Shouldn’t we be concentrating on digital therapeutics rather than ‘health apps’?

Where the money and attention are going. The first generation of Quantified Self apps was all about viewing your data and storing it online in a vault or graphs…somewhere, usually proprietary. Your Pebble, Fitbit, or Jawbone tracked, you crunched the numbers and found the meaning. At the same time, there are wellness companies like Welltok, ShapeUp, Keas, Virgin HealthMiles, and RedBrick Health, usually working with companies or insurers, that use various methods (money, gamification, other rewards) to influence lifestyle and improve a person’s health in a quantified, verifiable, but general way. What’s happened? There are now apps that combine both data and behavior change, focusing on a specific but important (again) condition, coach to change behavior and verify results rigorously through clinical trials. Some, like Omada Health, prove through those clinical trials that their program successfully changes pre-diabetic indicators, such as weight loss, decrease cholesterol and improved glucose control–without medication. This results in big savings for insurance companies, one reason why a $50 million Series C was led by Cigna. Another model is to work with pharmaceutical companies to better guide treatment. Propeller Health with its asthma/COPD inhaler tracker is partnering with pharma GlaxoSmithKline on a digital platform to better manage lung patient usage, and surely this will go through a clinical trial. We will be seeing more of this type of convergence in medical apps. (The rebooted Jawbone Health Hub is moving in this exact direction.) The Forbes article, while short, is written by someone who knows the business of apps– the co-founder of the AppNext distribution/monetization platform. He does achieve his aim in making us think differently about the potential of ‘health apps’. 

Wearables: it’s a journey, but is it really necessary?

click to enlargeIncreasingly, not in the opinion of many. We’ve covered earlier [TTA 21 Dec, 6 Feb] the wearables ‘bust’ and consumer disenchantment affecting fitness-oriented wearables. While projections are still $19 bn by 2018 (Juniper Research), Jawbone is nearly out of business with one last stab at the clinical segment, with Fitbit missing its 2016 earnings targets–and planning to target the same segment. So this Washington Post article on a glam presentation at SXSW of a Google/Levi’s smart jeans jacket for those who bicycle to work (‘bike’ and ‘bikers’ connote Leather ‘n’ Harleys). It will enable wearers to take phone calls, get directions and check the time by tapping and swiping their sleeves, with audio information delivered via headphone. As with every wearable blouse, muumuu, and toque she’s seen, this Editor’s skepticism is fueled by the fact that the cyclist depicted has to raise at least one hand to tap/swipe said sleeves and to wear headphones. He is also sans helmet on a street, not even a bike path or country lane. All are safety Bad Doo-Bees. Yes, the jacket is washable as the two-day power source is removable. But while it’s supposed to hit the market by Fall, the cost estimate is missing. A significant ‘who needs it?’ factor.

Remember the Quantified Selfer’s fascination with sleep tracking and all those sleep-specific devices that went away, taking their investors’ millions with them? Fitbit and many smartwatches work with apps to give the wearer feedback on their sleep hygiene, but the devices and apps themselves can deliver faulty information. This is according to a study published in the Journal of Clinical Sleep Medicine called “Orthosomnia: Are Some Patients Taking the Quantified Self Too Far?” (abstract) by Kelly Glazer Baron, MD with researchers from the Feinberg School of Medicine at Northwestern University. “The patients’ inferred correlation between sleep tracker data and daytime fatigue may become a perfectionistic quest for the ideal sleep in order to optimize daytime function. To the patients, sleep tracker data often feels more consistent with their experience of sleep than validated techniques, such as polysomnography or actigraphy.” (more…)

StartUp Health’s midyear report: digital health investment breaks record

The StartUp Health accelerator/investment organization continues with its quarterly analyses of health tech funding. (Rock Health may be at ‘last call’: TTA 11 May) Key points:

  • International investment reached $3.9 bn, a record.
  • There are 7,600 global startups in digital health.

But some things remain the same:

  • Most funding deals go to Series A companies, with seed rounds equal in number but not amount (33 and 32 percent, under $100 million and $400 million respectively).
  • Later stage companies still don’t have ‘legs’. Subsequent rounds after Series B (18 percent) continue to be weak (apparent since the beginning of these tracking reports). Series B now accounts for 18 percent of deals, $600 million in funding. Series C through E drop off precipitously from $400 to well below $100 million.
  • Median on rounds haven’t moved much: $3.9 million Series A and seed, $17 million in B/C, $21 million D and after.
    • Given the regulatory environment and the wisdom of going slow in health tech (poster child–Theranos), this also points to a disconnect between the Silicon Valley mentality of ‘make it quick and exit’ and reality.
  • IPOs have been a mixed picture, with most fluctuating in price and market cap, few making it to their IPO price.
  • International deals range from League in Toronto, Early Sense in Tel Aviv and Ping An Good Doctor in Shanghai, the last of which at $500 million beat the $400 million funding of payer Oscar for top funding honors.

