The dark side of wearable technology

An update on my talk in Boston, Will advancing technology make doctors unemployed?. 

It's confirmed for Fri April 11th at 12pm. The format will be a lunchtime session, with time for questions, and tickets are free. I believe there are still a few tickets available. Big thanks to Maggie Delano, Joshua Kotfila & Hack Reduce for helping me make this event a reality!

So, Wearable Technology, we are hearing more and more about it in 2014. New research is forecasting that wearable tech will become even more popular than tablets. Our lives will change, our health will improve, and generally it's simply amazing, right? The use of Google Glass in Houston to allow sick kids to virtually visit the zoo is one of the wonderful applications I've seen. Today, the headline in the local newspaper in Boston was about a local hospital that is the 1st hospital in the USA to employ Google Glass in everyday medical care, expanding it's use across the entire Emergency department.

However, my views on wearable technology have been challenged recently, which prompted me to write this blog. There is a dark side to this technology, and it's fascinating to see the headlines touting the benefits but not always mentioning the risks.

I was invited to speak at an event in London, hosted by NESTA in March 2014. The event was titled, Data, health and me: the future of people-powered healthcare , and I shared my research on the emergence of personal data marketplaces & the future scenario where patients can profit from selling their health data which has been collected using wearable technology. My research has also been cited in the recent report, Refilling the Innovator's Prescription: The new wave of medtech, produced by NESTA & Silicon Valley comes to UK,  

There is a great Storify summarising my talk, as well as the talks by the other 3 speakers.

One of the exercises we were set, was to examine a possible future in the year 2024, where it's so lucrative for patients to sell their health data, that they can use wearable technology to 'amplify' their illness or even perhaps give themselves an ilness? It sounds preposterous, but look at what happens today in India. Deliberately maiming children to increase profit from begging. As healthcare costs continue to spiral, OUR personal health data, will only become MORE valuable in the future.  

The discussion in our group was thought provoking, as our small group discussed the moral, social, legal, & cultural implications. How would a doctor know that your illness occurred naturally or you used wearable technology to give yourself the illness? What circumstances would compel healthy people to do this? Would it be the poorest sections of society who realised one of the few assets they have is their health data? Would there a black market in 'patches' that when applied to the skin would give you diabetes? All of this really made me think again about the concept of selling our health data to governments, pharmaceuticals & health insurers. It's not that simple as I originally anticipated, and I'd welcome comments from readers on the intersection of wearable tech, personal health data and these new marketplaces. Kudos to Jessica Bland & Cassie Robinson for hosting & curating this event. There is a great video with soundbites from participants, definitely worth watching. Incidentally, on the same day, there was an event in New York, on the Social, Cultural & Ethical Dimensions of “Big Data." I'm proud that the UK is not lagging behind the US when it comes to thinking about the future.

I came across a Google Hangout from an event in New York, discussing Augmented Reality & Privacy in the future. Featuring John C Havens, Dawn Jutla, and Jules Polonetsky, it was an inspiring 1 hour. Again, speakers who made me rethink my beliefs, assumptions and attitudes towards wearable technology with their sharp insights.

Think about the use of Google Glass in the Boston hospital. When rushed out of the ambulance into the ER room, are you really going to be in a position to ask where your face or voice data may be going, and who has access to it?

It's scary enough to consider these questions when thinking of our own privacy & security, but even more frightening when thinking how wearable technology could be used to do harm to our children? Fast forward 5 or 10 years, and if most kids are given wearable technology so that their parents, teachers & doctors can monitor their health and movements in real-time, are we considering that these data are also of interest to criminals? Children may be warned not just to avoid talking to strangers, but to avoid strangers with laptops sitting next to them on a train as their personal data may be being hacked!

An article this week reports how "Companies are ignoring serious security issues in their rush to release next-generation wearable devices, according to Symantec."

There are other risks associated with the expansion of wearable tech in our lives, but I've highlighted just a couple of scenarios that warrant further thought. It's important that we find a balance between creating conditions that encourage entrepreneurs to take the risks to experiment with these new ideas, but at the same time, we can't let our enthusiasm for new shiny gadgets blind us from discussing how we govern use of this (or any) technology in society.

I don't know if we have the answers, as we are not even confident in defining the questions. However, the wearable technology market is evolving at such a rapid pace, it's critical that we take time out to both, ask those questions, and answer them. Without that pause, we run the risk of society eagerly adopting and evangelising these products without pausing to consider the ramifications on different members of our communities.

If you are in Boston this week, and can't attend my talk on Friday, I'd definitely like to connect, especially if you're a wearable tech startup.  

[Disclosure: I have no commercial ties with the companies/individuals mentioned]

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An app a day keeps the doctor away?

An app a day keeps the doctor away may very well be what our children hear as they grow up in the 21st century. During my research, I found that the origin of the familiar phrase, "An apple a day keeps the doctor away", may have originated 148 years ago in Wales, UK . 

A Pembrokeshire proverb. Eat an apple on going to bed, And you'll keep the doctor from earning his bread.

Before I talk about apps replacing apples, I'd like to share some of the feedback that's been generated from my last blog post on tech making doctors unemployed. It's triggered a healthy debate within & outside the medical profession. I'm not sure doctors like me anymore! 

I've had docs email me saying stop pushing this kind of talk, I need to put my kids through college. Some of the younger doctors have responded positively, understanding that they might benefit by having digital skills as a doctor. Many older docs seem to be terrified, and some docs of all ages seem to be responding to the threat with at attitude of "Bring it on!"

All of this has really made me think deeply about the choices we face in society in this increasingly automated world. A visit to a London supermarket this week compelled me to ask this question. 

Whilst some doctors may be outraged that I have the audacity to even challenge the notion that their work cannot be automated by machines, there are deeper questions facing ALL of us in society. This recent Guardian article which has the headline, "When robots take our jobs, humans will be the new 1%. Here's how to fight back."

Even much of the work I've done for the past 20 years, in the realm of data analytics, is being handled by machines and software now. In fact, as a Futurist, I may be joining the doctors at the unemployment office in 2025, given that robots are now writing news stories, and some believe that 90% of the news could be written by computers by 2030.

Is the future that we're heading towards really the future we desire? If it isn't the future we desire, whose responsibility is to intervene? Should governments create policies that encourage institutions to retain human workers, even when the human is more expensive than the machine? Should the CEO of a corporation also wear the hat of Chief Ethics Officer? 

Will getting an app on prescription become the norm?

Many people including patients in rich countries may roll their eyes at using their mobile phone for healthcare, but patients in low and middle income have been using mobile phones in healthcare for several years, frequently using text messages with more basic phones, not apps with smartphones.

In fact, Africa is home to the largest number of mHealth projects in the world. A list with examples of projects can be found here. Patients in the US during 2014 will be able to download the world's first doctor prescribed app, Bluestar, for helping them to manage Type 2 Diabetes. This is a massive step, and could it be a signal of times to come? 

Well, a recent poll of physicians in the US revealed that "37% have no idea what apps are out there."

According to research conducted by Digitas Health in 2013, 90% of chronic patients in the US would accept a mobile app prescription from their doctor. Do you know what proportion of those patients said they would accept a prescription of medication? Just 66%!

