, I’d been feeling increasingly concerned by the growing chorus of voices telling us that technology is the answer for every problem, when it comes to our health. Many of us have been conditioned to believe them. The narrative has been so intoxicating for some.

Ever since this tragedy, it’s not an app, or a sensor or data that I turned to. I have been craving authentic human connections. As I have tried to make sense of life and death, I have wanted to be able to relate to family and friends by making eye contact, giving and receiving hugs and simply just being present in the same room as them. The ‘care robot’ that had arrived from China this year as part of my research into whether robots can keep us company, remains switched off in its box. Amazon’s Echo, the smart assistant with a voice interface that I’d also been testing a lot also sits unused in my home. I used it most frequently to turn the lights on and off, but now I prefer walking over to the light switch and the tactile sensation of pressing the switch with my finger. One day last week, I was feeling sad, and didn’t feel like leaving the house, so I decided to try putting on my Virtual Reality (VR) headset, to join a virtual social space. I joined a virtual computer generated room where it was sunny and in someone’s back yard for a BBQ, I could see their avatars, and I chatted to them for about 15 minutes. After I took off the headset, I felt worse.

There have also been times I have craved solitude, and walking in the park at sunrise on a daily basis has been very therapeutic. 

Increasingly, some want machines to become human, and humans to become machines. My loss has caused me to question these viewpoints. In particular, the bizarre notion that we are simply hardware and software that can be reconfigured to cure death. Recently, I heard one entrepreneur believe that with digital technology, we’ll be able to get rid of mental illness in a few years. Others I’ve met believe we are holding back the march of progress by wanting to retain the human touch in healthcare. Humans in healthcare are an expensive resource, make mistakes and resist change. So, is the answer just to bypass them? Have we truly taken the time to connect with them and understand their hopes and dreams? The stories, promises and visions being shared in Digital Health are often just fantasy, with some storytellers (also known as rock stars) heavily influenced by Silicon Valley’s view of the future. We have all been influenced on some level. Hope is useful, hype is not. 

We are conditioned to hero worship entrepreneurs and to believe that the future the technology titans are creating, is the best possible future for all of us. Grand challenges and moonshots compete for our attention and yet far too often we ignore the ordinary, mundane and boring challenges right here in front of us. 

I’ve witnessed the discomfort many have had when offering me their condolences. I had no idea so many of us have grown up trained not to talk about death and healthy ways of coping with grief. When it comes to Digital Health, I’ve only ever come across one conference where death and other seldom discussed topics were on the agenda, Health 2.0 with their “unmentionables” panel. I’ve never really reflected upon that until now.

Some of us turn to the healthcare system when we are bereaved, I chose not to. Health isn’t something that can only be improved within the four walls of a hospital. I don’t see bereavement as a medical problem. I’m not sure what a medical doctor can do in a 10 minute consultation, nor have I paid much attention to the pathways and processes that scientists ascribe to the journey of grief. I simply do my best to respond to the need in front of me and to honour my feelings, no matter how painful those feelings are. I know I don’t want to end up like Prince Harry who recently admitted he had bottled up the grief for 20 years after the death of his mother, Princess Diana, and that suppressing the grief took him to the point of a breakdown. The sheer maelstrom of emotions I’ve experienced these last few months makes me wonder even more, why does society view mental health as a lower priority than physical health? As I’ve been grieving, there are moments when I felt lonely. I heard about an organisation that wants to reframe loneliness as a medical condition. Is this the pinnacle of human progress, that we need medical doctors (who are an expensive resource) to treat loneliness? What does it say about our ability to show compassion for each other in our daily lives?

Being vulnerable, especially in front of others, is wrongly associated with weakness. Many organisations still struggle to foster a culture where people can truly speak from the heart with courage. That makes me sad, especially at this point. Life is so short yet we are frequently afraid to have candid conversations, not just with others but with ourselves. We don’t need to live our lives paralysed by fear. What changes would we see in the health of our nation if we dared to have authentic conversations? Are we equipped to ask the right questions? 

As I transition back to the world of work, I’m very much reminded of what’s important and who is important. The fragility of life is unnerving. I’m so conscious of my own mortality, and so petrified of death, it’s prompted me to make choices about how I live, work and play. One of the most supportive things someone has said to me after my loss was “Be kind to yourself.” Compassion for one’s self is hard. Given that technology is inevitably going to play a larger role in our health, how do we have more compassionate care? I’m horrified when doctors & nurses tell me their medical training took all the compassion out of them or when young doctors tell me how they are bullied by more senior doctors. Is this really the best we can do? 

I haven’t looked at the news for a few months and immersing myself in Digital Health news again makes me pause. The chatter about Artificial Intelligence (AI), where commentaries are at either end of the spectrum, almost entirely dystopian or almost entirely utopian, with few offering balanced perspectives. These machines will either end up putting us out of work and ruling our lives or they will be our faithful servants, eliminating every problem and leading us to perfect healthcare. For example, I have a new toothbrush that says it uses AI, and it’s now telling me to go to bed earlier because it noticed I brush my teeth late at night. My car, a Toyota Prius, which is primarily designed for fuel efficiency scores my acceleration, braking and cruising constantly as I’m driving. Where should my attention rest as I drive, on the road ahead or on the dashboard, anxious to achieve the highest score possible? Is there where our destiny lies? Is it wise to blindly embark upon a quest for optimum health powered by sensors, data & algorithms nudging us all day and all night until we achieve and maintain the perfect health score? 

As more of healthcare moves online, reducing costs and improving efficiency, who wins and who loses? Recently, my father (who is in his 80s) called the council as he needed to pay a bill. Previously, he was able to pay with his debit card over the phone. Now they told him it’s all changed, and he has to do it online. When he asked them what happens if someone isn’t online, he was told to visit the library where someone can do it online with you. He was rather angry at this change. I can now see his perspective, and why this has made him angry. I suspect he’s not the only one. He is online, but there are moments when he wants to interact with human beings, not machines. In stores, I always used to use the self service checkouts when paying for my goods, because it was faster. Ever since my loss, I’ve chosen to use the checkouts with human operators, even if it is slower. Earlier this year, my mother (in her 70s) got a form to apply for online access to her medical records. She still hasn’t filled in it, she personally doesn’t see the point. In Digital Health conversations, statements are sometimes made that are deemed to be universal truths. Every patient wants access to their records, or that every patient wants to analyse their own health data. I believe it’s excellent that patients have the chance of access, but let’s not assume they all want access. 

Diversity & Inclusion is still little more than a buzzword for many organisations. When it comes to patients and their advocates, we still have work to do. I admire the amazing work that patients have done to get us this far, but when I go to conferences in Europe and North America, the patients on stage are often drawn from a narrow section of society. That’s assuming the organisers actually invited patients to speak on stage, as most still curate agendas which put the interests of sponsors and partners above the interests of patients and their families. We’re not going to do the right thing if we only listen to the loudest voices. How do we create the space needed so that even the quietest voices can be heard? We probably don’t even remember what those voices sound like, as we’ve been too busy listening to the sound of our own voice, or the voices of those that constantly agree with us. 

