Ideas need people, not just inspiration

Before I write about my decision to find a coworking space in London to operate from, I just want to quickly follow up regarding my last post on wearables. An interview with Dr Jay Parkinson, a "physician entrepreneur" who some call the doctor of the future, was published last week. When asked his opinion on wearables, he dismisses them as "nonsense". He also states that "I don't think people will ever use webcams in a significant way in healthcare", when asked about the possibility of people being diagnosed through webcam and mobile apps.

I ask you then, if wearables truly are nonsense as he believes, then why is the US Air Force researching developing wearable sweat sensors for realtime blood test results? When it comes to video calling in healthcare, why is the University Hospital of North Staffordshire in England undertaking a trial where doctors will consult with patients via Skype?  Have the US Air Force & NHS got it all wrong? 

My search for a place to interact with others

Now, ever since I quit my job, and have been doing my own thing, I tend to work at home, or work in coffee shops when I've got meetings in London. I can work anywhere in the world, chiefly because much of my work involves working with data. However, despite all the progress I've achieved, there are days when I feel isolated. Particularly when I'm contemplating new ideas. I experienced this as an entrepreneur before when I quit my job to daytrade on the UK stockmarket back in the dotcom boom of late 90s. I made (and lost) in 6 months, enough money to buy a Ferrari [just a figure of speech, never actually bought one!], but the experience was socially isolating, and one of the main drivers in me going back into a salaried job in a buzzy office in an advertising agency. 

However, times have changed, especially here in London. In certain parts of the city, there are an abundance of co-working spaces. I went to check some of them out. Some great places, but a mixed bag.

I found many coworking spaces seem to be designed for 5 year old children, given the horrible little chairs they have on offer. I work in the world of health, I wanted a space that had ergonomic chairs. 

I turned to Twitter to see what the crowd could suggest. 

So a coworking space named "Huckletree" replied, and so I paid them a visit, and tried working there for a day. I travel so much I don't really need a permanent desk, just a community that I can 'hot desk' in when I'm in town. 

I was impressed by the experience, I signed up for their flexible package, allowing me 10 days of 'hot desking' a month. So why did I choose this unknown space, when there are many more established and well regarded coworking spaces in London? 

7 reasons 

1. Community, community, community. I've learnt over the years that the communities you inhabit and/or create can either open your mind or close your mind to new opportunities. Whilst many tech coworking spaces have very diverse communities inside the offices, the environment once you leave the space is very tech centred. What I love about Huckletree's location is that it's in the middle of Clerkenwell, a bustling London community. When I step out of their space, I come across all sorts of people, from office workers grabbing their cappucinos before work, to workers from the historic Smithfield market who might be finishing their shift. It's also literally moments away from the pub where I held my first Health 2.0 London event in 2012, so maybe there is a special energy about the area for me?

The sensor of humour adds to the vibe!

The sensor of humour adds to the vibe!

2. The other coworkers - a really mixed bunch, it's truly refreshing for me. The space is still just a few weeks old, so it's not full up yet. However, the people I've met there so far are in completely different industries (not all are tech), working on some very fun projects and ideas. It's easy for one to get stuck in a groove, especially as one gets older. Already, I've had my thinking challenged by conversations I've had at Huckletree over a coffee, and I hope that continues with each visit. 

3. The potential - I'm inspired by those who dare to be different, who experiment, who take risks in life. When I did my trial day, I could 'feel' the potential for Huckletree to become one of the best coworking spaces on the planet. Like many of the decisions I've made in my career, I've simply listened to my 'gut feeling'. I don't know if Huckletree will become the best coworking space in the world, but I don't see why not, and I want to be part of their journey. 

2.1A USB sockets!

2.1A USB sockets!

4. The small details - Regular readers will have noticed I have an array of gadgets, and all of these gadgets run on batteries that need charging. As a geek, I always search for USB power ports that offer 2.1A, as it means faster charging of my devices. At Huckletree, I noticed each desk had TWO 2.1A USB ports for charging devices. That makes a BIG difference to me. In addition, they have an abundance of regular power sockets. 