So, this is the future, right? Well, doctors have a right to be wary of apps. In a previous blog post, I mentioned how a certification program for health apps allowed an app to be certified which had flaws relating to protection of data in the app. We are heading into uncharted waters, and mistakes are to be expected. Looking beyond the hyperbole, the key question for me (and the regulators) is, do the benefits outweigh the risks? 

Source: Pew Internet Research Project

Source: Pew Internet Research Project

The conclusions of the first ever cross-stakeholder Pan-European seminar on Health Apps & how patients, policy-makers, healthcare professionals and industry see the future was recently published in a white paper. What I find encouraging in the paper is the that EU has made it clear that it does NOT want to discourage the burgeoning market for health apps by producing excessive red tape.

As Digital Health becomes more prevalent, the scenario of doctors everyday weighing up whether to prescribe an app or a medication to a patient is entirely possible in just a few years. However, as this recent paper in JAMA remarks, we will need an unbiased review & certification process for health apps, if this is to happen.

Exciting stuff, but I can't help but also wonder, exactly how much of an impact will prescribing of apps really make on healthcare, given that just 18% of Americans aged over 65 own a smartphone? That figure drops to 8% for those over 65s with annual household income of $30,000 or less!

Should we be asking innovators to focus their energy on technologies that solve the problems of the biggest users of healthcare, those aged over 65? Will many basic problems in healthcare remain unresolved, as the 'worried well' develop amazing technology, to be used primarily by the 'worried well'?

What role will community pharmacies play in public health if prescribing of apps takes off and fewer people actually walk into a physical pharmacy? Will apps cause pharmacists to also become unemployed in the long term? 

What is the impact on the future of the pharmaceutical industry which is not just slower than other sectors to adapt, but also employs considerable numbers of people around the globe? IMS Health, the world's largest health data broker, has launched AppScript, a platform that offers doctors easy, secure and evidence-based app prescribing.

What about absurdly simple problems, such as being prescribed an app, but your smartphone's battery barely lasts the whole day, and the battery could die just as you really need to use the app to manage your condition. A tablet doesn't need a power source. 

What about the impact on our eyes? Opticians have recently warned that overuse of smartphones may damage your eyes.

What's the impact on the fabric of our society if in the future, we can both be diagnosed & treated from the comfort of our own home just using a our smartphone combined with an app & a tricorder?

Scanadu Scout 

Scanadu Scout 

Not long to wait to answer that question! The combination of the long awaited Scanadu Scout and their app on Monday may indeed make the phrase, an app a day keeps the doctor away, part of our everyday vocabulary. The latest blog post from Scanadu, mentions "placing it over the forehead to take a composite, multi-parameter biometric signature that pulls in several vital signs in seconds: diastolic and systolic blood pressure, body temperature (core temperature is coming in a couple of weeks), SPO2 (blood oxygenation), and heart rate." 

I should be getting my hands on a unit soon, and look forward to sharing my feedback with you!

One more thing, what if the apps in our cars in the future 'prescribed' us a different route home to improve our health? Given Apple's development of CarPlay, I mocked up a possible scenario of the world we could be heading towards. The question again - is this a desirable world?

Asking Siri to navigate home may never be the same again.

My next talk - Boston!

I'm going to be passing through Boston, MA in 2 weeks time. It's last minute, but I'm hoping to be able to give a talk there on whether tech will make doctors unemployed and also share some of my ideas & thoughts on how the medical profession could adapt to this rapidly changing world of Digital Health. As soon as it's confirmed, I'll share the details on Twitter. If whilst I'm in Boston, your organisation wishes to book me as a speaker, please see my Public Speaking page.

[Disclosure: I have no commercial ties with any of the companies mentioned above]

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Healthcare in the future: Will advancing technology make doctors unemployed?

Yesterday, I spoke on this topic at Anticipating 2025, an event hosted by London Futurists.   [The talk was video recorded, and I will share when it's online]. The organiser, David Wood, is a smartphone pioneer, having been a co-founder of Symbian, the world’s first successful smartphone operating system. 

Vinod Khosla's controversial comments back in 2012, were (and still are) very provocative, "By 2025, 80 percent of the functions doctors do will be done much better and much more cheaply by machines and machine learned algorithms." 

2 years later, technology continues to advance, and we have more conferences on topics such as Wearable Tech and the Internet of Things. Healthcare is a complex & heavily regulated environment, and slow to change as the wrong decisions can cause harm to patients, and even death. The cost of healthcare, if allowed to continue rising is unsustainable. Today, it's reported that the NHS needs another £2bn. In the US, the 3rd leading cause of death is medical error, we have a shortage of 4.3 million doctors & nurses on this planet, and 1 billion people have no access to a doctor, hospital or clinic. I am always thinking, how can technology help?

Prevention of disease seems to be high up on the agenda in today's world. Well, what if all these new technologies heading our way can dramatically improve prevention? With sensors, what if our health could be monitored by the objects that are already around in our daily lives? Our phone, toilet, our shirt, our bed, our car? 

How do we feel with machines knowing more about our health than either us or our doctors?

What are the ethical, legal & social implications in the future if you stick an "electronic tattoo" on the body of your elderly parent with dementia/newborn baby to monitor vitals & stream data to you & your healthcare provider/insurer when 'informed consent' is not possible?

Do we want smart vending machines that recognise who we are as we stand it front of it, knows from our medical records that we have high cholesterol, syncs with our wearable activity tracker to determine we haven't had much sleep last night and rarely exercise? When we press the buttons selecting a chocolate bar and a can of Coca-Cola, and the smart vending machine suggests we select a granola bar and coconut water, do we feel comfortable with a vending machine using our data to remind us to make healthy choices?

 

Last night, before going to bed, I used an AliveCor device with my iPhone to record my ECG, and paid $8 to get a clinical analysis report within 24 hours. Less than 12 hours later, I open the app to find the report has been delivered. If I can do this in 2014 with equipment available to consumers, from the comfort of my bed in my own home late at night, without going to see a doctor at a hospital, what could we do in 2025?

Cloud Computing has enabled SaaS (Software as a Service), are we heading towards MaaS (Medicine as a Service)? No need to wait 7 days to see a doctor! Get your blood analysed anywhere, anytime using your mobile device? These guys in France are working to do exactly that with their Beta-Bioled, the first hand-held blood analyzer. In Switzerland, scientists are developing a blood test performed via the screen of your smartphone. 

What does this mean for physical hospitals and clinics? It's not just GPs that could be impacted. It's surgeons too. Imagine if we could take all the facilities, equipment and knowledge required to perform a successful surgery... and encode it in a single drop of saline. That's what Ido Bachelet is dreaming of when he talks about Surgical Nanorobotics at Solve for X in this video. 

Today there is no profit in preventing people getting sick. The more sick we are, the more job security a doctor has. Will advancing technology cause business models to evolve? Naturally, with possibility of a seismic shift in healthcare, power, profit & prestige are at risk. The conversation doesn't have to be adversarial. We have to remember, that sometimes in life, the needs of the many, outweigh the needs of the few. 

So, if technology does advance beyond our wildest expectations over the next 10 years, will the demand for doctors decline, or even disappear?