When it comes to the future, I still believe emerging technologies have a vital role to play in our health, but we have to be mindful in how we design, build and deploy these tools. It’s critical we think for ourselves, to remember what and who are important to us. I remember that when eating meals with my sister, I’d pick up my phone after each new notification of a retweet or a new email. I can’t get those moments back now, but I aim to be present when having conversations with people now, to maintain eye contact and to truly listen, not just with my ears, and my mind, but also with my heart. If life is simply a series of moments, let’s make each moment matter. We jump at the chance of changing the world, but it takes far more courage to change ourselves. The power of human connection, compassion and conversation to help me heal during my grief has been a wake up call for me. Together, let’s do our best to preserve, cherish and honour the unique abilities that we as humans bring to humanity.

Thank You for listening to my story.

Patients and their caregivers as innovators

I've been conducting research for a while now on how patients and their families have innovated themselves. They decided not to wait for the system to act, but acted themselves. One leading example is the Open Artificial Pancreas System project, and they even use the hashtag, ##WeAreNotWaiting. I was inspired to write this post today for two reasons. 

1. I delivered a keynote at the MISK Hackathon in London yesterday to innovators in both London & Riyadh reminding them that innovation can come from anyone anywhere on Earth.

2. A post by the World Economic Forum about an Tal Golesworthy, an engineer with a life threatening heart condition who fixed it himself. 

Digital Health Futurist @ManeeshJuneja takes to the stage at our London event #MiskHackathon pic.twitter.com/LOz8Lefi6u

— هاكاثون | Hackathon (@MiskTech) November 26, 2016

I thought this line in the WEF article was particular fascinating, as it conveys the shock, surprise and disbelief that a patient could actually be a source of innovation, "And it flags up the likelihood that other patients with other diseases are harbouring similarly ingenious or radical ideas." I wonder how much we are missing out on in healthcare, because many of us are conditioned to think that a patient is a passive recipient of care, and not an equal who could actually out-think us. Golesworthy who is living with Marfan Syndrome, came up with a new idea for an aortic sleeve, which led to him setting up his own company. The article also then goes on to talk about a central repository of patient innovation to help diffuse these ideas, and this repository actually exists! It's called Patient Innovation and was set up over 2 years ago by the Católica Lisbon School of Business and Economics. The group have got over 1,200 submissions, and after screening by a medical team, around 50% of those submissions have been formally listed on the website. Searching the website for what patients have done by themselves is inspiring stuff. 

In the title, you'll notice that I also acknowledged that it's not just the patient who on their own innovates, but their caregivers could be part of that innovation process. Sometimes, the caregiver (parent, family member or someone else) might have a better perspective on what's needed than the patient themselves. The project leader for the Patient Innovation repository, Pedro Oliveira, has also published a paper in 2015, exploring innovation by patients with rare diseases and chronic needs, and I share one of the stories he included in his paper. 

"Consider the case of a mother who takes care of her son, an Angelman syndrome patient. Angelman syndrome involves ataxia, inability to walk, move or balance well. The mother experimented with many strategies, recommended by the doctors, therapists, or found elsewhere, but obtained little gain for her child. By chance, at a neighbor’s child’s birthday party, she noticed her son excitedly jumping for strings to catch a floating helium-filled balloon. This gave her an idea and she experimented at home by filling a room with floating balloons. She found her child began jumping and reaching for the balloons for extended periods of time, amused by the challenge. The mother also added bands to support the knees and keep the child in an upright position. The result was significant improvement in her child’s physical abilities. Other parents to whom she described the solution also tried the balloons strategy and had positive results. This was valued as a novel solution by the medical evaluators."

So many of us think that innovation in today's modern world has to start with an app, a sensor or an algorithm, but the the solutions could involve far simpler technology, such as a balloon! It's critical that we are able to discriminate between our wants and needs. A patient may be led to believe they want an app, but their actual need is for something else. Or that we as innovators want to work with a particular tool or type of technology, and we ignore the need of the patient themselves. 

Oliveira concludes with a powerful statement that made me stand back and pause for a few minutes, "Our finding that 8% of rare disease patients and/or their non-professional caregivers have developed valuable, new to the world innovations to improve their own care suggests that a massive, non-commercial source of medical innovations exists." 

I want you to also pause and reflect on this conclusion. How does this make you feel? Does it make you want to change the way you and your organisation approaches medical innovation? One of the arguments against patient innovation is that it could put the patient at risk, after all, they haven't been to medical school. Is that perception by healthcare professionals of heightened risk justified? Maybe not. Oliverira also reports that, "Almost all the reported solutions were also judged by the experts to be relatively safe: out of 182, only 4 (2%) of the patients’ developments were judged to be potentially detrimental to patients’ health by the evaluators." Naturally, this is just one piece of research, and we would need to see more like this to truly understand the benefit-risk profile of patient innovations, but it's still an interesting insight. 

I feel we don't hear enough in the media about innovation coming from patients and their caregivers. Others also share this sentiment. With reference to the Patient Innovation website, in the summer of 2015, Harold J. DeMonaco, made this statement in his post reminding us that not all innovation comes from industry, "There is a symposium going on this week in Lisbon, Portugal that is honoring patient innovators, and I suspect this will totally escape the notice of US media."

I am curious why we don't hear much more about patient innovators in the media. What can be done to change that? If you're a healthcare reporter reading this post, and you haven't covered patient innovation before, I'm really interested to know why.

During my research, I've been very curious to determine what analysis has been done to understand if patients are better at innovation than others. After all, they are living with their conditions, they are subject matter experts on their daily challenges, and they have enough insights to write a PhD on 'my health challenges' if they needed to! I did find a working paper from March this year from researchers in Germany at the Hamburg University of Technology (Goeldner et al). Are patients and relatives the better innovators? The case of medical smartphone applications, is the title of their paper. Their findings are very thought provoking. For example, when they looked at ratings of apps, the ratings for apps developed by patients and healthcare professionals were higher than those apps developed by companies and independent developers. For me, the most interesting finding was apps developed by patients' relatives got the highest revenues. Think about every hackathon in healthcare you've attended, how many times were patients invited, and how many times were the relatives of patients invited? One of the limitations of the paper which the authors admit, is that it was using apps from Apple's App store. The study would need to be repeated using Google's Play store given that the majority of smartphones in the world are not iPhones. 

This hypothesis from the paper highlights for me why patients and those who care for them need to be actively included,  "We propose that patients and relatives also develop needs during their caring activities that may not yet been envisioned by medical smartphone app developers. Thus, the dual knowledge base might be a reason for the significantly superior quality of apps developed by patients and relatives compared to companies." They also make this recommendation, "Our study shows that both user types – intermediate users and end users – innovated successfully with high quality. Commercial mobile app publishers and healthcare companies should take advantage of this and should consider including patients, patents’ relatives, and healthcare professionals into their R&D process." 

If you're currently developing an app, have you remembered to invite everyone needed to ensure you develop the highest quality app with the highest chance of success? 

