This week’s big news (so far) of Fitbit’s $732 million initial public offering–the largest consumer electronics IPO ever–comes despite the Jawbone IP lawsuits [TTA 11 June]. Count us among those who question this ‘vote of confidence’ as raising unrealistic expectations for health tech by a fitness tracker not truly part of real digital health. Telemedicine provider Teladoc appears headed on the same track with an IPO estimated to come in at $137 million, probably by next week. This generous pricing (~$20/share) comes despite never being profitable in 13 years. Like Fitbit, Teladoc is facing lawsuits from its major competitor American Well on IP [TTA 9 June], with Teladoc asking the US Patent and Trademark Office to review the validity of several American Well patents. Both IPOs are on the New York Stock Exchange (NYSE). MedCityNews examines Fitbit and Teladoc.
What’s news at the end of the week
Care Innovations harmonizes seniors, Panasonic adds diabetes, Jawbone and Fitbit bite, the first EHR/PHR Hack and Concussion in Cleveland. Converging its interests in remote patient monitoring with its long-time footprint in senior housing resident monitoring (QuietCare), Intel-GE Care Innovations is testing its Health Harmony remote patient monitoring system, partnering with two California-located Front Porch communities and the Front Porch Center for Innovation and Wellbeing. The residents selected have poor chronic condition management or have returned after a discharge from a skilled nursing facility. No disclosure on projected number or duration–and it doesn’t appear that QuietCare is part of the monitoring. Release….Panasonic just bought Bayer Healthcare’s diabetes/blood glucose monitoring device unit for $1.13 billion as Bayer continues to shed non-life science businesses. While old-school prick-and-bleed monitors are being eclipsed by continuous glucose monitors (CGMs) and mobile-based devices such as Telcare in the US and in Europe, there’s plenty of market remaining in the West, and new ones in Asia and the Middle East for simple devices. It joins Panasonic’s existing blood pressure monitors. MedCityNews….Jawbone and Fitbit continue to snap at each other in court, with the former on Wednesday filing a second lawsuit on patent infringement, specifically “a wellness application using data from a data-capable band”, with the added fillip of going to the International Trade Commission, which could ban the import of Fitbit products or component parts. The 28 May lawsuit was about Fitbit’s hiring of five former Jawbone employees who allegedly stole IP. The companies between them have hundreds of patents, and as this Editor has noted in previous IP and patent troll articles, the US Patent and Trademark Office (USPTO) is not especially rigorous in ensuring that patents are not overbroad. Wonderful for the IP attorneys, but not exactly what Fitbit wants as a runup to their expected IPO next week. Wall Street Journal….Now an EHR and PHR join Hackermania Running Wild. Medical Informatics Engineering reported Tuesday that in May their server was cyberattacked, exposing PHI of patients in five clients and separately information contained in the NoMoreClipboard PHR subsidiary. POLITICO reports that this is the first recorded instance of an EHR compromise. MIE Release, POLITICO Morning eHealth….If you are in the Cleveland, Ohio area and have an interest, Concussion: A National Challenge is a free, two-day event on detection and diagnosis sponsored by the National Academy of Engineering, the Institute of Medicine, Case Western Reserve University, Metro Health and Taipei Medical University. Advance registration required.
Fitness/wellness trackers have amazing potential–to annoy
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/04/keep_calm_and_smash_watch.jpg” thumb_width=”150″ /]Your Editors have previously noted some interesting personal experiences with fitness bands/trackers. Editor Charles, at last report, was on his third Jawbone Up in a year; this Editor has remained immune to their mostly clonky charms (tempted by the classic Swiss watch looks of Withings Activité [TTA 26 June 14], put off by the $450 price, but now notes that the sporty, analog Activité Pop is available in the US at $150.) Even if not among the Quantified Self avant-garde, we who write about tech can deal with most of it without blinking too much. Over at FierceMobileHealthcare, Judy Mottl, a regular writer for their FierceHealthIT website, took “the plunge into the wearable device pool” and hit her head on the bottom. Her experience of mostly frustration with the app, bad data generation, inability to sync with the smartphone, saying you’re awake/sleeping when not and so on indicates that this is one wearable she should have returned to the store–or treated according to our picture. Is this one isolated example or a more common experience than the healtherati who adore wearables let on?