I believe we will still need humans in medicine - after all, delivering compassion & hope is not something a machine or a robot powered by artificial intelligence could do. When we are sick, we are weak, vulnerable & frightened. You need a human being to hold your hand & look you in the eye, and say "I'm here for you." Research shows that some older people visit their GP not because they are sick, but mainly because they are lonely. Will this push into Digital Health have a side effect of increasing loneliness & isolation?

 

Oxford University researchers published a study in 2013 where they estimated the probability of computerization of more than 700 occupations in the US. Overall, nearly 50% of occupations they analysed are at risk of disappearing. According to their model, the probability of doctors & surgeons being computerized over the next few decades is 0.4%. Not everyone in healthcare is safe though, medical record technicians are likely to disappear, and even 1 out of 5 epidemiologists.

[side note - Computer programmers are listed as 48%. It does make you wonder why governments are encouraging today's children to learn to 'code'. The infographic below is available here] 

Sources: University of Oxford, Carl Benedikt Frey and Michael A. OsborneGRAPHIC: AKI ITO / BLOOMBERG NEWS & DAVE MERRILL / BLOOMBERG VISUAL DATA

Sources: University of Oxford, Carl Benedikt Frey and Michael A. Osborne

GRAPHIC: AKI ITO / BLOOMBERG NEWS & DAVE MERRILL / BLOOMBERG VISUAL DATA

However, if much of what doctors do today gets automated, and they spend much more time delivering compassionate care, do they need to go through all that training in medical school? Does the definition of a human doctor change? Do doctors become nurses? With the explosion in data, be it genomic data or data from sensors and apps, is the doctor of 2025, a data detective?

Will the doctors who survive & prosper in 2025 be the ones that know Data Science, Computer Science, patient centred design as well as Biomedical science? A great blog post published yesterday by Kevin Wang, on how a smart washing machine helped him see the future for a safer ICU at the hospital. He's a quality and safety fellow, who wants want to integrate human-centered design into healthcare delivery and management. 

Will it become easier & cheaper to produce doctors and to eliminate the global shortage? Does this mean the 1 billion people finally get what the other 6 billion have got? Access to a doctor. 

If we don't manage to address the Digital Divide, will all this advancing technology simply increase inequalities in health? Will speedy diagnosis & treatment be the preserve of those wealthy enough to afford smart devices, sensors & the internet, whilst the poor have to wait several weeks to see an overworked human doctor? [Note: In Greece, a country of 11 million people, 65% of people have NEVER used the internet]

Just because we can use technology to automate tasks that humans do doesn't mean we have to do that. Despite all the promises, advancing technology isn't always used well, even by pioneers. Take Google Flu Trends (GFT), a program designed to provide real-time monitoring of flu cases around the world based on Google searches that match terms for flu-related activity. A new study shows that GFT over-predicted the prevalence of the flu in 100 out 108 weeks. This article describes the failings of Google's use of big data, and labels it, "automated arrogance."

Ultimately, technology has to serve the needs of humanity, not the other way round. 

My vision of where technology could take us in 2025

My vision of where technology could take us in 2025

I genuinely believe we can transform the world of healthcare at a global level, but it requires taking time out of the present to actively consider our shared future, and the wide ranging implications of advancing technology. Unthinkable as it sounds, doctors could become the dinosaurs of the 21st century, given the relentless pace of automation through technology.

If your organisation is wanting to understand how to survive & prosper over the next decade in an uncertain world, do get in touch.

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

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The future of your health data

Your health data usually belongs to someone else. If you go see a doctor and are diagnosed, the electronic record of that diagnosis is stored and could be part of a much larger anonymised dataset. If you're in the US, you may be one of the 180 million patients whose health insurance claims data are part of the MarketScan data from Truven Health Analytics. If you're in England, you may be aware of the government's plans to build a dataset, called care.data containing the GP & Hospital data for the 53 million patients who live in England. If you use a activity tracker, such as FitBit etc., you're once again giving your personal health data away, which may or may not be sold in the future.

Naturally, one of the important applications of all these data are to improve human health, especially when it comes to medical researchers looking to understand how we get sick, and how we respond to drugs & vaccines in the real world. These data are also valuable to health insurers and healthcare providers when it comes to improving their services. 

Nearly a year ago, at TEDx O'Porto, I shared my radical vision of how 7 billion people could get paid for sharing their health data, as well as having full control over who can access that data. Many leaders in the healthcare arena have laughed at my dream, or have responded with silence. It tends to be patients & startups that get most excited at my ideas. That's understandable, as we are talking about big changes in how we collect health data, store it and sell it. These changes are not going to happen overnight, but I'm pleased to see that changes are happening faster than I anticipated. 

I read an article today in MIT Technology Review about a New York based startup, DataCoup. According to the article, "DataCoup are running a beta trial where people get $8 a month in return for access to a combination of their social media accounts, such as Facebook and Twitter, and the feed of transactions from a credit or debit card." Looking at DataCoup's website, it claims to be the 1st personal data marketplace. 

Interesting, the article, also says "The company also might offer people the option of sharing data from lifelogging devices such as the FitBit or parts of their Web search history." When I tweeted earlier today, DataCoup confirmed that incorporating health data is in their plans. 

The dawn of a new industry?

blogheartdata.jpg

This news is extremely exciting for me, and gives me hope that 2014 is likely to be a turning point in raising awareness of how valuable our health data is. If you suffer from multiple diseases, and take multiple medications, your data may be more valuable to 3rd parties than someone who is healthy and not on any medications. Many entities currently profit from using your health data. Time for patients to share in that profit?

There is also a London startup called Handshake that is also a personal data marketplace. Their website states, "Handshake is an app and a website that allows you to negotiate a price for your personal data directly with the companies that want to buy it.". They appear to be in a closed beta at the moment. 

Then you have the concept of patient data co-operatives. Our Health Data Co-Operative is in the US, and has recently been recognised by the White House as playing a role in promoting "Data to Knowledge to Action". The founder, Patrick Grant, states, "Our Health Data Cooperative is built on the premise that Patients should benefit economically from access by third parties to their health information."

Over to Europe, and I recently came across HealthBank. A patient data co-operative based in Switzerland, but aiming to build a global secure depository for patient data. Their website talks of patients having "a HealthBank account,  to store, access, manage and share their health data. And users can earn financial and other returns on their health data, similar to receiving returns from a bank account."

You've heard of Bitcoin, the cryptocurrency that's hit the news? What if you could trade your health data for Healthcoins that could be used to pay for your healthcare or for healthy food? There is a guy in the Netherlands, Andre Boorsma, who has put forward the concept of Healthcoins. I'm curious - would this concept be tried in Emerging Markets first? 

What's the catch?

Exciting stuff, and we are entering a new era in the creation & use of personal health data. However, there are important hurdles to overcome. The first one is trust. The companies listed above have to build trust with the individuals who would be sharing data. Building trust takes time, unless you partner with an existing brand that is already trusted. Would you be more willing to use the services of DataCoup, Handshake, OurHDC, or HealthBank if they were associated with Amazon or Samsung? 

The second hurdle relates to privacy, security & governance. Do we have the technology in place to genuinely keep our personal data private & secure in these emerging platforms? Do we have the legislation (both country level & internationally) to fairly govern the sharing, management and trading of these data? There is also the thorny issue of obtaining informed consent. The vulnerable, such as a person with Dementia who may be given a Fitbit to wear, but someone else profits from their activity data being traded? 