20140502_191300.jpg

5. Sustainability - It's the UK's first sustainable coworking space, and that's to be applauded. It's again the small details that I notice, from the eco-kettle, to the sheer amount of natural light that pervades the space through the multiple windows. 

6. Hours of operation - I found some coworking spaces didn't offer pay as you go memberships and/or were limited to 9-5 office hours. Many of my clients are based in the US, and the fact that Huckletree are open until 8.30pm Mon-Fri, is really useful for me. 

7. Multiple spaces - I often need peace and quiet when doing some research, and sometimes I'm on the phone all afternoon. Sometimes I want to have a private phone call where nobody can hear me. I was impressed that Huckletree has been designed to cover all my needs. One floor looks like a normal coworking space, but when you go to the top floor, it's designed to be a 'quiet' space with no phone calls allowed. In addition, there are 'Time Machine' booths where you can have that private phone call or teleconference. 

The quiet area on the very top floor

The quiet area on the very top floor

I also found the vibe of the founder, Gabriela Hersham to be very unique, and it's her values that resonate throughout the space. It's clear that Gabriella has put her heart & soul into creating Huckletree, and since that's how I approach my projects too, it reminds me of how powerful it can be when one is authentic and aligned to one's core values. 

Here is a short video from Gabriela explaining more about Huckletree. 

For readers of my blog who decide to sign up to Huckletree before May 31st 2014, I've managed to get you 15% off your first month's fees. Simply use the promotion code, thanksmaneesh. 

Huckletree may not be to everyone's tastes, but I'm likely to be working from Huckletree at least 2 days a week. So if you find yourself in the area and wanting to chat about Digital Health over a cup of coffee, don't be a stranger! 

[Disclosure: I have no commercial ties with Huckletree] 

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Wearables: Hope or Hype?

I've been thinking about this question a lot in 2014. I'm seeing more articles proclaiming that wearable technology is a 'fad', has no 'practical' value, and in the context of health are often viewed as inferior to officially certified & regulated medical devices.

"Technology is beyond good or bad", said Tamara Sword, at yesterday's Wearable Horizons event. Now, a very common piece of technology in our kitchen, the knife, is a classic example. Used for it's purpose, it speeds up the food preparation process by slicing carrots. However, it can also be used for harm, if used to slice a finger off.

The same goes with wearable technology like Google Glass. It can do immense good, such as saving someone's life. However, it could also be used to harm, if someone wearing Glass takes a picture of your 5 year old child in Starbucks without obtaining consent from your child or yourself [credit to the visionary John Havens for making me think about the Starbucks scenario]

We all have to start somewhere

We have to remember that the market for wearables is embryonic, it's not mature in any shape or size. Every innovation I see & test is crude & clumsy, with many flaws. Thinking back to 1903, wasn't the first airplane crude & clumsy?  Wearables WILL evolve, just like the the airplane [Hopefully, it won't take 111 years like the airplane] 

I salute those willing to take a risk and develop wearable technology. From the lone entrepreneurs to Nike, what unites them is that they took a risk. They experimented. Experiments don't always turn out to be successful, noting Nike's recent withdrawal from Wearables. That's entirely normal, we can't expect everyone to succeed at their first attempt. What would our world look like today, if Steve Jobs had given up after his first attempt? 

How many of you failed your driving test the first time? Instead of dismissing the brave efforts of those willing to take a risk into the unknown, we should be encouraging & supporting them. It's those willing to take those chances, to explore unknown waters, to imagine a better world, that have helped humanity make so much progress. 

Courageous conversations

There are many questions around wearables that remain unanswered. There are uncomfortable, awkward & terrifying conversations surrounding the use of wearable technology that are sorely needed, not just within society, but within our political, legal and regulatory framework too. If we place a piece of wearable tech on a patient with dementia, how do we obtain informed consent from the patient?

When I saw the recent headline that a hospital in Boston is equipping everyone in the ER room with Google Glass, my first reaction was one of excitement, with my second reaction being one one of curiosity. What happens to the face & voice data? At 3am, when the ambulance rushes you & your sick child to the hospital, will you really stop to ask the hospital staff, what the privacy policy is, regarding the images captured using Google Glass of your child in the hospital?