There’s some evidence that the leaders in fitness bands realize their shortcomings on the app side. Fitbit acquired fitness coaching app developer, FitStar, for at least $17.8 million. Mobihealthnews
Update 2 April: Editor Charles reports on his third Jawbone Up, and his daughters’ experience:
I took to wearing the third Jawbone UP the other way round – i.e. with the two ends in line with the back of my hand, and the thicker bit in line with the inside of my hand and that seems to have done the trick. However my older daughter (more…)
MWC 2015 Part II – a few companies, some of potential interest
The Mobile World Congress in Barcelona does, as the name suggests, cover the whole mobile world. It can come as a disappointment then to find quite how insignificant Health is when compared to items like hardware, payment or even ‘4G backhaul’ (whatever that is). There certainly now seems to be a case for a sparate health stream, as finding the pearls proved very challenging for this reviewer. Relying on the search engine on the site too often revealed a company where too many boxes had been ticked. There was also an alarming number of healthtech ‘no shows’ on the when I reached the country stands of eg Finland, Greece & Italy.
However, there were a few exciting finds. These included:
Coros which are offering incredibly low-priced wearables: washable vests that do HR, respiration, temperature & ECG. If the prices I was quoted by Ethan Wu, Sales Director of a few $10s are good, and the kit works, they’ll be struggling to meet demand.
Dr Security offers an app that enables you to track all the people in your party, call for help, find your mobile device and more. Impressive and I’d have thought most welcome particularly for teachers with school parties or those with really any large outings.
Essence is an Israeli company that has been around for 20 years that offers an activities of daily living (ADL) monitoring service similar to (more…)
Fitbit accurate in measuring energy expenditure: AHA presentation
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/05/acitivity-trackers_wellocracy_chealth-blog-kvedar.jpg” thumb_width=”150″ /]The current judgment on commercial fitness monitors is that they are worthwhile directionally, but accurate–not so much [TTA 10 May 14]. This may be changing, albeit on a specific, non-clinical measurement. A Columbia University Medical Center (New York, NY) team tested the Fitbit One and Fitbit Flex for tracking energy expenditure during treadmill walking and running exercise, versus energy expenditure assessed by indirect calorimetry, and found themto be valid and reliable devices. Correlation between measurements was 0.95 – 0.97. These devices were interestingly placed on wrists and hips; perhaps a user can enlighten me. Poster presentation/Abstract MP11 published in the American Heart Association’s journal, Circulation.
Tunstall adopts new Tactio in patient management
Tunstall Healthcare is partnering with Canadian mHealth developer Tactio Health Group in what is a distinct first for them: creating a mobile care management system that is 1) smartphone-based for the patient and 2) prominently integrates non-Tunstall apps and devices. The patient uses the smartphone and the Tactio-developed mTrax app to collect a wide spectrum of data–everything from activity, sleep, pregnancy, body fat and mood tracking to the traditional constellation of vital signs. This uploads to the care provider’s tablet mPro Clinical App which overviews, details and reports the data for each patient and patient groups in care. The data comes from well-known mHealth apps outside the Tunstall world: BodyMedia, Fitbit, Fitbug, Garmin, Jawbone UP, Medisana and Wahoo Fitness, as well as connected (presumably Bluetooth) medical devices from A&D Medical, Mio, iHealth, Telcare, Withings and Nonin. Tunstall has also added two-way patient coaching and health journal features.
Tunstall’s positioning for what they call Active Health Management or AHM is “supported self-management” and “shift(ing) from reactive care to cost-effective active care.” (more…)
The ultimate ‘comfy sensor patch’–an implant
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/3036175-inline-i-2-from-the-designers-of-fitbit-a-digital-tattoo.jpg” thumb_width=”175″ /]John A. Rogers and his ‘skunkworks’, take notice. From the design shop that brought you Fitbit, NewDealDesign (FDR would be puzzled), comes the next big step in wearables–a sensor patch concept which would be implanted in your hand and multi-task till the cows come home. Project Underskin would detect fitness levels, vital signs such as blood glucose or body temperature, unlock your door or pre-authorize your credit card. The curved implant (more…)
Yesterday’s Apple intros and implications for health monitoring
A knockout or a catch up? Now that the Hype Dust is settling (along with Apple’s stock price), let’s take a look at what we know today about the new, larger iPhones and the Apple Watch regarding health monitoring.