Another issue is going to be accuracy, especially with health data that can be generated using wearable technology. Users are manipulating fitness trackers, as reported here. If you're a researcher buying access to aggregated data on Fitbit users, how accurate are the data? How representative will these data be of the general population? 

If we can trade our health data for economic returns, will this commoditization of our health data attract the attention of cybercriminals? 

What about Open Data? Some people argue that these new sources of health data should be donated into a commons, free for researchers to use for the benefit of humanity. 

What does this mean for you? 

Health data brokers - you need to be thinking about these trends, and how you adapt your company's strategy. If you don't, your future revenue streams are likely to suffer (or disappear!)

Healthcare providers & insurers - Are you ready for a world in which patients can choose who they want to share their health data with? 

Patients - Would you feel comfortable trading your health data for economic rewards? 

Pharmaceutical companies - How will this impact how you source data for clinical trials & observational studies? 

Startups - Immense opportunities (and pitfalls) ahead. If personal data marketplaces and patient data co-operatives take off, it could create a brand new industry. 

Policymakers & regulators - The world is definitely moving towards a personal data ecosystem where individuals can own, control and profit from their own data. Legislation needs to consider the rights of everyone involved with such a system. Will their be a special tax for those people who decide to sell their health data? 

[Disclosure: I have no commercial ties with any of the companies mentioned above]

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Digital Health: Q&A with Ben Gowland

Thanks to social media, it's now possible to engage with leaders in healthcare, in a manner that was not feasible a few years ago. Using Twitter, I recently connected with Ben Gowland @ccginsider, Chief Executive of Nene Clinical Commissioning Group (CCG), which is the organisation responsible for commissioning healthcare for most of Northamptonshire, England. 

Given the recent changes in NHS England, I was curious to hear Ben's perspective on the future of healthcare in England, especially the role that Digital Health may play in that future. It makes for fascinating reading, especially if you're a Digital Health startup! 

BG.JPG

1. Many people are still confused about clinical commissioning in England - could you explain what it means, and how it differs from the prior approach?

There are generally two parts to this question.  The first is understanding what ‘commissioning’ means.  The way the NHS works is that the money to fund healthcare is raised through general taxation, and then this money is distributed to commissioning organisations (like Nene) to buy (or ‘commission’) healthcare services from provider organisations (such as hospitals) for their local area.  So Nene CCG has a budget of £660M to commission healthcare for the population it serves.

Whether commissioning is successful or not is determined by the extent to which commissioning organisations use the money to improve health outcomes and experience.  At its crudest level this means whether people live longer, healthier lives, as a result of the way that the money is used. 

But of course the big challenge facing the NHS, and the majority of healthcare systems, is that in the current economic downturn there is less money available.  Health inflation outstrips any growth in funding and the demand for healthcare services such as accident and emergency attendances and emergency admissions to hospital continue to rise year on year.  Public expectations also rise every year.  So the real challenge facing commissioning organisations like Nene is how do we improve outcomes and experience when there is less money available.

Which brings me to the second part of your question.  Clinical commissioning means that those now responsible for commissioning healthcare are clinical commissioning groups (CCGs).  CCGs are membership organisations of GP practices, so for example Nene has 60 member practices.  These GP practices elect some GPs to be directors of the organisation, who in turn are supported by management directors (like myself) to run the CCG. 

The point of this is that 90% of healthcare contacts happen in primary care.  GPs have always been the ‘gatekeepers’ of the NHS.  As such they are the group best placed to understand the needs of the population, because they see patients every day.  In the past commissioning organisations were essentially management led organisations, and it is this shift to being membership organisations of GP practices that represents the biggest difference from the past.

At the heart of the challenge to improve outcomes and reduce expenditure is the need to reduce the reliance of the healthcare system on acute hospitals.  This requires a bigger focus on prevention, better services in the community and the ability to manage patients with long term conditions outside of hospital.  The challenge for clinical commissioners is to make this a reality, a challenge that previous iterations of commissioning in the NHS have been trying to do for many years without success.

2. How many patients & staff are covered by Nene CCG? 

Nene CCG covers a population of 625,000, and has around 200 staff.  Nene is one of the biggest CCGs in the country.  Some CCGs cover much smaller populations (the smallest covers a population of 70,000) and as a result will have far fewer staff.

3. What are your 3 biggest challenges over the next few years?

The headline challenge for all CCGs is as I have started to outline above: how to improve outcomes and experience in the current financial environment.  Within this there are specific elements that are important, so I have tried to pick 3:

  • How to transform general practice so that it can strengthen its gatekeeper role and partner more effectively with other parts of the health and social care system

  • How to integrate community health and social care services in local communities around the needs of individuals

  • How to change the hospital sector so that it supports the delivery of out of hospital care and provides specialist services as required, rather than acting as the default point of healthcare provision

4. Do you believe Digital Health technologies have a role to play in helping you meet those challenges?

For me the biggest component of all of these challenges is the need to shift the role of individuals within healthcare.  Currently we receive healthcare when we need it.  When we are ill, we transform from citizens to ‘patients’ and let others (health professionals) make decisions about our healthcare.  There are many reasons for this, and a key one is the information imbalance between health professionals and patients.  Technology has a key role in enabling individuals to take control of their health throughout their lives (not just when we need it), as well as becoming partners with health professionals in decision making and treatment when the need arises.

More specifically there are some key information technology challenges impeding progress today.  Effective ‘risk profiling’ populations to identify those at highest risk of admission to hospital so that action can be taken in the community to prevent it is an ongoing challenge.  We are also still struggling to enable information systems between different provider organisations to talk to each other. If we want to commission whole pathways for patients rather than simply commissioning services from individual organisations (which we do) we need joined up information across these pathways.

5. What are your staff & patients asking to be done differently in the future (where technology might help)? 

A key challenge is tackling variation.  It starts with identifying where variation exists, understanding it, and taking action to reduce it.  Variation exists everywhere: between individual clinicians, between GP practices, between hospitals, between the behaviours of different populations.  Alongside this is the systematic implementation of best practice.  It still takes far too long for proven new ways of working to be systematically embedded within the NHS.  If we could do these two things: reduce variation and rapidly implement known best practice we would be in a much better position to manage the current challenges.

We are currently seeing significant growth in the regulation of the NHS.  There is now a chief inspector of hospitals and a chief inspector of general practice, and there are a multitude of organisations with responsibility for different aspects of regulation.  Much of the current demand is to support organisations to be able to meet the requirements of these different regulators.

6. If UK entrepreneurs and innovators want to develop Digital Health technologies that can benefit Nene CCG, what's your advice to them?

New ideas tend to fall over for two reasons.  The first is that they do not look at the financial return on investment.  CCGs have no money, and so can only spend on what will reduce spending overall.  The days of commissioners making decisions on how to invest their growth money have long gone!  The second is ensuring that total cost to the commissioner will be reduced.  New services often stimulate new demand, and so there needs to be clarity that it is existing demand that is being impacted.  So for example it is no good demonstrating that COPD admissions will be reduced for a specific cohort of people with the introduction of a new digital monitoring service if the total number of emergency admissions goes up (whether COPD or otherwise), because the money identified to pay for the new service has gone.  Often new community based or easy access services tap into previously unmet demand, which means that even though they are busy as commissioners we do not see a corresponding decrease in demand elsewhere in the system.