I'm attending a Mobile Health meetup in London next week, called "Designing with the Dementia community" - they have 2 fantastic speakers at the event, but neither of them are people living with Dementia. Perhaps the organisers have tried to find people living with Dementia (or their caregivers) to come and speak, but nobody was available on that date. I remember when I founded the Health 2.0 London Chapter, and ran monthly events, just how difficult it was to find patients to come and speak at my events. How do we communicate to patients and their caregivers that they have unique insights that are routinely missing from the innovation process, and that people are wanting to give them a chance to share those insights? Another event in London next month, is about Shaping the NHS & innovation, with a headline of 'How can we continue to put patients first?' They have 4 fantastic speakers, who are all doctors, with not a patient in sight. It reminds me of conferences I attend where people will be making lots of noise about improving physician workflow, yet at these conferences nobody ever advocates for improving patient workflow. 

In the UK, the NHS appears to making the right noises with regard to wanting to include patients and the public in the innovation process. Simon Stevens, CEO of NHS England has spoken of his desire to enable patients to play a much more central role in innovation. Simon Denegri's post reviewing Steven's speech to the NHS Confederation back in 2014 is definitely worth a read.

Despite the hopes of senior leaders, I still feel there is a very large gap between the rhetoric and reality. I talk to so many patients (and healthcare professionals) who sadly have stopped coming up with ideas to make things better because the system always says No or dismisses their idea as foolish because they are not seen as experts. Editing your website to include 'patient centred' is the easy part, but actually getting each of your staff to live and breathe those words on a daily basis is a much more difficult task. Virtually every organisation in healthcare I observe is desperate for innovation, except that they want innovation on their terms and conditions, which is often a long winded, conservative and bureaucratic process. David Gilbert's wonderful post on patient led innovation concludes with a great example of this phenomenon;

"I once worked with a fabulous cardiac rehab nursing team that got together on a Friday and asked each other, ‘what one thing have we learned from patients this week?’ And ‘what one thing could we do better next week?’ We were about to go into the next phase and have a few patients come to those meetings and my fantasy was to get them to help design and deliver some of the ideas. But the Director of Nursing said that our idea was counter to the Engagement Strategy and objected that patients would be ‘unrepresentative’. Now they run focus groups, that report to an engagement sub-committee that reports to a patient experience board that reports to… crash!"

It's not all doom and gloom, times are changing. Two UK patients, Michael Seres & Molly Watt, have each innovated in their own arenas, and created solutions to solve problems that impact people like them. I'm proud that they are both my friends, and their efforts always remind me of what's possible with sheer determination, tenacity and vision, even when all the odds are stacked against you.

Tomorrow, four events in the UK are taking place which fill me with hope. One is People Drive Digital, where the headline reads, "Our festival is a creative space for people orientated approaches to digital technologies and online social networks in health and care" and the second is a People’s Transformathon, where the headline reads, "Bringing together patients, carers, service users, volunteers and staff from across health and care systems in the UK and overseas to connect, share, and learn from one another."

The third event is called Patients First, a new conference from the  Association of Medical Research Charities (AMRC) and Association of the British Pharmaceutical Industry (ABPI), where the headlines reads, "It brings together everyone involved in delivering better outcomes for patients – from research and development to care and access to treatments – and puts patients at the heart of the discussion."

The fourth event is a Mental Health & Technology: Ideas Generation Workshop hosted by the Centre for Translational Informatics. Isn't it great to read the description of the event, "South London and Maudsley NHS Foundation Trust and Kings College London want you to join what we hope will be the first in a series of workshops, co-led by service users, that will hear and discuss your views of the mental health technology you use, want to use or wish you had so that we can partner with you in its design, development and deployment." In the FAQ covering the format of the event, the organisers state, "The event will be in an informal and relaxed, there are no wrong opinions! We want to hear your ideas and thoughts." What a refreshing contrast to the typical response you might get within an hospital environment. 

The first event is in Leeds, the second is online, and the third and fourth are both in London, and I know that the first three are using a Twitter hashtag, so you will be able to participate from anywhere in the world. What I find particularly refreshing is that the first two events start their title with the word people, not patient. 

I also noticed that the Connected Health conference next month has a session on Patients as Innovators and Partners, with a Patient Advocate, Amanda Greene, as a speaker. I'm inspired and encouraged by agents of change who work within the healthcare system, and are pushing boundaries themselves by acknowledging that patients bring valuable ideas. One of those people is Dr Keith Grimes, who was also mentoring teams at the MISK Hackathon, and the 360 video below of our conversation, shows why we need more leaders like him. The video is an excerpt from a longer 9 minute video where we even discussed how health hackathons could innovate in terms of format. 

As we approach 2017, I really do hope we see the pace of change speed up, when it comes to harnessing the unique contributions that patients and their caregivers can bring to the innovation process, whether it's at a grassroots community level or the design of the next big health app. More and people around the globe that were previously offline are now being connected to the internet and/or using a smartphone for the first time. How will we tap into their experiences, ideas and solutions? Whether a patient is in Riyadh, Riga or Rio, let's connect with them, and genuinely listen to them, with open hearts and open minds. 

We can also help  to create a different future by educating our youth differently, so they understand their voice matters, even if they don't have a string of letters after their name. We are going to have to have difficult conversations, where we feel uncomfortable, where we'll have to leave our egos out of those conversations. There are circumstances where patients will be leading, and the professionals will have accept that, or risk being bypassed entirely, which is not a healthy situation. Equally, there are times when we'd probably want a paternalistic healthcare system, where the healthcare professionals are seen as the leaders in charge of the situation i.e. in a medical emergency.

The dialogue on patient innovation isn't about patients vs doctors, or about assigning blame, it's about coming together to understand how we move forward. Many of us are conditioned to think and act a certain way, whether it's because of our professional training or just how society suggests we should think. Unravelling that conditioning on a local, national, international and global level is long overdue. 

What will YOU do differently to foster a culture where we have many more innovations coming from patients and their caregivers? A future where having a patient (or their advocate) keynote at an event isn't seen as something novel, but the norm. A future where the system acknowledges that on certain occasions, the patient or their caregiver could be superior at generating innovation. A future where the gap between the rhetoric and reality disappears. 

[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

Engaging patients & the public is harder than you think

Back in 2014, Google acquired a British artificial intelligence startup in London, called Deepmind. It was their biggest EU purchase at that time, and was estimated to be in the region of 400 million pounds (approx $650 million) Deepmind's aim from the beginning was to develop ways in which computers could think like humans. 

Earlier this year, Deepmind launched Deepmind Health, with a focus on healthcare. It appears that the initial focus is to build apps that can help doctors identify patients that are at risk of complications. It's not clear yet, how they plan to use AI in the context of healthcare applications. However, a few months after they launched this new division, they did start some work with Moorfield's Eye hospital in London to apply machine learning to 1 million eye scans to better predict eye disease. 

There are many concerns, which get heightened when articles are published such as "Why Google Deepmind wants your medical records?" Many of us don't trust corporations with our medical records, whether it's Google or anyone else. 

So I popped along to Deepmind Health's 1st ever patient & public engagement event held at Google's UK headquarters in London last week. They also offered a livestream for those who could not attend. 