I observe that many, including those in the business of creating or using regulated medical devices, look down upon some wearable technologies. Activity trackers are frequently viewed as fun toys, not 'proper' medical devices.

Let me ask you something. If an overweight & inactive person aged 40, uses a $99 Fitbit to track their activity & sleep, leading to insights that trigger behaviour change over the long term, is it still a toy? For example, what if developing the habit of walking 10,000 steps a day (versus 1,000 today), reduces their risk of a heart attack, delays the onset of Diabetes or even prevents high blood pressure? Still just a 'glorified' pedometer?

Imagining a better tomorrow

I believe wearable technology, particularly for health, is just one step on the journey in today's digital world. There will continue to be failures, and whilst there is significant froth & hype, there is also significant hope. Our ability to imagine a better future is what has gotten us to where we are today. Imagination could be one of the most useful attributes for any organisation wishing to meet the challenges facing human health in the 21st century.

It appears likely that firms which don't have roots in health could be helping us realise this new world. Perhaps this shift frightens those firms that have got their roots in health? I'm intrigued to note that Samsung, are holding an event in San Francisco later this month, promising that a new conversation about health is about to begin. Having visited South Korea a few years ago, and learning so much about Samsung's history & vision, I'm going to be watching what they do very closely. 

Is it a bad thing if wearable technology (and the resulting data, insights & education) empowers patients and makes them less dependent on doctors & the healthcare system?

Is it wrong to dream of 'smart fabrics' where our health could be monitored 24 hours a day?

Is it silly to want to develop sensors that could one day transmit data directly from our internal organs to our doctors?

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Want to innovate? Start listening

In my last post, I wrote about the launch of the Babylon health service here in the UK, and how I observed the omission of the T&Cs and privacy policy from the website. I tweeted about it early on Tuesday morning, and by Wednesday evening, Babylon's website had been updated. Ali Parsa, founder of Babylon left a comment at the bottom of that blog post, explaining that they'd listened to me, and made changes to their website. This simple act of listening (and responding swiftly) is extremely powerful in fostering a culture of trust. Other healthcare organisations, both large & small would be well placed to learn from Babylon's leadership. It's also a lesson for innovators, who would benefit from listening to the needs & potential concerns of their users before launching a new product. 

Still begs the question, if innovators working in a regulated space, are legally obliged to have such lengthy terms, full of complex legal jargon, what if we had easy to understand terms for mobile health apps? Would that result in MORE patients feeling they can trust these new services?

If the regulators are listening, please do something about this.

It's disconcerting to observe brilliant people like Ali Parsa, pushing the boundaries of healthcare but having to operate within a regulatory framework designed for the 20th century. 

Listening & connecting - it's an exciting combination! 

I was honoured to be part of a panel discussion yesterday, titled 'Facilitating innovation with Open Health Data', hosted by the Connected Digital Economy Catapult. It was the launch of the Open Health Data platform, where "We're challenging technologists, analysts, visualisers and businesses to show the world what can be done with open health data." [For a definition of Open Data, see here]

The discussion generated a number of insights, many of which centred around privacy of our health data, and who in the future will have access to it, and who might be profiting from it. It's clear that simply saying, let's share more of our health data in the public domain so we can innovate in healthcare, is not enough to convince the general public. A national (and ideally global) debate to help us move forwards is sorely needed. Is anyone listening?

From my perspective, yesterday was also the tube strike in London, so many people, had to walk much more than normal (including me).

It got me thinking, what if Open Health data was 'mashed up' with the aggregate data from Fitbit users in London to quantify the impact of the tube strike on both people's health as well as the NHS? Would a side effect of the tube strike mean that people walked more and the number of visits to GPs declined in the next few days? Or would this 'mashup' reveal that there were more walking related injuries placing pressure on the system? If the former, should London's public health policy including closing the tube once a month?

What if GPS data of ambulances was open, just like the bus & train GPS? Could a startup build an app that allowed you to understand exactly how long it would be before the ambulance arrived to your home? Would such an app have helped the rugby player who waited 2 hours for an ambulance? 