The funding available to the NHS is fixed, and determined by government.  A new technology can provide lots of benefits but key to bear in mind is where the money will come from to fund it. We will always look for a reduction in expenditure elsewhere.  I think partnerships between CCGs and those introducing new technologies on some sort of risk share basis are the most realistic way forward.  Where these are directly offered by providers commissioners are much more likely to be responsive.

Prevention is the biggest area where technologies can help and yet it is one of the areas that is hardest to demonstrate a return on investment. Proving what is not a hospital admission that would have been had it not been for the new technology is very difficult indeed.  One of the key individuals in any area for those wanting to operate in the prevention field is the Director of Public Health.  These posts are now based in local councils (county councils where there are two tier authorities) and having them on side early on will be critical to success.

7. Some technologists, primarily in the USA, believe that the future of healthcare delivery may be the smartphone. Do you think it's realistic that in England in 2018, patients will be performing certain diagnostics on themselves using Digital Health technologies?

If you think about the need to develop individuals as partners in their healthcare rather than simply recipients of it, I think there is a huge role for personal technology like smart phones in enabling this.  In my view the quicker we can get to this the better.  Where now we have some individuals monitoring simple things such as the number of steps they take through a pedometer, empowering individuals means they need to be able to monitor a whole range of diagnostics to monitor their ‘healthiness’ and identify at the earliest possible stage the requirement for intervention. 

There will inevitably be a nervousness and resistance amongst the professions to this.  Many pathologists were resistant to near patient testing when it was introduced and we are talking about something that is a whole stage on from that.  As a result initial demand for this technology is likely to come from individuals themselves wanting to take control of their own health rather than via the professions.  The bigger challenge will then be getting the professions to accept the results as valid!

[Disclosure: Maneesh Juneja has no commercial ties with Nene CCG]

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Think twice before sharing your data

Who needs hospitals? We have smartphones, sensors and data!

According to Eric Topol, who is one of the leading voices in Digital Health, the smartphone is going to be the healthcare delivery platform of the future. Awesome right? No need to go into a hospital in the future, the app on your phone can record your blood pressure and transmit it to your doctor via the internet etc. 

Is it just a few rich people in California who believe this? Not according to Intel's latest research (see infographic below on what health information people are willing to share). The survey collected responses from people in Brazil, China, France, India, Indonesia, Italy, Japan and the United States. 84% would share their vital stats like blood pressure and 75% would share information from a special monitor that's been swallowed to track internal organ health. In fact, India is the country most willing to share healthcare information to aid innovation. Super awesome news, right?

Eric Dishman, Intel fellow and general manager of the company's Health and Life Sciences Group, says "Most people appear to embrace a future of healthcare that allows them to get care outside hospital walls, lets them anonymously share their information for better outcomes, and personalizes care all the way down to an individual's specific genetic makeup." 

Also, this week was the mHealth Summit in Washington, DC. It's the largest event of it's kind, over 5,000 people from around the world gathered. I attended last year, but participated this year from London via Twitter. Amazing energy and bold visions of the future on mHealth. 

In fact, this week, I also participated in the world's first G8 Dementia Summit via Twitter. "Big Data" captured from patients around the globe was cited by many of the leaders as one of the ways in which we can work to beat Dementia by 2025. Yes, the G8 put a rather ambitious  goal of a cure (or disease modifying drug) by 2025. Again, we just need to collect all this data from individuals, remove personal information, make it anonymised, and Global Health in the future will be transformed, right?

Easier said than done

Unfortunately, many of the people at conferences who are envisioning a world where we happily share our personal health data altruistically for the benefit of medical research to improve Global Health are unaware of the realities on the ground. "Big Data" seems to be inserted by anyone and everyone into their speeches and tweets. Doctors, politicians, and corporate leaders frequently use the phrase, in the hope that more people will sit up and pay attention to what they are saying.

Let's take anonymisation. If someone tells you that your personal data will be anonymised and then aggregated and made available to 3rd parties, you believe them, when they tell you your data can't identify you. Let's see what the report from the Royal Society in June 2012 said; 

"the security of personal records in databases cannot be guaranteed through anonymisation procedures"

"Computer science has now demonstrated that the security of personal records in databases cannot be guaranteed through anonymisation procedures where identities are actively sought"

It's good to have people like Professor Ross Anderson who dare to question the viability of anonymisation. 

Now, there are tens of thousands of health apps, and generally how many of us take the time to read terms and conditions before downloading any app, let alone a health app? We trust the brand, don't we? How do we determine as consumers and patients, whether a health app is safe to use? 

A company in the US, Happtique is working on a program of certification for health apps. Definitely a worthwhile initiative. So whilst I was monitoring the Twitter stream during the mHealth Summit, I noticed a software developer, Harold Smith, at the event had shared his blog post with his findings that there were security issues with some apps that had passed the certification process at Happtique. Yes, shocking news, but even more shocking is how a lot of people in this industry don't seem to care. Kudos to Happtique, they did react swiftly to this news by suspending their certification program. 

Here in the UK, the NHS have set up a health apps library. Their review process is listed too. Their website says, "All apps submitted to the Health Apps Library are checked to make sure that they are relevant to people living in England; comply with data protection laws and comply with trusted sources of information, such as NHS Choices". I've got no reason to doubt the security of the apps on the NHS library, but I'm curious - what if someone independent like Harold Smith took a look at these apps? What would his findings be? 

2014 & beyond 

In an ideal world, none of us as end users would have to worry about the security & privacy of our personal health data. We all want improved health, and improved healthcare, and we are told that mobile technology, sensors & big data could make the world a much better place. As a Digital Health Futurist, I truly want to believe that. 

However, the road ahead is potentially very dangerous, largely because the froth and hype in Digital Health is overshadowing the need to have an open and candid discussion in society on the risks and benefits of going down this road. Companies such as GE, Intel, & Cisco are pumping billions into the Internet of Things. This week the Allseen Alliance was announced, standards to allow different devices to connect to each other. Again, exciting stuff, right? 

Imagine, your smart toilet connected to your smart fridge connected to your smartphone. Personalised meal suggestions on your phone based upon the combination of the clinical analysis of your urine and what food you have remaining in your fridge? More data about our health, more data about us being transmitted between devices and apps using wifi. Hmmm, how many of us have stopped to reflect upon what safeguards are needed to prevent our bodies from being the target of hackers? 

In principle, I'm not against any company or government collecting more data about us and our health. If collecting more data can help us develop a cure for diseases such as Cancer or Dementia, that would be an amazing achievement for science. 

However, I do want all of us, wherever we live on this planet, to be able to make INFORMED choices about how we share our health data, and who we share it with. Who will drive conversations that lead to a society where we can make informed choices about our health data? How do we get informed consent to participate in data sharing initiatives from those members of society who are vulnerable, such as children or older people with Dementia? Is that even ethical? 

One piece of good news that came out this week is that the Data & Society Research Institute is a new non-profit organisation launching in 2014. Based in New York City, it will be dedicated to addressing social, technical, ethical, legal, and policy issues that are emerging because of data-centric technological development. 

bill-of-rights.jpg

Data about us may be the key to improving the health of 7 billion people, but that can only happen if our rights are protected at all times. The issues are common to all personal data, not just health data. Perhaps the way forwards is the creation of an international bill of digital rights?