What follows is a tweetstorm from me during the event, which nicely summarises my reaction to the event. [Big thanks to Shirley Ayres for reminding me that most people are not on Twitter, and would benefit from being able to see the list of tweets from my tweetstorm] Alas, due to issues with my website, the tweets are included as images rather than embedded tweets. 

Finally, whilst not part of my tweetstorm, this one question reminded me of the biggest question going through everyone's minds. 

Below is a 2.5 hour video which shows the entire event including the Q&A at the end. I'd be curious to hear your thoughts after watching the video. Are we engaging patients & the public in the right way? What could be done differently to increase engagement? Who needs to do more work in engaging patients & the public?

There are some really basic things that can be done, such as planning the event with consideration for the needs of those you are trying to engage, not just your own. This particular event was held at 10am-12pm on a Tuesday morning. 

[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

Managing our health: One conversation at a time

If you've watched movies like Iron Man, featuring virtual assistants, like JARVIS, which you can just have a conversation with and control your home, you probably think that such virtual assistants belong in the realm of science fiction. Earlier this year, Mark Zuckerberg, who runs Facebook set a personal challenge to create a JARVIS style assistant for his own home. "My personal challenge for 2016 is to build a simple AI to run my home and help me with my work. You can think of it kind of like Jarvis in Iron Man." He may be closer to his goal, as he may be giving a demo something this month. For those that don't have an army of engineers to help them, what can be done today? Well, one interesting piece of technology is Amazon's Echo. So what is it? Amazon describes it as, "Amazon Echo is a hands-free speaker you control with your voice. Echo connects to the Alexa Voice Service (AVS) to play music, provide information, news, sports scores, weather, and more—instantly. All you have to do is ask." Designed for your home, it is plugged into the mains and connected to your wifi. It's been on sale to the general public in the USA since last summer, and was originally available in 2014 for select customers.

This week, it's just been launched in the UK and Germany as well. However, I bought one from America 6 months ago, and I've been using it here in the UK every day since then. My US spec Echo does work here in the UK, although some of the features don't work, since they were designed for the US market. I've also got the other devices that are powered by AVS, the Amazon Tap, Dot and also the Triby, which was the first 3rd party device to use AVS. To clarify, the Echo is the largest, has a full size speaker and is the most expensive from Amazon ($179.99 US/£149.99 UK/179.99 Euros). The Tap is cheaper ($129.99, only in USA) and is battery powered, so you can charge it and take it to the beach with you, but it requires that you push a button to speak to Alexa, it's not always listening like the other products. The Dot is even cheaper (now $49.99 US/£49.99 UK/59.99 Euros) and does everything the original Echo can do, except the built-in speaker is good enough only for hearing it respond to your voice commands. If you want to use it for playing music, Amazon expect you to connect the Dot to external speakers. A useful guide comparing the differences between the Echo, Dot and Tap is here. The Triby ($199.99) is designed to be stuck on your fridge door in the kitchen. It's sold in the UK too, but only the US version comes with AVS. Amazon expect you'd have the Echo in the living room, and you'd place extra Dots in other rooms. Using this range of products has not only given me an insight into what the future looks like, but I can see the potential for devices like the Echo (and the underlying service, AVS) to play a role in our health. In addition, I want to share my research on the experiences of other consumers who have tried this product. There are a couple of new developments announced this week which might improve the utility of the device, which I'll cover towards the end of the post. 

Triby, Amazon's Tap, Dot & Echo

You can see in this 3 min video, some of the things I use my Echo for in the morning, such as reading tweets, checking the news, weather/my Google calendar, adding new events to my calendar or turning my lights on.  For a list of Alexa commands, this is a really useful guide. If you're curious about how it works, you don't have to buy one, you can test it out in your web browser, using Echosim (you will need an Amazon account though) 

What's really fun are experimenting with the new skills [i.e apps] that get added by 3rd parties, one of which is how my Echo is able to control devices in my smart home, such as my LifX lights. I tend to browse the Alexa website for skills and add them to my Echo that way. You can also enable skills just by speaking to your device. At the moment, every skill is free of charge. I suspect that won't always be the case. 

Some of the skills are now part of my daily routine, as they offer high quality content and have been well designed. Amazon boast that there are now over 3,000 skills. However, the quality of the skills varies tremendously, just like app stores for other devices we already use. For example, in the Health & Fitness section, sorted by relevance, the 3rd skill listed is one called Bowel Movement Facts. 

The Echo is always on, it's 7 microphones can detect your voice even if the device itself is playing music and you're speaking from across the room. It's always listening for someone to say 'Alexa' as the wake up word, but you have a button to mute the Echo so it won't listen. I use Siri, but I was really impressed when I started to use my Echo, it was felt quicker than Siri in answering my questions. Anna Attkisson did a 300 question test, comparing her Echo vs Siri, and found that overall, Amazon's product was better. Not only does the Echo understand my London accent, but it also has no problem understanding me when I used some fake accents to ask it for my activity & sleep data from my Fitbit. I think it's really interesting that I can simply speak to a device in my home and obtain information that has been recorded by the Fitbit activity tracker that I've been wearing on my wrist. It makes me wonder about how we will access our health data in the future. Whilst at the moment, the Echo doesn't speak unless you communicate with it, that may be changing in the future, if push notifications are enabled. I can see it now, having spent all day sitting in meetings, and sat on my smart sofa watching my smart TV, my inactivity as recorded by my Fitbit, triggers my Echo to spontaneously switch off my smart TV, switch my living room lights to maximum brightness, announce at maximum volume that I should venture outside for a 5,000 step walk, and instruct my smart sofa to adjust the recline so I'm forced to stand up. That's an extreme example, but maybe a more realistic one is that you have walked much less today than you normally do, and you end up having a conversation with Echo because your Echo says, "I noticed you haven't walked much today. Is everything ok?"

We still don't know about the impact on society as our homes become smarter and more connected. For example, in the USA, those with GE appliances will be able to control some of them with the Echo. You'll be able to preheat the oven, without even getting off your sofa. That could have immense benefits for those with limited mobility, but what about our children? If they grow up in a world where so much can be done without even having to lift a finger, let alone walk a few steps from the sofa to the kitchen, is this technology a welcome advance? If you have a Hyundai Genesis car, you can now use Alexa to control certain aspects of your car. When I read this part of the Hyundai Genesis article, "Being able to order basic functions by voice remotely will keep owners from having to run outside to do it themselves" it made me think about a future where we just live an even more sedentary lifestyle, with implications for an already over burdened healthcare system. Perhaps having a home that is connected makes more sense in countries like the USA and Australia which on average have quite large houses. Given how small the rooms in my London home are, it's far quicker for me to reach for the light switch than to issue a verbal command to my Echo (and wait for it to process the command)

Naturally, some of us would be concerned about privacy. Right now, anyone could walk into the room and assuming they knew the right commands, could quiz my Echo about my activity and sleep data. One of the things you can do in the US (and now in Europe) is order items from Amazon by speaking to your Echo, and Alex Cranz wrote a post saying, "And today it let my roommate order forty-eight Cadbury Creme Eggs on my account. Despite me not being home. Despite us having very different voices. Alexa is burrowing itself deeper and deeper into owners’ lives, giving them quick and easy access not just to Spotify and the Amazon store, but to bank accounts and to do lists. And that expanded usability also means expanded vulnerability.", he also goes on to say, "In the pursuit of convenience we have to sacrifice privacy." Note that Amazon do offer the ability to modify your voice purchasing settings, so that the device would ask you for a 4 digit confirmation code before placing the order. The code would NOT be stored in your voice history. You can also turn off voice purchasing completely if you wish.