And there are new darlings: patient/consumer experience, wellness, personalized health/Quantified Self (!), big data, workflow and clinical decision support.

An interesting addendum to the report is the 50+Market, which includes companies which are relevant to 50+ needs and those which focus on it. Interestingly, half of investment is residing here and skews heavily towards Series B and later stage companies. StartUp Health page (download). The report for viewing only is on Slideshare.

Silicon Valley’s betting on ‘citizen doctors’, ‘citizen science’ and useful data

A fascinating and slightly cynical overview of Silicon Valley’s ideological view of health tech that will fix our ‘deeply flawed healthcare system’ and what is getting funded (or not) is in next month’s San Francisco magazine. It profiles the ‘citizen doctor’ founders of vital signs ‘tricorder’ Scanadu (Sam–who’s not often mentioned–and Walter De Brouwer), bacteria tracker uBiome, ‘personal data recorder’ and experience charter We Are Curious (founded by Linda Avey, a long-departed co-founder of 23andme) and touches on the Theranos debacle. While these stories are bracing and in the instance of the De Brouwers, courageous, the notion of ‘citizen science’ (defined as direct-to-consumer health data) and its companion, Dr Eric Topol’s patient-centered/controlled medicine, has its drawbacks, viewed through the slightly gimlety ‘digital doctor’ eye of UC San Francisco’s Dr Robert Wachter. “The overarching message—not just from Theranos but from other companies struggling to get a toehold—is that, ultimately, the laws of economic gravity hold. The companies will have to produce products that add real value, either to patients or to payers. If they don’t, the market—or the regulators—won’t treat them kindly.” Flatly, there aren’t enough Quantified Selfers right now to support these companies. And Mr Market is a hard master. 23andme is back in the good graces of the FDA after a two-year scuffle and back doing direct response TV here in the US. Scanadu’s two products, Vitals (formerly Scout) and Urine are still not through the long slog of FDA clearance. The jury’s out on Theranos. And all these companies, including ‘unicorn’ Theranos, are bleeding cash and nowhere near turning a profit. ModernLuxury. Hat tip to Dr Topol via Twitter, who had a patient-centered conversation with Dr Wachter that we covered back in September.  Another recent podcast with Dr Wachter is here (Community Health Center radio).

Update: ‘Citizen science’ is nothing new, as revealed by the Science Museum (London)–it’s over 300 years old. While it entered the OED in 2014, ‘in 1715, Edmund Halley used Philosophical Transactions to ask colleagues to help him observe a total solar eclipse, prompting observers from all over the country to respond.’ Other examples are from Benjamin Robins in the same publication in 1749 on fireworks, Charles Darwin and evolution, to the present day. The difference is the flow–similar to what we now call crowdsourcing versus the individual using the data to affect their care.

 

Big home health win for telehealth confirms trend: must expand services, analytics

One of the most logical places for telehealth, remote care management (RCM) and transitional/chronic condition management (TCM/CCM) is with home health providers and post-acute care, yet perennially it has been on the ‘maybe next year’ list for most telehealth providers. That ‘next year’ may be getting a little closer with the news that Intel-GE Care Innovations has inked a multi-year deal (no pilot-itis here) with major (~400 facilities) home health provider Amedisys using their PC/tablet-based Health Harmony platform.

The initial focus is an ambitious one: reducing hospitalizations and ER/ED visits among patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, depression as well as patients who have two or more of these conditions (co-morbidities). The most interesting to this Editor is the parenthetical mention of analyzing ADLs (activities of daily living) with clinical data. Does this imply the engagement of their venerable ADL monitor QuietCare? (It’s something the founding company worked on circa 2006 while this Editor was there; one would think the analytics have advanced since then.) Another aspect is that Care Innovations will manage Amedisys’ complete RCM program from recruiting to logistics, data analytics and application integration services. Business Wire

What this means: Telehealth (and telecare) companies are now increasingly obliged in these big wins to provide a plethora of additional related services. Health care providers demand services beyond the monitoring technology. They want the turnkey package, from nurse evaluations, care coordination/management, to analytics and logistics.This ‘service creep’ implies alliances and mergers to add on to technological monitoring capabilities–and beaucoup financing. (more…)

Fancy £35,000 to develop a Quantified Self solution to meet a real need?