What was most surprising for me was how the Neil Crockett, the CEO of this new 'Digital Catapult' wanted to listen to the audience and understand what they needed to build new services, new companies and to innovate in Digital Health. I've often returned to London after my visits to Silicon Valley, feeling frustrated and despondent with some of the 'risk averse' attitudes displayed by some leaders in London (when compared with the mindset of leaders in the Valley).

However, I left the event yesterday feeling full of hope for the future, that there is now an organisation in my home city that is truly prepared to listen to the needs of Digital innovators. In my eyes, it's a real turning point, and over time, might even encourage our brightest minds to stay in the UK rather than leaving for Silicon Valley. 

Taken from the Digital Catapult's website, "Our key differentiator lies in our neutral convenor role. There are many opportunities for industry-led innovation and growth that have not gained traction because of commercial tensions between the players. The UK's innovation landscape has many areas of excellence but is often fragmented and lacks critical mass – we will act as a connector to bring innovators together to collaborate on programmes and projects of significance." 

Upon leaving the event, I got an email about an event in London next month, 'The future of Digital Britain: Why technology should be front & centre of parties' ideas for the 2015 election'. Is it me, or do others also feel a new energy pulsating through the UK this year?

The rise (and fall) of Wearable Technology?

You may have noticed recently that commentators are dismissing 'wearable tech' as a fad & that the market is dead. Well, two signs it might not be a fad. The world's largest online retailer, Amazon, has just launched a 'wearable tech' storefront. 

Then, this weekend in London, a 2 day free (but sold out!) event on Wearable Technologies, not just with demos of current tech, but asking questions such as;

"Will your smartphone soon become outmoded?" 

"Will you be buying clothing with location technologies?"

"Maybe your socks will record your journey history?" 

So, WHO do you currently listen to? Are you listening to the people who created the past, or are you listening to the people creating the future?

If you are listening, are you listening without judgement?

What's it going to take before your organisation decides that 'listening' becomes one of the key ingredients in the recipe for innovation in Digital Health?

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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. 

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. 

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Burning Man and Innovation - What's the connection?

What is Burning Man? 

Some call it the biggest party on the planet. Wikipedia mentions that it is described as an experiment in community, art, radical self-expression, and radical self-reliance. The Burning Man website says that trying to explain what Burning Man is to someone who has never been to the event is a bit like trying to explain what a particular colour looks like to someone who is blind.

It's linked to startup culture, since Eric Schmidt, the CEO of Google was hired by Sergey Brin, and Larry Page in 2001, partly because "He was the only candidate who had been to Burning Man". I remember spending 2 days during 2012 at an unconference in Google's Mountain View headquarters. In one of the buildings, I noticed many photographs of Burning Man plastered over multiple walls. One of my hosts told me, he takes his entire team from Google to Burning Man each year. 

I heard that many startups are created during those 8 days in the dusty Nevada desert each year. If you stand up at many tech events in Silicon Valley and ask the 'burners' in the room to put their hands up, a lot of hands go up! ['Burner' is the term used to describe people that have attended] Whatever your opinion, it's most definitely a unique experience. Trying to reach many of my friends in Silicon Valley when Burning Man occurs is usually tough, as many are at Black Rock City.

Why did I attend? 

I tracked down one of the motorised cupcakes the next morning.

I tracked down one of the motorised cupcakes the next morning.

It was 2010, I was on my 6 month round the world trip. I had no plans to visit the USA during my journey, but a very good friend who had been to Burning Man in 2009, insisted that I needed to go. He told me that this would change my life. Nothing would prepare me for what I was going to experience. He was right as I'm still digesting the experience of attending Burning Man, 4 years later! 

The experience

It's simply staggering, how 50,000 strangers come together and build a city in the desert, including streets!  How do you describe riding a bike at 2am in the desert, and hearing a stranger call out, "Dude, you're awesome!"? Zooming alongside me, was a guy driving a motorised cupcake, decorated with flashing lights.