Matt Novak filed a FOI request to ask if the FBI had ever wiretapped an Amazon Echo. The response he got, "we can neither confirm nor deny."

If you don't have an Echo at home, how would you feel about having one? How would you feel about your children using it? One thing I've noticed is that the Echo seems to work better over time, in terms of responding to my voice commands. The way that the Echo works is that it does record your voice commands in the cloud, and by analysing the history of your voice commands, it refines its ability to serve your needs. You can delete your voice recordings, although it may make the Echo less accurate in future. Some Echo users whose children also use the device say their kids love it, and in fact got to grips with the device and it's capabilities faster than the parents. However, according to this Guardian article, if a child under 13 uses an Echo, it is likely to contravene the US Children’s Online Privacy Protection Act (COPPA). This doesn't appear to have put off households installing an Echo in the USA, as research suggests Amazon have managed to sell 3 million devices. Another estimate puts the installed user base significantly lower, at 1.6 million. Either way, in the realm of home based virtual assistants, Amazon are ahead, and probably want to extend that lead, with reports that in 2017 they want to sell 10 million of these speakers. 

Can the Echo help your child's health? Well a skill called KidsMD was released in March that allows parents to seek advice provided by Boston Children's hospital. After the launch, their Chief Innovation Officer, John Brownstein said, "We’re trying to extend the know-how of the hospital beyond the walls of the hospital, through digital, and this is one of a few steps we’ve made in that space." So I tested Kids MD back in April, and you can see in this 3 minute video what it's like to use. What I find fascinating is that I'm getting access to validated health information, tailored to my situation, simply by having a conversation with an internet connected speaker in my home. Of course, the conversation is fairly basic for now, but the pace of change means it won't be rudimentary forever. 

I was thinking about the news last week here in the UK, where it was announced that the NHS will launch a new website for patients in 2017. My first thought was, what if you're a patient who doesn't want to use a website, or for whatever reason can't use a website. If the Echo (and others like it) launch in the UK, why couldn't this device be one of the digital channels that you use to interface with the NHS? Some of us at a grassroots level are already thinking of what could be done, and I wonder if anyone in the NHS has been formally testing an Echo to see how it might be of use in the future? 

@shirleyayres @ManeeshJuneja my first thought is that we could hack a natural language front end to the NHS 111 protocols quite easily

— Keith Grimes (@keithgrimes) September 3, 2016

The average consumer is already innovating themselves using the Echo, they aren't waiting years for the 'system' to innovate. They are conducting their own experiments, buying these new products with their own money. One man in the USA has used the Echo to help him care for his aging mother, who lives in a different location from him. 

Brilliant use of #AmazonEcho to help a son care for his #aging mother https://t.co/yEAT2wRVyN #IoT pic.twitter.com/YQicNebdO0

— Maneesh Juneja (@ManeeshJuneja) February 5, 2016

In this post, a volunteer at a hospice asks the Reddit community for input on what the Echo could be useful for with patients. 

How about Rick Phelps, diagnosed back in 2010 at the age of 57 with Early Onset Alzheimer's Disease, and now an advocate for Dementia awareness. Back in Feburary, he wrote about his experience of using the Echo for a week. What does he use it for? To find out what day it is, not knowing what day it is because of Dementia.

For many of us, consumer grade technology such as the Echo will be perceived as a gimmick, a toy, of being of limited or no value with respect to our health. I was struck by what Rick wrote in his post, "To many, the Amazon Echo is a cool thing to have. Some what of a just another electronic gadget. But to a dementia patient it is much, much more than that.It has afforded me something that I have lost. Memory. I can ask Alexia anything and I get the answer instantly. And I can ask it what day it is twenty times a day and I will still get the same correct answer." Rick also highlights how he used the Echo to set medication reminders.

I have to admit, the Echo is still quite clunky, but the original iPhone was clunky too, and the 1st generation of every new type of technology is usually clunky. For people like Rick, it's good enough to make a difference to the outcomes that matter to him in his daily life, even if others are more skeptical. 

Speaking of medication reminders, there was a 10 day Pymts/Alexa challenge this year, using Alexa to "to reimagine how consumers interact with their payments and financial services solutions providers." What I find fascinating is that the winner was DaVincian Healthcare, and they created something called DaVincianRX, an “interactive prescription, communication, and coordination companion designed to improve medication adherence while keeping family caregivers in the loop." You can read more and watch their video of it in action here. People and organisations constantly ask me, where do we look for innovation and new ideas? I always remind them to look outside of healthcare. From a health perspective, most of the use cases I've seen so far involving the Echo are for older members of society or those that care for them. 

I came across a skill called Marvee, which is described as "a voice initiated voice-initiated concierge application integrated with the Alexa Voice service and any Alexa-enabled device, like the Amazon Echo, Dot or Tap." Most of the reviews seem to be positive. It's actually refreshing to see a skill that is purpose built to help those with challenges that are often ignored by the technology sector. 

In the shift towards self-care, when you retire or get diagnosed with a long term condition for the first time, will you be getting a prescription for an Amazon Echo (or equivalent)? Who is going to pay for the Echo and related services? Whilst we have real world evidence that shows the Echo is making a positive impact on people's lives, I haven't been able to find any published studies testing the Echo within the context of health. That's a gap in knowledge, and I hope there are researchers out there who are conducting that research. Like any product, there will be risks as well as benefits, and we need to be able to quantify those risks and benefits now, not in 5 years time. Earlier I cited how Rick who lives with Alzheimer's Disease finds the Echo to be of benefit, but for other people like Rick, using the Echo might lead to harm rather than benefit. We don't know yet. However, not every application of the Echo will require a double blinded randomised clinical trial to be undertaken. If I can already use my Echo to order an Uber, or check my bank balance, why can't I use it to book an appointment with my doctor?

In the earlier use case, a son looked through the data from his mother's usage of her Echo to spot the signs when something is wrong. Surely, Amazon could parse through that data for you and automatically alert you (or any interested person) that there could be an issue? Allegedly, Amazon is working on improvements to the service where Alexa could one day recognise our emotions and respond accordingly. I believe our voice data is going to play an increasing role in improving our health. It's going to be a new source of value. At an event in San Francisco recently, I met Beyond Verbal, an emotions analytics company. They are doing some really pioneering work. We already have seen the emergence of the Parkinson's Voice Initiative, looking to test for symptoms using voice recordings.