 

[Disclosure: I have no commercial ties with any of the companies mentioned above]

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Silicon Valley comes to Oxford 2013

I've attended Silicon Valley comes to the UK (SVC2UK) at the University of Cambridge for the last 3 years, which led to me quitting my job. The chance to attend, Silicon Valley comes to Oxford (SVCO) came up, and I registered, curious to see how it would compare. I knew the university was old, but I didn't realise exactly how old, until I asked Siri.

As you remember from my post a few weeks ago, my first impressions of SVC2UK in 2013 were not great, as no public wifi in the venue. So, full marks to University of Oxford for having free public wifi available in the venue, from the moment I entered the venue.

Also, I received a survey from SVCO asking for feedback, 2 days after the event. Contrast this with SVC2UK, which sent me a survey by email, 17 days after the event. It does make me wonder.

The day I registered for involved 20:20 sessions featuring leaders from California, along with the Oxford Union debate in the evening. Tracks for the day's sessions were Venture Capital, Tech Entrepreneurship, Technology Executives, Health Care & Tech, and Sales & Marketing in Tech. The primary interest for me was the Health Care sessions.

First up was Dr David Edwards, who talked about redesigning food & how it will impact human health over the next 2 decades. One venture he has founded is Aerolife, which currently makes air based smart nutrition products. He was giving out samples after his talk. I took the breathable energy, excited to try it out. I tried it out today. Loved the energy boost and mode of delivery, but it left a horrible taste in my mouth. I was compelled to then drink a cup of coffee to get rid of the taste!

Next was Gary Lauer, CEO of eHealth who talked about the consumer centric approach in healthcare.

I spend so much time with medical professionals, investors, techies & patients, that hearing Stacey's Chang talk was very refreshing. Director of the IDEO Healthcare Practice, his talk was about 'Returning Humanity to Healthcare'. It wasn't just me who appreciated his unique perspective, you could see by the tweets and reactions of people around the room. One of the best talks I've heard in 2013.

For the last session, I decided to hear Michael Fertik, CEO of Reputation.com, talk about the future of Big Data, Privacy & the Individual. I didn't necessarily learn anything new, but it was the manner in which he explained his thoughts which was well received. Do we want to be a data serf or a data landlord?

Now, we had the chance after each of the 20:20 sessions to ask questions, plenty of time was allotted, and it was fairly informal. All of the speakers were great at taking questions, apart from one, who behaved arrogantly, Michael Fertik. People who had just heard him speak, asked him questions, and he interrupted, in a sarcastic tone, each person who was asking him a question. We had quietly listened to his talk, and yet he couldn't show the same respect when audience asked him questions? Maybe he was trying to be humourous, but he came across as a complete idiot. 

Should we rest our hopes on technology?

In the evening was the Oxford Union debate. So exciting, given that it's been going for 189 years, and is considered the world's most prestigious debating society. 

Panoramic view of Oxford Union's debating chamber

Panoramic view of Oxford Union's debating chamber

Dr Catherine Mohr

Dr Catherine Mohr

The debate was centered around one thing, "This house believes that the technology revolution will solve the global health care crisis". I really enjoyed it, as did the 8 leaders from Silicon Valley who participated. What's fascinating is that Dr Catherine Mohr, Director of Medical Research at Intuitive Surgical was the ONLY woman who was part of the debate, and everyone thought she was brilliant too, judging by the applause. Oh the final result, the opposition won the debate. I was one of those who voted for the opposition. I don't believe technology can solve ALL of the problems in Global Health. Certain problems can only be solved by using the ultimate technology, our brains! I managed to record the opening minutes of the debate being introduced, video is below (and is quite fun to watch).  

The beginning of the debate, opening remarks by Joe Dinucci

Mindset & Culture

I really appreciate events like SVCO & SVC2UK, as I'm sure there is much preparation involved. Both are now firmly on my calendar for 2014. However, these events are just one element of the change that is needed in the UK. Yes, we have brilliant minds in the UK, and yet why is that many of those brilliant minds only flourish once they relocate to Silicon Valley. In my numerous visits to the Valley, I observe how the 'energy', the 'culture', the 'mindset' is so unique and inspires me each time I'm over there. Reading this great article this week on Silicon Valley, two sentences stand out,

  1. Silicon Valley is as much about mindset as it is about the location.

  2. This mindset is something rarely studied as it is woven through the fabric of the Valley and difficult to see.

I don't have the answers about how we cultivate that 'mindset' in this country. If you do, I'd love to know what your thoughts are. 

Perhaps, it's too late for those of us who've been through the established education system here? Maybe it's the 5 year old children of today who we need to influence and inspire, as both their hearts & minds are relatively more open than the MBA graduates of today? Perhaps in 2014, we can have "Silicon Valley comes to your primary school"?

In healthcare, the reality is often far different than events such as SVCO. Starting a business and creating new technology is the easy part, finding people willing to pay for your innovation is much harder, and sometimes impossible. Pascal Lardier, who runs the international conferences for Health 2.0, recently wrote about how the NHS isn't doing as well as it wanted to, when it comes to working with UK health tech startups.

We were told at the start of Sunday by Professor Andrew Hamilton, Vice-Chancellor, University of Oxford that the university wanted to be more like Stanford & Berkeley. That we shouldn't be fooled by the old architecture, we are a very modern university. However, having visited both Stanford & Berkeley, I was struck by how many people in suits were in attendance at the event in Oxford. When I attend events in the Valley, I'm struck by how few people are wearing suits. This is what I mean about 'mindset' and 'culture'. 

What were people saying on Twitter?

Not that much actually. Despite the fact that the printed program had the Twitter handle of each speaker listed (well, actually, out of 51 speakers, 24 had a Twitter handle). Kudos to the organisers, most events I attend do not list this in the program, and you waste time searching to see if the speaker you're hearing is on Twitter. 

Given the multi-billion dollar IPO of Twitter this year, I was surprised by the low number of people at an event with 'Silicon Valley' in the title engaging in the Twitter conversation. Apparently, 600 attendees the day I attended. Being a data person, I turned to Tweet Binder to analyse the hashtag of the event, #SVCO to gather evidence You can see excerpts from the report below. Naturally, if someone tweeted during the event, without the hashtag, it's not included in the report. So, 247 original tweets from 179 contributors. Interesting stuff! 

Twitter hashtag analysis #SVCO

Twitter hashtag analysis #SVCO

So who exactly was tweeting? If you've read my previous posts, you'll know that I'm very active on Twitter. The definition of 'Most Active' in this report is the contributor who sent the highest number of tweets (RTs included). 'Most popular' is simply the number of followers for each contributor, it's the 'highest impact', defined as number of tweets or RTs multiplied by number of followers for that contributor. 

Twitter hashtag analysis #SVCO

Twitter hashtag analysis #SVCO

Conclusion

Overall, an enjoyable, inspiring and educational day, and the organisers must be applauded for running this for the 13th year. I got a dose of Silicon Valley without having to sit on a plane for 11 hours!