Where it was a catch up:
- Size and screen in phones. Apple got the message: squinting at tiny type and swiping to enlarge is rapidly becoming yesterday’s pain. As smartphones and larger screens knocked out the Blackberry, Samsung led the way in sizing up and higher resolution–and others followed suit. The awful fact is that the smartphone market is aging, both in users and who’s left in the market to grow it, and we want to see, not squint.
- [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/09/apple-watch-beauty-shot.png” thumb_width=”150″ /]Finally (drum roll), a sleeker smartwatch with fitness tracking, out sometime next year–and not just a sports model. The basic model is a rubbery Sport watch, the mid-line has a sapphire crystal, stainless steel case and (proprietary) swappable bands. The beauty is the upmarket version in gold with a leather band (left, courtesy re/Code).
- Here Apple is up against multiple in-market competition from Fitbit to Moto to Withings to Samsung Gear–whose pricing is well below the starter Apple Watch at $349 in the $200 and below range.
- The Apple Watch looks seriously great, distinctively thinner and it’ll be a prestige item. But does it track more and better? No. According to reports (updated today) this is what it has: heart rate monitor, pulse, daily activity for which you need the phone. No sleep monitoring. It also has to be charged every night. There may be other features from developers, but they are under wraps for now and will likely require phone tethering. (re/Code) It’s not a comprehensive lifestyle watch–yet.
Where it could be a knockout in healthcare:
- Finally, a compelling reason for health care providers to ditch the old iPhone and not go Android. Healthcare providers in the US are heavily wedded to iOS: (more…)
2015: mHealth’s breakout year–or more of the same sideways?
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/09/the-thinker-statue-flickr-satyakam-khadikar-480.jpg” thumb_width=”150″ /]Adopting or Ditching It? We’re barely into September, yet the first 2015 prediction-of-a-sort is on the record from Center for Connected Health‘s Dr. Joseph Kvedar in The eHealth Blog. Does Apple HealthKit+Samsung‘s SHealth’s iterations+Google Fit+smartwatches everywhere (including LG’s G Watch R) equal $7.2 billion in wearables alone by 2018 as part of a mHealthy $49 billion by 2020? He’s optimistic, yet he hedges his bets with the caveat
“The challenge in health care is that, though we know what patients/consumers need to do to improve their health, most of them don’t want to hear about it.”
Which indicates that Dr. Kvedar has joined our small group of Thinkers puzzling out why health apps haven’t taken off beyond their Quantified Selfer early adopters and what Parks Associates termed ‘Healthy and Engaged’ [TTA 11 Aug]. With 1/3 of the purchasers of activity trackers putting them in the drawer after six months and the unstickiness of apps (80 percent are abandoned after a shocking two weeks), the winning combination isn’t obvious. But is it ‘focus on engagement’ and ‘personal, motivational and ubiquitous’? Certainly key factors, but how do we get the ‘Challenged but Mindful’ with a chronic condition–or two or three–to track and reward their real progress, even on a bad day–which an activity tracker which constantly presses you to exceed your performance has trouble gauging. (more…)
Forced to wear a fitness tracker for insurance? (US)
For those covered by corporate health policies, the day is not far away where employee health insurance programs will require wearing a fitness tracker and meeting certain metrics, such as walking a million steps or sleep quality. Already some programs have the employee log food, exercise, blood glucose, heart rate and other vital signs to qualify for a discount. The trajectory is much like BYOD–once unheard of, now it is expected to be the norm in 50 percent of US companies by 2017, with a concomitant loss of personal security and privacy. CVS Caremark and other companies have already made the stick, not the carrot, the norm of employee wellness programs [TTA 12 April 2013]. Writer Adrian Kingsley-Hughes asks: “How much access do we want our employers to have to our medical data? How much access to our daily activities do we want our employers and insurers having?” And what about spoofing those Fitbits and Jawbones? His ZDNet article notes the interest that Apple (plus Samsung and Google, despite Sergey’s and Larry’s vapors–Ed.) has in health, then takes it out a few more yards with Wearables and health insurance: A health bar over everyone’s head (and do check out the comments.)