How might a device like the Echo contribute to drug safety? Imagine it reminds you to take your medication, and in the conversation with your Echo, you reply that you're skipping this dose, and it asks you why? In that conversation, you have the opportunity in your own words to say why you have skipped that dose. Throw in the ability to analyse your emotions during that conversation, and you have a whole new world of insights on the horizon. Some of us might just be under the impression that real world data is limited to data posted on social media or online forums, but our voice recordings are also real world data. When we reach a point when we can weave all this real-world data together to get a deeper understanding of our health, we will be able to do things we never thought possible. Naturally, there are immense practical challenges on that pathway, but progress is being made every day. Having all of this data from all of these sources is great, and even if it's freely available, it needs to be linked together to truly make a difference. Researchers in the UK have demonstrated that it's feasible to use consumer grade technology such as the Apple watch to accurately monitor brain health. How about linking the data from my Apple watch with the voice data from my Amazon Echo to my electronic health record?

An Israeli startup, Cordio Medical has come up with a smartphone app for those patients with Congesitve Heart Failure (CHF) that captures voice data, analyses it in real-time, and "detects early build-up of fluids in the patient’s lung before the appearance of physical symptoms", and deviations found in the voice data would trigger an alert, where "These alerts permit home- or clinic-based medical intervention that could prevent hospitalisation." For those CHF patients without smartphones, could they simply use an Echo at home with a Cordio skill? Or does Amazon offer the voice data directly to organisations like Cordio for remote monitoring (with the patient's consent)? With devices like the Echo, if Amazon (or their rivals) continue to grow their user base over the next 10 years, they could have an extremely valuable source of unique voice based health data that covers the entire population. 

At present, Amazon has surprisingly made rather good progress in terms of the Echo as a virtual assistant. However, other tech giants are looking to launch their own products and services. For example, Google Home, that is due to arrive later this year. This short video shows what it will be able to do. Now for me, Google plays a much larger role in my daily life than Amazon, in terms of core services. I use Google for email, for search, for my calendar, and maps for navigation. So, Google's Home might be vastly superior to Echo, simply because of that integration with those core services that I already use. We'll have to wait and see. The battle to be a fundamental part of your home is just beginning, it seems. 

The battle to be embedded in every aspect of our lives with extend beyond the home, perhaps in our cars. I tested the Amazon Dot in my car, and I reckon it's only a matter of time before we see new cars on sale with these virtual assistants built into the car's systems, instead of being an add-on. We already have new cars coming with 4G internet connectivity, offering wifi for your devices, from brands like Chevrolet in the USA. 

For when we are on the move, and not in our car or home, maybe we'll all have earphones like the new Apple Airpods, where we can discreetly ask our virtual assistants to control the objects and devices around us. Perhaps Sony's product, the Experia Ear, which launches in November, and is powered by something called Sony's Agent, which could be similar to Amazon's AVS, is what we will be wearing in our ears? Or maybe none of these big tech firms will win the battle? Maybe it will be one of us, or one of our kids who comes up with the virtual assistant that will rule the roost? I'm incredibly inspired after watching this video where a 7 year old girl and her father built their own Amazon Echo using a Raspberry Pi. This line in the video's description stood out to me, "She did all the programming following the instructions on the Amazon Github repository." Next time there is a health hackathon, do we simply invite a bunch of 7 year old kids and give them the space to dream up new solutions to problems that we as adults have created? Or maybe it should be a hackathon that invites 7 year olds with their grandparents? Or maybe we have a hackathon where older adults are invited to co-design Alexa skills with younger people for the Echo? We don't just have financial deficits in health & social care, but we have a deficit of imagination. Amazon have a programming tutorial where you can build a trivia skill for Alexa in under an hour. When it comes to our health, do we wait for providers to develop new Alexa skills, or will consumers start to come together and build Alexa skills that their community would benefit from, even if that community happens to be a community of people scattered around the world, who are all living with the same rare disease?

You'll have noticed that in this post, I haven't delved into the convergence of technologies that have enabled something like the Echo to work so well. This was deliberate on this occasion. At present, I'm really interested in how virtual assistants like the Echo make you feel, rather than the technical details of the algorithm being used to recognise my voice. For someone living far away from their aging parents/grandparents, does the Echo make you feel reassured? For someone living alone and feeling social isolated, does the Echo make you feel not alone? For a young child, does it make you feel like you can do magic, controlling other devices just with your voice? For someone considering moving out of their own home into an institution, does the Echo make you feel independent again? If more and more services are becoming digital by default, how many of these services will be available just by having a conversation? I am using my phone & laptop less since I've had my Echo, but I'm not yet convinced that virtual assistants will one day eliminate the need for a smartphone, but some of us are convinced. 50% of urban smartphone owners around the world believe that smartphones will be no longer be needed in 5 years time. That's one of the findings when Ericsson Consumer Lab quizzed smartphone users in 13 cities around the globe last year. The survey is supposed to represent the views of 68 million urban citizens. In addition, they also found, "Furthermore, a third would even rather trust the fidelity of an AI interface than a human for sensitive matters. 29 percent agree they would feel more comfortable discussing their medical condition with an AI system." I personally think the consumer trends identified have deep implications for the nature of our interactions with respect to our health. Far too many organisations are clinging on to the view that the only (and best) way that we interact with health services is face to face, in a healthcare facility, with a human being. Despite these virtual assistants at home not needing a smartphone with a data plan to work, they would need fixed broadband to work. However, looking at OECD data from December 2015, fixed broadband penetration is rather low. The UK is not even at 40%, so products such as the Echo may not be accessible for many across the nation who might find it beneficial with regard to their health. This is an immense challenge, and one that will need joined up thinking, as we need everyone included in this digital revolution.

You might be thinking right now that building a virtual assistant is your next startup idea, it's going to be how you make an impact on society, it's how you can change healthcare. Alas, it's not as easy as we first thought. Cast your mind back to 2014, the same year that the Echo first became available. I was one of early adopters who pledged $499 for the world's first social robot, Jibo [consider it a cuter or creepier version of the Echo with a few extra features] They raised almost $4 million from people like me, curious to explore this new era. Like the Echo, you are meant to be able to talk to Jibo from anywhere in the room, and it will act upon your command. The release got delayed and delayed, and then recently I got an email informing me that the folks behind Jibo have decided that they won't be shipping Jibo to backers outside of the USA, and I was offered a full refund.

One of the reasons that cited was, "we learned operating servers from the US creates performance latency issues; from a voice-recognition perspective, those servers in the US will create more issues with Jibo’s ability to understand accented English than we view as acceptable." How bizarre, my US spec Echo understands my London accent, and even my fake ones! It took the makers of Jibo 2 years to figure this out, and this too from people who are at the prestigious MIT Media Lab. So just how much effort does it take to make something like the Echo? A rather large amount, it seems. According to the Jeff Bezos, the CEO of Amazon, they have over 1,000 people working on this new ecosystem. A very useful read is the real story behind the Echo explaining in detail how it was invented. Apparently, the reason why the Echo was not launched outside of America until now, was to so it could handle all the different accents. So, if you really want to do a hardware startup, then one opportunity is to work on improving the digital microphones found not just in the Echo, but in the our smartphones too. Alternatively, Amazon even have an Alexa Fund, with $100m in funding for those companies looking to "fuel voice technology innovation." Amazon must really believe that this is the computing platform of the future. 