In fact, I met people at the event that may be interested in working with me in 2014 in the area of Digital Health. A totally unexpected bonus. It reminds me that despite our fixation with being online in the digital economy, we can learn so much by connecting with people in real life at events such as SVCO.

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Highlights from Health 2.0 Europe

At the start of this week, Health 2.0 Europe began. Previous held in Berlin, the event has now moved to London. Having been to Health 2.0 Europe last year, Health 2.0 Middle East and Health 2.0 Silicon Valley this year, I was pleasantly surprised to see many new faces at the event. I didn't recognise the majority of delegates.

Great to see such enthusiasm, and looks of surprise and amazement on people's faces as they watched demos on the stage. I've seen so much in this space myself through running the Health 2.0 London Chapter, that I didn't see what the fuss was about. I then realised that I'm part of a bubble. Whilst being able to use an app for medication adherence may seem 'normal' to me, for the vast majority of people, it's still something they've never seen before.

I wasn't able to attend every session, so these highlights are from sessions I did attend. Additionally, if you want to get a flavour of Health 2.0 Silicon Valley, you can read my posts about Day 1, Day 2 & Day 3.

Day 1

Back to London, in the first session, Improving and Enriching the Patient-Provider Relationship, 3 out of the 4 demos were from US companies. That led to some in the audience feeling surprised.

However, the reality is that there are far fewer companies in this space in Europe vs the USA, even fewer when you are looking for high quality companies with a high quality product or service to demo on stage. Whilst the conference could have perhaps had only EU companies on stage, the conference would have probably been over by mid-afternoon on Day 1.

As part of the first session, it was encouraging to see a real patient on stage sharing their experience.

Next up from NHS England, were Tim Kelsey and Geraint Lewis giving a double keynote on what's happening with NHS data. Care.data is one of the big initiatives that was mentioned. For a fascinating and thought provoking article on care.data which just was published yesterday, take a look here.

The session on Health 2.0 for the brain was well received. Jon Stamford, himself a Parkinsons' patient said that the best app is the one that people will want to use. So true.

We had a session called NHS Compass with Alex Abbott and Tracey Watson who shared their one year plan to open the NHS up for business. One great question from the audience was whether NHS England would have any influence over the local trusts to buy products & services from SMEs? It didn't sound like they have any influence, and the question was for the most part, avoided. We heard from Tracey that NHS England are likely to set up a 'Centre of Excellence' and new processes and procedures as part of the plan to help entrepreneurs navigate the NHS. Many entrepreneurs in this space have left the NHS to pursue their ideas without getting entangled in bureacracy, processes & procedures. To be fair, the NHS is extremely complex, it employs 1.7 million, and it's going to take time to change such a large organisation. Could you or I do a better job of opening up the NHS to startups? Maybe, maybe not. The task of doing so is immense, so kudos for the NHS for starting to change. 

However, myself and other entrepreneurs aren't interested in hearing about the IT failures of the past, or the internal problems facing the NHS today. They simply want to know exactly which person they need to speak to if they have an app that could help the NHS. They want to know what tech solutions the NHS is willing to pay for. Why doesn't NHS England have one website that lists all the current 'wants', just like GSK Consumer Healthcare does?

Now, when it comes to the catering at Health 2.0 Europe, many delegates told me how they were impressed with the food. However, Inga Deakin's tweet during one coffee break made me smile. Even when I worked at GSK, vending machines were stuffed full of fizzy drinks, chocolate bars and crisps.

One of the most inspiring sessions of the entire conference for me was the 'Empowering patients session'. The audience loved hearing from Maria Gjerpe, a patient from Norway who raised $1.2 million for a clinical trial using crowdfunding. Now that's what you call courageous leadership. We need more people like her within the healthcare system itself. More on here story here.

Day 2

The first session was on Sensors & Tracking: Quantifying the Self & Listening to Your Body. One of the speakers, Adriana Lukas who runs Quantified Self London, pointed out that whilst self-tracking leaders to greater self awareness, most people stop tracking after 3 months. I heard a new term mentioned during this session, Email Apnea. Yes, many of us stop breathing whilst reading an email.

In the session on Health 2.0 Tools for Doctors & Hospitals, we heard from Chris Farmer on how it can be a challenge for doctors in the hospital to share data with each other, i.e. medical photography due to consent models. Chris also told us that sometimes, they have to use 7 or 8 different software applications to view data in a single clinic. When I hear from people like Chris, I realise that we have people on the inside of healthcare systems who are equally as frustrated with the status quo when it comes to not having access to the right technologies.

Many of us have ideas but we often need someone to invest in our idea. Financing Health 2.0: Who's Stepping Up? was a fascinating and candid discussion. It is very challenging here in Europe. Every time a startup in Europe asks me about getting funding, I remind them of something I read in the Startup Genome report published in Nov 2012, "Even developed ecosystems such as New York and London have more than 70 percent less risk capital available than Silicon Valley". When you add the scarcity of risk capital, the fear of failure, and the challenges of doing business with the NHS, I don't find it surprising when I see European entrepreneurs heading to the US in order to follow their dreams. I find it sad, that after quitting my job in 2012, and becoming a consultant in the field of Digital Health, I still don't have any clients in the UK. The only organisations who pay me to work for them are all outside of the UK. As much as I'd like the country of my birth, the UK, to succeed and prosper, I now encourage any startups that ask for my advice, to also consider either Silicon Valley or an Emerging Market. There are even entrepreneurs in the UK who give up on their ideas here, since they aren't likely to make any money from them. 

A great talk from Richard Smith, about the rise of chronic disease in the world, and that a lot of patients don't take their drugs. Many in the area of Digital Health see apps as a possible path towards behaviour change. I remain unconvinced, and this post by Nir Eyal on why behaviour change apps fail to change behaviour is one of my favourite things I've read in 2013.

The final session of the day was Not your mother's Health 2.0, covering the topics that health tech conferences don't actually have on the agenda. I loved all of the demos. Mark Steedman, an expert in End of Life Care, remarked that we don't study how people die. He also told us that most people want to die at home, but actually die in hospital. Mark challenged the entrepreneurs in the audience to develop technology that could help End of Life Care.

Ever wished you could check how much alcohol is in your blood before you drive a car? Dr Gautam Mehta has developed a gadget that plugs into the headphone jack of your phone that will allow you to do that.

So, what was it like?

In conclusion, fascinating to see how much this scene in Europe has progressed in just a few years. It's encouraging for those that want to support European entrepreneurs, and inspiring for those who have ideas but have yet to make the jump into doing their own startup. The Twitter stream was very active at this conference, and I hope that this event has triggered new conversations here in Europe. I was impressed to see how much energy there was during the final coffee break of the conference. One suggestion for next year is to have a patient in each session. I believe having a patient in each session would provided much needed insights into what they actually need (and want to use!).

Lots of energy during the final coffee break on Day 2

Lots of energy during the final coffee break on Day 2

We can come up with so many innovations, but the ultimate question is, "Who is going to pay for it?". Whilst many of my friends have left Europe to either head to California or an Emerging Market, there are rays of hope here. One UK startup, uMotif, was on stage twice at this conference. Once in my pre-conference workshop on Sunday, and again on Monday on the main stage. I remember when I invited them to demo at my Health 2.0 London event on mHealth back in September 2012. It's been amazing to see them go from strength to strength. Just recently, they beat hundreds of other startups to win Cisco's British Innovation Gateway award, with a prize package worth $200,000.