One of the 10 principles of Burning Man, is gifting. I will never forget walking down one of the main streets on an extremely hot day, and seeing a queue of people. Someone was gifting ice cream! Another principle is radical inclusion. There was an amazing atmosphere of tolerance and acceptance. Nobody was judging you. I recall walking down the street, and a guy in a yellow alien outfit needed help finding the toilets. His costume didn't fit very well, and he couldn't see out of it easily. As I helped him to his destination, we chatted. It turns out his was a high flying corporate lawyer from Washington, DC. Yes, there were quite a few naked people wandering around as well, including some very beautiful women! At first, it was really bizarre. After a couple of days, you just got used to another of those 10 principles, Radical Self-expression. 

beyourself.jpg

I'll never forget meeting a chap called 'Mitch' one day, who was from Montana. He was mid 50s, and his wife had just left him. Instead of lounging in self-pity, he packed a small backpack, grabbed his bicycle and cycled alone 800 miles south to take part in Burning Man. Mitch had run out of food & water after 3 days in his tent. So I invited him to our 'camp' to have dinner with us, and we learned more about his life story. Another one of the principles, is Radical Self-reliance. 

How did it impact my approach to innovation? 

It definitely impacted my creative approach to problem solving. When solving problems at work, you go through many ideas. The level of creativity expressed at Burning Man was simply exceptional [and that's over and above my experience of working in an advertising agency]. I believe many of the innovative projects I've delivered in the last few years are inspired by what I saw and heard on the 'playa'. 

The concept of gifting, without expecting anything in return really inspired me. When I was at GSK, I spent lunchtimes working on organising events to bring different people from the company together to network and exchange ideas. It wasn't part of my job description, and it wouldn't lead to a bigger bonus or increase in pay. Some colleagues asked me, Why are you doing this? I also founded Health 2.0 London based upon the principle of gifting. I do my best to curate each event like a mini TED conference, and my time was not paid, and there was no charge for attendance. Again, people kept asking me, What do you get out of this? You could be using your time on paid projects. 

The other principle I experienced was participation.  Taken from the website,

"We believe that transformative change, whether in the individual or in society, can occur only through the medium of deeply personal participation. We achieve being through doing. Everyone is invited to work. Everyone is invited to play."

The view of the street from our camp

The view of the street from our camp

So, whether I'm inviting people to a Health 2.0 London event, or working with one of my clients, I do my best to include people in the work I'm looking to do, and despite wearing different 'hats' we all have a contribution to make. I remember writing an email at GSK to one of the senior leaders in R&D suggesting he fine tune his future messages when delivering global webcasts to employees. To ask everyone to participate in the journey of making a medicine, from the janitors to the most senior leaders.

In the emerging area of Digital Health, I believe we need everyone to participate in innovation, not just startups, but healthcare professionals, government, corporations and academia too! 

It's also strengthened my links with that hotbed of innovation, Silicon Valley, as many of the 'burners' I have come to know work out there. I consider myself extremely privileged to have been able to participate in Burning Man, and the personal and professional growth as a result.

Critics of Burning Man argue that despite it's counterculture origins, it's become an elitist and pretentious event, attended mostly by wealthy corporate folks from California and Oregon. There is also the fact that you don't see that many people of colour there. The experience can be so bizarre, your mind has such a problem adjusting after the event concludes, that you have to 'decompress'. It's definitely not everyone's cup of tea. 

Even if you choose that Burning Man isn't for you, I just have one thing to say to you, "You're awesome, dude!".

Cycling was the best way of getting around the community

Cycling was the best way of getting around the community

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Thinking the unthinkable

In Boston, a couple of weeks ago, I gave an updated version of my talk, "Will advancing technology make doctors unemployed?" It was well received, and sparked a number of conversations after the event.

I opened the talk by referencing that I'd taken part in the 238th re-enactment of the Boston Tea Party in December 2011. Why are the events of 1773 relevant to healthcare in 2014? It's because those people that gathered in Boston all those years ago, thought the unthinkable, they challenged the status quo, not just with words, but with action! That episode escalated into the American revolution, and ultimately independence of America from the British Empire. 