Moving on this week's news, the UK Echo will have UK partners such as the Guardian, Telegraph & National Rail. I use the train frequently from my home into central London, the station is a 15 minute walk from my house, so that's one of the UK specific skills I'm most likely to use to check if the train is delayed or cancelled before I head out of the front door. Far easier and quicker than pulling out my phone and opening an app. The UK version will also have a British accent. If you have more than one Echo device at home, and speak a command, chances are that two or more of your devices will hear you and respond accordingly, which is not good, especially if you're placing an order with Amazon. So now they have updated the software with ESP (Echo Spatial Perception) and when you talk to your Echo device, only the closest one to you will respond. It's being rolled out to those who have existing Echo devices, so no need to upgrade. You might want to though, as there is a new version of the Echo Dot (US, UK & Germany), which is cheaper, thinner, lighter and promises better voice recognition than the original model. For those who want an Echo in every room, you can now buy Dots in 6 or 12 packs! In the UK, given that the Echo Dot is just £49.99, I expect this Christmas, many people will be receiving them as presents. 

Amazon's Alexa Voice Service is one example of a conversational user interface, and at times it's like magic, and other times, it's infuriatingly clumsy.  I'm mindful that my conversations with my Echo are nowhere near as sophisticated as conversations I have with humans. For example, if I say "Alexa, set a reminder to take my medication at 6pm" and it does that, and then I immediately say "Alexa, set a reminder to take my medication at 6.05pm", and so forth, it currently won't say, "Are you sure? You just set a medication reminder close to that time already." Some parents are concerned that the use of an Echo by their kids is training them to be rude, because they can throw requests at Alexa, even in an aggressive tone of voice, with no please, no thank you, and Alexa will always comply. Are these virtual assistants going to become our companions? Busy parents telling their kids to do their homework with Alexa, or lonely elders who find that Alexa becomes their new friend in helping them cope with social isolation? Will we end up with bathroom mirrors we can have conversations with about the state of our skin? Are we ever going to feel comfortable discussing the colour of our urine with the toilet in our bathroom? When you grab your medication box out of the cupboard, do you want to discuss the impact on your mood after a week of taking a new anti-depressant?

Could having conversations with our homes help us to manage our health? It seems like a concept from a science fiction movie, but to me, the potential is definitely there. The average consumer will have greater opportunities to connect their home to the internet in years to come. Brian Cooley, asks in this post if our home becomes the biggest health device of all.

A thought provoking read is a new report by Plextek examining the changes in the medical industry by 2020 from connected homes. I want you to pause for a moment when reading their vision, "The connected home will be a major enabler in helping the NHS to replace certain healthcare services, freeing up beds for just the most serious cases and easing the pressure on GP surgeries and A&E departments. It will empower patients with long-standing health conditions who spend their life in and out of hospitals undertaking tests, monitoring, rehabilitation or therapy, and give them freedom to care for themselves in a safe way."

Personally, I believe the biggest barrier to making this vision a reality is us, i.e people and organisations that don't normally work together will have to collaborate in order to make connected homes seamless, reliable and cost effective. Think of all the people, policies & processes involved in designing, installing, regulating, and maintaining a connected home that will attempt to replace some healthcare services. That's before we even think about who will be picking up the tab for these connected homes.

Do you believe the Echo is a very small step on the path towards replacing healthcare services, one conversation at a time?

[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

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

Robots as companions: Are we ready?

Nao

Some people on Earth seem to think so. In fact, they believe in the concept so much, they are actually building the world's first personal robot that can read & respond to human emotions. A collaboration between French robotics firm, Aldebaran, and Softbank mobile from Japan. You may already know one of Aldebaran's existing robots, Nao. The new robot is called Pepper, is due to launch in Japan in February 2015, and is priced at 198,000 Yen. Using today's exchange rates, that's approximately $1,681 and £1,074, although only the Japanese launch has been confirmed for now. Pepper may be sold in the USA through Sprint stores at some point. The notion of a robot in your home that can interact with you, and even tell you a joke if you're feeling sad, attracted my curiosity. So much so, that in September 2014, I hopped on a train from London to Paris. 

Me & Pepper in Paris

Why Paris? Well, the world's first home robot store opened in Paris this summer, called Aldebaran Atelier, and they had Pepper in the store. You can't buy any of the robots in the store just yet, it's more a place to come and learn about these robots. 

So what's Pepper like? You have to bear in mind that the version I interacted with in Paris is not the final version, so the features I saw are not fully developed, especially the aspects of recognising who you are, and getting to know you and your needs. The 3 minute video below shows some of the interaction I had. For now, Pepper understands English, French and Japanese. 

A bit more about how Pepper works. In the final version, Pepper will be able to understand 5 basic emotional expressions of the face: smiling, frowning, surprise, anger & sadness. Pepper will also read the tone of your voice, the verbage used, as well as non verbal communication such a tilting your head. So for example, if you're feeling sad, Pepper may suggest you go out. If you're feeling happy, Pepper may sing a song and do a dance for you (more on that later). According to a Mashable article, "Pepper has an 'emotional engine' and cloud based artificial intelligence". The article also states, "The cloud AI will allow Pepper to share learnings with cloud-based algorithms and pull down additional learning, so that its emotional intuition and response can continually improve. It's either a technological breakthrough or the most terrifying robot advancement I've ever heard of."

Some facts and figures for you; 

• 4 feet tall, and weighs 61 lbs/28kg

• 12 hour battery life - and automatically returns to charging station when battery is low

• 3D camera which senses humans and their movements up to 3 metres away

In the press kit I was given at the store, it's stated that "Pepper's number one intention is about being kind and friendly. He has been engineered to meet not functional but emotional needs." 

It's not just speech and movement that Pepper responds to, it's also touch. There are sensors on the upper part of his head, upper part of his hands and on the tablet attached to his chest. Pepper may be talking to you, and if you place your hand on his head, the way that you would with a child, Pepper will go quiet. Although, when I tried it, Pepper responded by saying something about sensing someone was scratching his head! 

The creators anticipate Pepper being used to care for the elderly and for baby sitting. What are your thoughts? Do YOU envisage leaving your elderly parent or young child with Pepper for company whilst you do some chores or dash to the supermarket? I told Shirley Ayres, Co-Founder of the Connected Care Network, about Pepper. Her response was; "I'd prefer a robot companion to 15 minutes of care by a worker on minimum wage struggling to provide quality care on a zero hour contract."

Given aging populations, and the desire for many to grow old in their own home, rather than an institution, are household companion robots the answer to this challenge? As technology such as Pepper evolves, will a robot at home be the solution to increasingly lonely societies? Will we really prefer the company of a household robot versus another human being? Will we end up treating the purchase of Pepper the same way we treat the purchase of an Ipad? Will your children buy you a Pepper so they don't have to visit you as often as you'd like? The CEO of Aldebaran, Bruno Maisonnier, believes they will sell millions of these robots. Apparently, they'll be able to make a profit from the sales of robot related software and content. Apps for robots?