Innovate UK has announced a £175k IC tomorrow innovation contest focusing on Quantified Self, launching Monday 14 September.

As most TTA readers will be well aware, Quantified Self relates to the use of digital technology in self-tracking, monitoring and sensing to improve wellbeing. In particular the contest will be looking for solutions relating to the areas of: nutrition, older people, younger people, mental health and data capture. The winning solutions will focus on ways of empowering users to take ownership of their data to influence behaviour change and improve wellbeing.

The contest will include five challenges each offering up to £35,000 and the chance to work with one of challenge partners: Jamie Oliver, Toshiba, AXA PPP Insurance, Saga and Bupa. The winning company will trial their solution with the challenge partner over a period of three months.

The Knowledge Transfer Network is running two briefing events for this call. To register please sign up below:  (more…)

Forget fitness and sleep–now chemical exposure tracking

click to enlargeChemical exposure is no laughing matter. MyExposome is a seemingly simple silicone rubber wristband similar to those issued for various causes. But the silicone is different–it absorbs and stores environmental chemicals to which an individual may be exposed. It’s the commercialization of research from Oregon State University undertaken by Drs Kim Anderson and Steven O’Connell, who founded the company.  The test is a simple one: wear the specially packaged bracelet for one week, mail it back in its impermeable pouch, and they will run tests that screen for 1,400+ chemicals (full list on their website). There’s a separate, additional cost panel for flame retardant chemicals. The wearer then receives a report detailing their exposure to specific chemicals, and against their database of MyExposome users. The analysis process is the complicated and expensive part. It is designed to pick up external chemicals, not ones ingested unless excreted through the person’s skin. The company also makes it clear that they don’t make recommendations or give advice re the chemical exposure.

Currently the founders (plus another OSU program director and a CEO/entrepreneur) are reaching out via Kickstarter for funding and to determine acceptance of the present design and pricing. Based upon this, the band pricing (more…)

Guilt and money: the manipulative side of fitness tracking

Show me the money! The bottom line of fitness apps can now be cash rewards, much like many credit cards. There’s FitCoins that exchange into bitcoins, the digital currency much in the news and recognized by some legitimate (and non legitimate) retailers; Pact which makes you invest in your goals with a pool of others, rewarding you if you make them, deducting from your account if you do not; GOODcoins which rewards you only with ‘positive things’ (no chocolate or anything that contributes to, say, global warming). But after all, you should only bask in the glow of doing GoodThings for yourself, eh? Getting paid to stay fit (Ozy)

But then there’s always guilt. Fitness tracking is on the way of becoming so omnipresent that it becomes a part of you. Beyond the wrist, fitness clothes, implants and digital tattoos or bandages will be tattling (via your smartphone or directly) on your vital signs, activity and weight gain from too much to eat at dinner. On one hand this can be a good thing in shaping behavior. A study by two researchers associated with University College London and Ashfield Business School, Berkhamsted found many positives in Fitbits shaping female wearers’ behaviors, with 76 percent self-reporting healthier eating habits (more…)

Fitness/wellness trackers have amazing potential–to annoy

click to enlargeYour 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…)

Looking back over Telehealth & Telecare Aware’s predictions for 2014, part II

click to enlargeEditor Charles has treated you to a look back on his 2014 predictions, daring Editor Donna to look back on hers. Were they ‘Decidedly so’, ‘Yes’, ‘Reply hazy, try again’ or ‘My sources say no’? Read on…

On New Year’s Day 2014, it looked like “the year of reckoning for the ‘better mousetraps’”? But the reckoning wasn’t quite as dramatic as this Editor thought.

We are whipping past the 2012-13 Peak of Inflated Expectations in health tech, diving into the Trough of Disillusionment in 2014.

There surely were companies which turned up ‘Insolvent with a great idea’ in Joe Hage’s (LinkedIn’s huge Medical Devices Group) terms, but it was more a year of Big Ideas Going Sideways than Crash and Burns.

Some formerly Great Ideas may have a future, just not the one originally envisioned. (more…)

Why a smartwatch may feel…de trop

De tropFrench, adjective, meaning too much, too many, unwanted

Have you noticed that many early adopters have skipped smartwatches? Other wearables such as fitness trackers have taken their place successively on the wrists of your favorite Quantified Selfer or weekend warrior. (A sign: they are now mass market at drug stores like CVS and sports stores for the holiday.) But how many people are looking forward to a special delivery of an Apple Watch, Samsung Gear S or even the well-reviewed and well-priced LG G Watch R in Santa’s pack? Having just returned from the NYeC Digital Health Conference, I saw few on the wrists of DH mavens. Smartwatches (and clothing wearables) also faded out at CES Unveiled [TTA 21 Nov], a complete turnaround from June’s event.