[Speaking of Empires, I found this wonderful book published in 1971, titled; The American Health Empire: Power Profit & Politics]

Please don't be mistaken, I certainly don't compare myself to the brave visionaries who stood up to the most powerful entity on the planet at that time. However, the mindset shown by the people who weren't afraid to consider an alternative future, who dared to dream of a different reality, has inspired me to do what I do. 

I'm used to being ridiculed for my ideas when it comes to data & technology, some say I'm silly, some will say I'm a dreamer, but I ask you something?

Is it wrong to dream of a world where we have zero medical errors? Is it wrong to dream of a world where we can use technology to improve the lives of the most vulnerable members of our society? Is it wrong to dream of a world where 1 billion people who've never had access to a doctor or a hospital, might use a mobile device to access healthcare?

I hold my hands up, I'm guilty of being a dreamer. Many of us dream of a better future, not just for us, but our children, and their children. I'm one of them, and hard working people I meet during my travels around the world also have dreams. 

Now, it's truly fascinating to observe the spectrum of opinions when it comes to the future of technology in healthcare. Take the contrasting statements of two UK doctors on Twitter. 

I'm the first to admit, there is significant froth and hype in the emerging arena of Digital Health, and it's critical that we are able to successfully discriminate between the technology that can really transform healthcare, vs technology that doesn't do much at all (or even puts patients at risk). You'll see that in my recent TEDx talk on 'How Digital Health technologies could make Guernsey the best place to live on Earth', that I remark on the need for Evidence based Digital Health.

Having said that, we must be mindful not to make the process of evaluating & adopting Digital Health so laborious & dogmatic that we stifle the very innovation that patients are most in need of.

One of the thought leaders in Digital Health who continues to inspire me to think differently, is Lucien Engelen, in the Netherlands. He recently published a post, Dr Apple & Dr Google will see you know on LinkedIn. The post is wonderful, but what's really illuminating is reading the full range of comments on his post.

Lucien closes his post by remarking, "For all I know we need extraordinary solutions to the challenges ahead, maybe even moonshots" [For those of you wondering what a moonshot is, in the context of technology, I recommend this great post from Google]

Just published today is a provocative post titled 'Creating a parallel system to health care', by Dr Pritpal S Tamber, a fearless visionary, who always challenges my beliefs. Not only is he a medical doctor, but he's also the pioneer of Wellthcare,  which is an exploration, and an attempt to find new ways to create and value health. [I am honoured to be a Wellthcare Explorer].

In his post , Dr Tamber asks, "Health needs an 'Institute For New Health Thinking'. It needs a safe space for people to propose and debate new thinking on creating health. But who will lead this?" - I suggest reading his earlier posts, he repeatedly asks questions that his peers may well classify as 'thinking the unthinkable'.  

What do YOU believe?

Should we ONLY be thinking of solutions that can integrate within the context of the existing system of health & social care?

Who should be allowed to innovate in Digital Health? Only people who've been to medical school?

Are we wasting our time considering a future where we might not need so many physical hospitals?

Should the needs of the few outweigh the needs of the many? 

Do we tell our children that dreaming of solving humanity's biggest challenges is not a good use of their time? 

I know that if I had not dared to 'think the unthinkable' back in 2012 when I quit my job, I probably wouldn't be here writing this blog post today. 

Here's to the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes... the ones who see things differently -- they're not fond of rules... You can quote them, disagree with them, glorify or vilify them, but the only thing you can't do is ignore them because they change things... they push the human race forward, and while some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think that they can change the world, are the ones who do - Steve Jobs

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The power of grassroots communities to transform health & social care

I hired the function room in this London pub for the first two events I ran! 

I hired the function room in this London pub for the first two events I ran! 

Just over 2 years ago, as a volunteer, I founded the Health 2.0 London Chapter, which has since grown to over 630 members and has become the largest health tech grassroots community in the UK. I'm going to share why I did this, the experience & the impact on health & social care in the UK. 