Pepper does have all sorts of sensors so it can understand humans as well as understand the environment it's operating within. I understand it will collect data, but it's not clear to me, at this stage, exactly what would be collected or shared. Just because Pepper seems kind and friendly, doesn't mean we should not consider the risks and benefits associated with any data it collects on us, our behaviours and intentions. There could be immense benefits from a robot that can 24 hours a day remind an older person when to take their medications, and potentially collect data on when doses are being skipped and why.

An Institute of Medicine panel has just recommended that "Physicians should collect more information about patients' behaviour and social environment in their electronic health records." Some of the information the panel recommends collecting include "whether they are experiencing depression; their social connections and sense of social isolation." Is technology such as Pepper the most effective route to collecting that data? Do we want a world where our household robot sends data to our doctor on how often we feel sad and lonely? Perhaps for those of us too afraid to reach out for help and support, that's a good thing?

My brief interaction in Paris with Pepper was fun and enjoyable, a glimpse into a possible future. With it's childlike gestures and ability to monitor and respond to our emotions, could we as humans one day form emotional attachments to household robots? Here is the video of Pepper wanting to play some music for me in the Paris store. 

One does wonder how the introduction of these new robots might impact jobs? What does technology such as Pepper mean for human carers? A recent report from Deloitte forecasts that 30% of jobs in London are at high risk from automation over the next 20 years. It's low paid, low skill jobs that are most at risk. Microsoft is trying out a different robot called K5 from Knightscope as security guards in their Silicon Valley campus. In Japan, Pepper has been used by Softbank to conduct market research with customers in a Tokyo store. Nestle is planning to use Pepper to sell coffee machines in 1,000 of it's stores across Japan by the end of 2015. Here is the video showing how Pepper might work in selling to consumers in Nestle's stores. 

Now, some of us may dismiss this robot technology as crude and clumsy, with little or no potential to make a significant impact. I personally think it's amazing that we've reached this point, and like any technology, it won't stand still. Over time, it will improve and become cheaper. We are at a turning point, whether we like it or not. Does Pepper signify the dawn of a new industry, or will these household robots be rejected by consumers? How are household robots treated by the law? Do we need to examine how our societies function rather than build technology such as Pepper? Are we becoming increasingly disconnected from ourselves that we need Pepper in our homes to connect with ourselves as humans? Does the prospect of having a robot like Pepper in your own home with your family, excite you or frighten you?

Given the intense pressure to reduce costs in health & social care, it would be foolish to dismiss Pepper completely. So in the future, will we also see companion robots like Pepper stationed in hospitals and doctor's offices too? Can personal robots that connect with our emotions change how we 'deliver' and 'receive' care?

[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

A doctor in your pocket?

A new app was launched in the UK this week, Babylon, which promises just that. Their website states "We are building the world’s first integrated digital healthcare system combining the latest advances in technology with modern medicine. "

Additionally, an article in Wired UK says "Designed to make booking healthcare appointments as simple as 'booking a Hailo cab', Babylon gives patients access to doctors 12 hours a day, six days a week for £7.99 per month." 

This is extremely exciting, and particularly inspiring that it's come from a UK company, not a US one. Kudos to Ali Parsa and his team for pushing the boundaries of what we know as Digital Health. According to the same Wired UK article, Parsa has said that in their beta trial prior to launch, the company could resolve 75% of problems virtually, and just 25% of cases required a visit to a clinical professional. I will be following their progress with much anticipation, and truly hope it will improve how healthcare can be delivered in the 21st century, not just in the UK, but globally. 

However, when I viewed their website, no terms and conditions or privacy policy were available to view. When I searched for the app in the Play Store, I found the same. It was only when downloading the app, and creating an account within the app, that you could view the terms & conditions and privacy policy. Given the recent care.data saga over the poor communication & lack of transparency regarding the use of our health data within the NHS, I find this oversight, quite surprising. In my opinion, transparency in terms & conditions is critical to how organisations gain the trust of the consumer when rolling out new services. 

@ManeeshJuneja @babylonhealth @clarkmike I agree really important to understand how #personaldata is stored & used before downloading app

— Shirley Ayres (@shirleyayres) April 29, 2014

The video below shows you what I found when I viewed the terms and conditions & privacy policy within the app. Despite having the latest Samsung S5 smartphone with a rather large screen, I was swiping for many pages. Full of legal jargon that left me confused [and I'm a digital savvy person who has worked with data for 20 years], it makes me wonder if the average patient wanting to use the app would be able to make an informed choice? It's not reflective of Babylon per se, this applies to virtually every app I download today. Do YOU read the T&Cs & privacy policy of every app or website you use? Are you even AWARE of what terms you've accepted? How many of you have heard of Terms of Service Didn't Read?

Looking at T&Cs of Babylon Health app version 1.0.2 on Play Store - 30th April 2014

I did share my concerns over email with Ali Parsa yesterday, and he swiftly replied, promising to add the T&Cs and Privacy policy to their website. I appreciate as a startup, they must be super busy, so kudos for responding so quickly. So, when journalists write articles about new health apps, should they also be reviewing & sharing their opinions on how patient friendly the terms and conditions are?

Dr Watson in your pocket

What if you could ask IBM's supercomputer, Watson, a question at 3am via an app, regarding your child's symptoms, and get a 100% trusted response based upon the latest medical knowledge? That could be a possibility in the near future, according to this article in New Scientist.

2 days ago, IBM unveiled the 25 ideas selected in response to their The Watson Mobile Developer Challenge issued at February's Mobile World Congress in Barcelona, Spain. Out of these 25 ideas, just 3 will be chosen to be developed, making them the first 'Watson in the cloud' apps. You can browse the 25 ideas here, with 6 of the ideas having a focus on health. 

Remember I recently talked about a possible future in 2025, where doctors are unemployed? Look at how rapidly Digital Health is evolving before our very eyes, and you begin to wonder what the implications would be if you had a service like Babylon in the future, powered not by human doctors, but by Watson in the cloud? How comfortable would you feel with your child's medical history being processed by a supercomputer in the cloud? 

Think of all the companies, products & services that haven't even been invented yet! 

For the 65% of the UK that has a smartphone, Babylon & Watson could both transform how healthcare is delivered to them.

For the 35% of the UK that don't have a smartphone, looks like you'll still need to make a physical trip to a doctor's office until 2018 [by 2018, it's forecast that smartphone penetration in the UK will be 100%]

Whatever happens in the future, no matter what shiny new gadgets & services you are offered, I strongly recommend doing your own research to understand where who owns your health data, who has access to it, and who profits from using it!

Remember, it's YOUR health data from YOUR body that is central to the anticipated revolution that Digital Health promises all of us. Are you fully informed on what data you've agreed to share and with whom? Want to understand more about what's at stake? This Guardian article published this week arguing that it's time to solve problems around data privacy is a good place to start. 

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

Delivered by FeedBurner