All that Quantified Self data? Drowning doctors don’t want to see it.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/08/reduce-documentation1.jpg” thumb_width=”150″ /]Our long-time readers will remember Questions # 3, 4 and 5 of The Five Big Questions (FBQ*). They have not lost their salience as doctors are rejecting the not-terribly-accurate ‘telehealth’ data [TTA 10 May] generated by popular fitness trackers such as Fitbit, Misfit Shine and Jawbone. We do note that Apple’s Health/HealthKit has trotted out alliances with Mayo Clinic and Epic Systems (EHR) on apps and integrating data into an PHR [TTA 3 June], as well as Samsung’s SAMI [2 June] funding a University of California (UCSF) research center and (of course) Google. But this article confirms (more…)
A Gimlety look at fitness trackers and startup bloviation
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]It must be summer and The Gimlet Eye is looking for amusement and diversion. In a Real World of shotdown passenger aircraft and Middle East war, even Neil Versel in Meaningful HIT News is opting for the lighter side. He draws our attention to the humor of Steven Colbert on the subject “The Golden Era of Digital Toys”. Instead of actually running a marathon, simulate it with your Fitbit by mounting it to a paint shaker. But beyond these yuks, Mr Colbert aptly points to the vaporous language used by every DH3-er (Digital Health Hypester Horde) to promote their ‘revolutionary’ device.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Vessyl.jpg” thumb_width=”150″ /]Case in point: Vessyl, a cup that reads out what you are drinking down to the brand, flavor and calorie count and tosses the information to an app on your smartphone. (Of course, you could read the container, but that would be soooo uncool.) Colbert uses Vessyl to skewer Healthcare Startup Bloviation. There’s the Founder with red oblong glasses on ‘tracking real time hydration’. Then another principal, of whom The Gimlet Eye notes must be so dedicated that has no time to shave, tweeze his eyebrows, comb his hair or put on a clean shirt for the promo video, uttering their mission statement like Moses Bringing Down The Tablets from Sinai: ‘we help people make healthier and more informed decisions in real time.’ The final reductio ad absurdum is the creative director whispering in awe on its seven years of intensive design work. For a drink cup. Retail $200 if it meets its early 2015 ship date. Raising $50,000 via MarkOne’s oh-so-hip ‘n’ cool glossy demo website. With the requisite hipsters (none over 25) livin’ large in San Francisco’s glam settings, of course clutching their Vessyl.This is what gets funded? As in the proverb, has the mountain labored to bring forth a mouse? Mr Colbert’s device in counterpoint is brilliant. It should be funded shortly. Colbert Video.
Additional breathless D3H coverage: VentureBeat. CNet traces its ties to the Jawbone UP designer. (Editor Donna note: the cup readout on brands and accuracy re sugar and caffeine does sound a bit too good to be true. Let’s see if it’s for real in 2015.)
Is consumer digital device engagement sticky? Or just the hype?
A wonderfully cranky essay by Laurie Orlov on her new blog Boomer Health Tech Watch might make you think The Gimlet Eye was her guest writer (see below). Ms Orlov observes the ratched-up noise level around wearables, fitness bands, smartwatches (in which your Editor will be drenched quadrophonically next Wednesday at CEWeek NYC, glutton for punishment as she is). Yes, we’re swooning around Apple Health [TTA 3 June] and having a minor swivet around Samsung’s Simband and SAMI [TTA 2 June]. The bucket of cold water in Ms Orlov’s grip is the high dropout rate among fitness band users (33-50 percent, cited from Endeavour Partners and NPD Group); this Editor will also add the devices’ relative inaccuracy, fragility and glitches [TTA 10 May]. But ‘the investor community (via the media) clearly IS being transformed, at least temporarily’ as well as outside the health industry, by a belief that these devices will push the world into Quantified Selfing for the Masses. Will wearables herald our arrival at the New Jerusalem of Health? Certainly it’s been trumpeted and tromboned by the D3H (Digital Health Hypester Horde) badly needing a fresh fave rave. But can digital health survive another Hype Curve dive? Can we? The Consumerization of Health Care — is it working?