 

 

The need for diverse grassroots communities

I've wrote in my first ever blog post about how starting the Health 2.0 London Chapter was part of me venturing out from GSK into the unknown. I observed that events in healthcare were often very expensive to attend & either focused on the tech, or the clinical aspects, the NHS, or investment opportunities. Nothing wrong with that, but there wasn't one space where all those groups could come together, with a genuine focus on the patient. I've always enjoyed bringing diverse groups of people together, whether it's at work or outside. At the end of my recent trip to Boston in the USA, I hosted a 'mindful' dinner for 10 amazing people that didn't know one another, some of whom I'd never met, but had formed friendships on Twitter. 

Back to Health 2.0 London, the turning point was the event I ran in Nov 2012 on 'Disruptive Innovation in Clinical Trials'. I decided I wanted to try having a real patient start the event, by sharing their experience of participating in a clinical trial. We had the wonderful Jeri Burtchell, a patient from the USA share her story in a Skype video call, displayed on the big screen in the venue.  

During the Q&A after her talk, I witnessed men & women from the audience coming up to my laptop, and giving feedback to Jeri via the webcam, with tears in their eyes. Yes, Jeri's stories of her experience of clinical trials as a patient was something many in the audience had never heard, despite many of them working in the field of clinical trials. Her fears, her concerns, & her hopes for the future, shared with a group of strangers in London. We then had an industry expert speak, followed by a startup. 

After the 3 talks finished, what was magical was witnessing the new conversations between people who might normally never meet. A mobile app developer, an academic & a clinical trials expert, exchanging ideas on how they might work together to improve the patient experience during a clinical trial. It was incredibly rewarding to witness this unique energy at an event I'd curated. Don't take my word for it, you can read the reviews of the Chapter by attendees here.

I curated and ran 20 Chapter meetings since I founded the Chapter, with the help of Mateusz Tylicki, my assistant organiser. A wide range of events, with just a few memorable events listed below;

Information Obesity: A possible side effect of Digital Health?

Care Homes: How can data & technology impact the lives of vulnerable patients?

Digital Health in UK hospitals: Hope or Hype? 

You can't do it alone!

I'm fiercely independent, and don't like to rely upon anyone, but I learnt that you have to be humble enough to ask for help. Special thanks to Mateusz Tylicki who helped me with every event, and each of the speakers who shared their time, expertise & insights (for free) with the Chapter. Ultimately, it was the people who coped with travels through London rush hour to attend our events on Wednesday evenings, that helped build a healthy and vibrant community.  In the beginning, as the community grew, I couldn't continue to hold the meetings above a pub in London, I needed a proper venue. Dawson King, a UK healthcare entrepreneur was our first sponsor, and helped us when we needed it the most.

Most recently, it was David Dowe at the ICT Knowledge Transfer Network (itself funded by the Technology Strategy Board), who approached me back in 2012 and offered to support the Chapter by providing a venue & food/drinks for nearly every event since Nov 2012. 

I believe there are now over 70 Health 2.0 Chapters around the globe, and I got to know other Chapter Leaders such as Eugene Borukhovich (Amsterdam), Sebastian Yuen (Birmingham, UK), Alex Fair (New York), Liam Ryan (Dublin), Ben Heubl (Copenhagen), Juliane Zielonka (Berlin) & Idalia Dawidowska (Manchester, UK). Each of them inspired me to keep pushing the boundaries!

Finally, a big thanks to Matthew Holt, Indu Subaiya & Pascal Lardier from Health 2.0 for their support along the way! 

What else helped build this community?

  • Having small meetings with a clear focus. I attended many tech meetups in London, some of which had up to 200 people attend. I wanted to create something different with Health 2.0 London, a more intimate dialogue, where it's possible to talk to everyone during the course of the evening. That's why I capped attendance at 40-45 people each time. 

  • Placing filters on who can join the Chapter. The Chapter was managed via meetup.com, and anyone wishing to join the Chapter had to answer a few questions when applying to join the group, and I would review each application personally. With experience, I learnt how to spot applications from those people genuinely interested in being part of this grassroots community. 

  • Not charging for attendance. I never once charged people to attend. My desire was to give everyone a chance to participate in this community, especially students, & others with limited finances.  

So, what was the impact on UK health & social care? 

Enough about me, how did people benefit from being part of the Chapter? I've included a few quotes below. 