So, it IS possible to succeed without being in Silicon Valley.

Can't wait until Health 2.0 Europe 2014? We have 3 Chapters in the UK. Health 2.0 Manchester & Health 2.0 Birmingham. In terms of the Health 2.0 London Chapter, which I run as a volunteer, we now have 540 members. I've already scheduled 4 events for 2014. A big thanks to the ICTKTN for sponsoring our events. The events are kept small as we've found it works well in 2013. If you are interested in attending, don't be put off by the fact that all of the events are full. Join the waiting list, as many people registered can't attend due to work & family, so people on the waiting list usually get a space. 

  • Jan 22nd - Digital Health: How do we avoid 'Digital Exclusion' in Health & Social Care? 

  • Feb 19th - Digital Health in UK hospitals: Hope or Hype?

  • Mar 18th - The Internet of Things: Could this be the catalyst for innovation in the NHS?

  • Apr 16th - Does giving patients more data actually increase engagement & improve outcomes?

[Disclosure: I have no commercial ties with the companies listed above, apart from Health 2.0, which uses me as a consultant from time to time]

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Ontario: The global hub for 'science driven' wearable tech startups?

Last week I was part of a panel discussion in Toronto, Canada. Hosted by MaRS and Ontario Genomics Institute (OGI), the topic was Big Data and Personalized Medicine. The event was part of the MaRS Global Leadership series. MaRS is a place where science, technology and social entrepreneurs come together and get the help they need, where new conversations take place, and innovation is actively nurtured. OGI is a private, not-for-profit corporation focused on using world-class research to create strategic genomics resources and accelerate Ontario’s development of a globally-competitive life sciences sector.

Rhonda Tannenbaum, VP of Business Development at Ontario Genomics Institute introducing the event

Rhonda Tannenbaum, VP of Business Development at Ontario Genomics Institute introducing the event

The other two panellists had amazing backgrounds. Phyllis Frosst, Senior Policy Fellow at the Personalised Medicine Coalition, and Fiona Stewart, practices at Belfast City Hospital, specialises in Clinical Genetics & also is part of the UK Genetic testing network. I learnt so much from spending time with them (as did the audience).

 

I shared my thoughts on trends in Digital Health and what it means from a data perspective. Such as the forthcoming explosion of data generated by our bodies 24/7 but now being captured by sensors, apps and genetic tests. How will it best be shared? How will it be governed? Do we need to rethink data privacy & security in the 21st century? How can patients be given real-time dynamic consent when it comes to toggling levels of access to their health data? How can these data support personalised medicine or will they just be meaningless datasets in 5 years time? One of the last questions from the audience was whether these trends in technology & data will lead to Canada's population being served in the future by doctors based in other countries. Healthcare without borders may well be one of the options employed in order to cope with rising costs.

Participating in the event reminded of the need for more 'science driven' health tech startups. In the world of health & social care, which is used to evidence based medicine, I believe those startups which are based upon good science, have the greatest chances of long term success & prosperity.

Science driven wearable tech startups

Whilst I was in Toronto, I decided to grab some time with a number of wearable tech startups that are based out there. After meeting them, I was truly impressed by their passion, 'science driven' approach, and their humility. None of the arrogance and false superiority displayed by many startups I've met in other places.

I met with Mike Lovas from PUSH. They are working on the first fitness tracking device that measures strength. When performing your bench press, squats, or deadlift in the gym, the device promises to capture sets, reps, force output, power, and velocity. The goal of PUSH is not to replace the human trainer/coach, but to support the trainer. I started imagining the possibilities of combining PUSH with other wearable tech. For example, what if during your squats, PUSH records your strength, your Lumoback would measure your posture, and smart socks from Sensoria would measure if your feet are moving in the wrong direction. Combine all of the resulting data, and provide real-time feedback via earphones to the person performing the exercise. Not only does this feedback loop optimise your workout, but you could prevent injuries due to poor technique. Wouldn't that be awesome? You can hear more about PUSH in the video.

Mike Lovas, Chief Design Officer, co-founder at PUSH 

Next I met with, Ashley Beattie from Kiwi Wearable Technologies. They are currently working on the kiwi move, which is is an internet-enabled motion sensing device and can be used to track your activity, automate your home and even secure your valuables. We didn't have much time for our meeting, so didn't get a chance to view their device. However, I was enthralled by the conversation with Ashley and the vision for Kiwi. I remember that he told me, "the dominant wearable tech company of the future wll be a platform company, having multiple apps, with one device, creating a 'pivot chart' for your sensor data." Definitely a company to keep an eye on. You can hear more about Kiwi in the video.

Ashley Beattie, co-founder, Kiwi Wearables 

Running around Toronto, I popped into the offices of Interaxon, and caught up with Trevor Coleman. In addition to being the person that persuaded me to start using Twitter back in early 2012, when I met him at Wisdom 2.0 in Silicon Valley, he's working on MUSE, their new brain sensing headband. I admire how they want people to use the technology to actually connect to themselves. Trevor possesses unique insights into the merging of wisdom & technology. I'm excited to see reactions from consumers once the product starts shipping in 2014. Hear more from Trevor in the video.

Trevor Coleman, Chief Product Officer, Interaxon

Finally, I got a chance to meet the super busy Saul Colt, principal at Kinetic Cafe and also the head of the new Fresh Startups program. Saul is a pioneer who is challenging the status quo when it comes to our beliefs regarding accelerating and incubating health tech startups. Their differentiator is their partnership with Freshii, a health food restaurant chain looking to shake up fast food while keeping meals healthy. You must watch the short video of Saul explaining why he started the Fresh Startups program. 

Saul Colt, Founder, Fresh Startups 

I meet a lot of startups, in different parts of the world, but in Toronto, something seemed to make them different. Their commitment to creating 'science driven' wearable technology in the world of fitness & health. I see so many startups in this area developing a product simply because it's cool or sexy, but based on little or no science. What seems to give Toronto's wearable tech startups an edge over other parts of the world can be found by driving 115km away from Toronto, to the University of Waterloo. "Every Canadian in a successful startup seems to be from the University of Waterloo", remarked Mike Lovas.

According to Startup Genome’s Startup Ecosystem Report 2013, three Canadian cities rank among the top 20 most active startup scenes in the world. Toronto, Vancouver & Waterloo. I'm seriously impressed that Waterloo is ranked 16th, just behind Berlin. Why am I impressed? The population of Waterloo is just 124,600! I didn't get a chance to meet Airo Health, and Thalmic Labs, two more wearable tech startups, who are based near Waterloo.

UK Independence Party advert

UK Independence Party advert

From a cultural perspective, whilst the UK Independence Party is trying to change influence policy to limit immigration, Toronto in particular seems to be welcoming immigrants with open arms. Nearly 50% of Toronto's population is foreign born. That's critical when it comes to attracting global talent.

Poster in downtown Toronto welcoming new immigrants

Poster in downtown Toronto welcoming new immigrants

My experiences in Toronto have left me enlightened and inspired. My last thoughts as I headed back to London, were that if current trends continue, the province of Ontario (which includes Toronto and Waterloo) may well become the global hub for 'science driven' wearable tech startups.

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