Further in this jugular vein, Business Investor, in a superficial swipe, dubs smartwatches uncool just because they trail fitness bands by six points. They did a better job in March delving into the real challenges that wearables face: smartwatches look and feel like a brick on your wrist (Ed. D’s term), Google Glass is socially unacceptable in many quarters (banned in Silicon Valley!) and wearables are still in Early Adopter-Ville.
Update: Ms Orlov just sent to this Editor a brief comment with a link to a thoughtful NY Times article not only on The Trouble with Apple’s Health App, but also how the barriers are more subtle–and more common-sensical–than the hype around how consumers are eager to register every burp on a PHR (they’re not), they don’t want to be nagged by technology (easier than your mom to be rid of) and the group that needs it most (the old, poor) has the least, for now, access to it. But largely ignored by the D3H.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”75″ /]On assignment off Cape May, New Jersey inventorying readiness of coastal defense fortifications. Just between us. Shhhh!Apple Health, minus the ‘book’, announced
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.
Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”
Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)
In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.
The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?
Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday? Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?
Hat tip to Editor Toni Bunting
More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and More, Apple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8, Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.
Smartwatches, fitness trackers: overload in several ways
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/05/acitivity-trackers_wellocracy_chealth-blog-kvedar.jpg” thumb_width=”150″ /]Dedicated Quantified Selfers, who have more than one device strapped to their arm and wrist, know that when like measurements are compared from two different devices (e.g. step counts, weight, activity, blood pressure), like stock or mutual funds, their performance will vary. Sleep trackers are among the worst offenders. But newbies just ‘into’ this may be confused. Not to worry! The prescription from Dr Kvedar is: “Expecting these consumer devices to have scientific accuracy is unrealistic. Expecting them to help you keep your activity level top of mind and measured in context from day to day is realistic and in most cases helpful.” They set a tone and help motivation, with other tools such as social groups and coaching. Reassuring words, especially as Dr Kvedar has launched Wellocracy to help individuals to understand that.
There’s of course pressure from clinicians to upgrade fitness monitor readings to clinical quality so they can use it…but absolutely no clarity on exactly how they would use it, a seemingly contradictory statement which centers on the quality of analysis and what alerts would be pushed to the clinician, who memorably has his or her ‘hair on fire trying to do what they do right now.’ (more…)
Intel and its ‘Basis’ instinct
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/03/intel-basis-smartwatch_large.png” thumb_width=”150″ /]Intel now in the smartwatch business…or are they?
TechCrunch reported yesterday that fitness tracker Basis sold to Intel, ending weeks of speculation of a sale to Apple, Google, Samsung and Microsoft. The price is between $100 and $150 million according to TechCrunch’s sources. A higher-end ($200) watch which recently entered the sleep tracking area, Basis’ Health Tracker B1 currently tracks steps (accelerometer), calories burned, heart rate, skin temperature and perspiration through wrist contact. Their proprietary software loads up the information to a dashboard for analysis and tracking. Basis has not developed into a major fitness smartwatch, having 7 percent of the market according to TechCrunch but far less according to NPD Group’s 2013-4 retail sales year , with Fitbit at 68 percent, Jawbone at 19 percent and Nike FuelBand at 10 (Mobihealthnews). With Intel premiering at CES a smart chip called Edison for wearables and a Siri-like Bluetooth headset dubbed Jarvis, the speculation is that the purchase is to give Intel both entreé into and a ready-made working team for the Internet of Things and wearables, since it largely missed the boat in mobile. Also Motley Fool, Apple Insider and one tech observer on why Intel shouldn’t be in the smartwatch business.
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