"The ICTKN was delighted to support the growth of Health 2.0 London. When I first met Maneesh, I could see that he really understood the need for a new community in this area, and was prepared to put the hard work into finding speakers and building interest, so we were really happy to support his efforts. 

We’re very glad that its turned out to be such a success - its vital that this community continues to meet, to understand the opportunities which Digital Health presents and to continue to challenge accepted wisdom in health” - David Dowe, ICTKTN

"The meetings have been stimulating – brain food. I’ve met interesting people, useful contacts and seen new opportunities for research, including a letter of support from Maneesh for a PhD programme in Digital Health. Maneesh has been a visionary Chapter leader, constantly challenging accepted paradigms and raising thought-provoking topics for discussion." - Dr. Jacky Pallas, Director, UCL Research Platforms

Bruce Hellman

Bruce Hellman

"It's an incredibly exciting time to be a Digital Health start-up, with a massively growing market and a hugely supportive and encouraging ecosystem developing.  Fora such as the London Health 2.0 meetup group have really crystallised the ecosystem and network, and presenting has certainly helped us develop new relationships and gather new insights." - Bruce Hellman, co-founder & CEO, uMotif

 

 

 

 

 

The future of Health 2.0 London 

It's been extremely rewarding, but it's taken a lot of effort to get to this point. I put my heart & soul into everything that I do, whether I'm being paid or volunteering. 

Cristina de Juan

Cristina de Juan

Now that I'm becoming a lot busier with my own consultancy work in Digital Health, I recently stepped down as Chapter Leader. It's also good to give new people to bring fresh leadership to the community. 

There are two new Chapter Leaders, Mateusz Tylicki & Cristina de Juan, and I have every confidence they will do a fantastic job taking this community to the next level. 

"I'm very excited about the opportunity to take the Health 2.0 London Chapter forward. My aim in this role is to bring healthcare innovators together to ensure the UK is a leading country in Digital Health, with the ultimate of goal of helping patients." - Cristina de Juan, VP Clinical Partnerships, TrialReach 

Cristina & Mat did a sterling job at their first event last week which questioned the true impact of giving patients more data! 

In a brilliant Wired UK article, Ben Heubl, observes that Boris Johnson [Mayor of London] recently launched MedCity, an initiative to build the world's most powerful life sciences cluster, which appears to neglect the emerging Digital Health sector in London.

Could this gap in official support be an opportunity for a grassroots community like Health 2.0 London? I'm convinced through first hand experience that grassroots communities can make a difference in health & social care. It doesn't have to be technology that is the main focus, it's simply about bringing people together, discussing real world problems and creating a safe environment where people can express themselves & share (often radical) ideas without fear of being judged. 

What's next for me? 

During my visit to Boston, a reminder in a restaurant of the perception that there are differences between the 'Old World' & the 'New World'

During my visit to Boston, a reminder in a restaurant of the perception that there are differences between the 'Old World' & the 'New World'

As an entrepreneur, it's fun to experiment and try new things. I'm increasingly finding that clients are approaching me with particular problems because they view me as the bridge between the 'old world' of healthcare, and the 'new world' of Digital Health.

I recently spent a week in Boston, USA [which London's MedCity is aiming to compete with], and found it a very enlightening visit.

I met one Digital Health entrepreneur there, who remarked, "London?! Don't you feel limited there? In Boston, we believe that anything is possible."

Indeed, there still seems to an 'Old World' mindset in Europe that seems to lead to less risk taking, but it's changing.

My mind is very restless, and comes up with new ideas all the time! As someone with a data background, I'm becoming increasingly curious about how Open Data could make an even bigger difference in healthcare & social care. 

I'm delighted to be part of a panel discussion in London on April 30th 2014, 'Facilitating Innovation with Open Health Data', hosted by the Connected Digital Economy Catapult.

It's free to attend, and whilst primarily aimed at SMEs and Digital Health startups, anyone with an interest in Open Data & the Digital Economy should definitely consider attending. I'm hoping the event & subsequent discussions will help stimulate new ideas, new startups & new solutions that can ultimately help patients and remind us that the 'Old World' can still generate world class innovations. 

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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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