If you’ve been wondering too, you’ll be nodding like a bobblehead at John Nosta’s blog post in NuviumThe Death of Wearables. (more…)

CES Unveiled New York

11 November, New York

The annual event that is CES Unveiled in New York City is meant to be a nanoparticle-scale preview of International CES in Las Vegas, 6-9 January.  It’s a smörgåsbord of what used to be called ‘consumer electronics’ and now is all about innovation–a taste of everything from ever-smarter video and audio to sensors, smarter homes with IoT (the cutely named Internet of Things), Big Data, robotics and (drum roll) Digital Health and the Quantified Self (QS). This Editor regrettably missed the opening briefing by Shawn DuBravac, CEA’s Chief Economist and Senior Director of Research which would likely touch on his areas of the innovation economy and disruption along with the other four 2015 trends to watch: big data analytics, immersive entertainment content, robotics and digital health. (CEA helpfully provides the 30-page white paper here.)

The exhibitors at the Metropolitan Pavilion did not fully represent the trends, however. (more…)

Rubber Bands – The next big thing in wearable sensors?

Rubberbands

When you’re ten years old, pinging rubber bands across the classroom is fun. Getting caught doing so by your teacher is not. However you have to admit it’s kind of a novel use for those flexible little bands. Now Irish researchers may have upped the game by finding another, even more novel application for them.

The team at AMBER, the Science Foundation Ireland-funded materials science centre, and the School of Physics TCD, working with researchers from the University of Surrey, have discovered a method of creating wearable sensors from shop-bought rubber bands. If you were listening back in class, you’ll remember that rubber doesn’t normally conduct electricity. However, the researchers whose findings have just been published in ACS Nano, a leading international nanoscience publication, discovered that by adding graphene the rubber bands became electrically conductive. In tests, the bands were strongly affected by any electrical current flowing through them if the band was stretched, which means tiny movements such as breath and pulse could be sensed by the technology.

The potential of graphene to be used in wearable sensors was noted by our TTA Editor-In-Chief, Donna, in her Pointer to the Future item back in 2011, Nanosheets and graphene: powering sensors, computers. Because rubber is available widely and cheaply, this latest development could open up major possibilities in the manufacturing of wearable sensors worldwide. Which means we can all look forward to finding graphene infused biosensors in everything from our bras to our bionic underpants.

Read more: TANN IrelandENGINEERING.com

Now a sensor for healthier necks and spines (TW/CN)

click to enlargeWould you like to monitor your neck and spine as an aid to fitness, better posture and to avoid strain? This Editor, who has a history of both neck and back problems, surely would–and it’s an area not covered by current fitness monitors. Fineck, developed by the China/Taiwan company VEARI with central Taiwan’s Sport and Health Research Center at National Chung Hsing University of Taiwan, claims to have developed a waterproof, reasonably presentable (left) necklace sensor along with analytics. It will send alerts via smartphone when it determines bad body posture or too much inactivity. ‘Neck-Health’ pictures demonstrate what you should do. While not clinical grade like devices such as those from Australia’s dorsaVi, it opens a whole new pursuit for QSersFineck website. VentureBeat

All that Quantified Self data? Drowning doctors don’t want to see it.

click to enlargeOur 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…)

Tons of app health data, bound for…third parties?

click to enlarge The law of unintended consequences also applies to Quantified Selfers. Health apps seem to be reaching beyond the QS early adopters and becoming a commonplace, whether on your wrist or built into your smartphone. Apple, Google, IBM and Samsung are all in.The DH3 set (Digital Health Hypester Horde) could not be more pleased. But where is that data going? According to the US Federal Trade Commission (FTC), it’s ending up where your online data goes–profitably sold by developers large and small to your friendly data broker and onward to marketers. You may think it’s private, but it isn’t. There is the famous case of an Target (store) app used to determine whether female customers were pregnant (purchases such as pregnancy tests) and then market related and baby products to them. Commissioner Julie Brill doesn’t like the possibility that health data could be part of the Spooky Monster Mash that is Big Data. “We don’t know where that information ultimately goes,” Brill told a recent Association for Competitive Technology panel. “It makes consumers uncomfortable.” (Ahem!) From the consumer protection standpoint, the FTC would like to do something about it, and they happen to be very good at that type of regulation. Compliance will not only be an added cost of doing business, it will cut into that ol’ business plan. And you thought that the only problem around apps and the Feds was gauging risk to users. Do you have that creepy ‘Big Brother is Watching You’ feeling?  Health IT Outcomes, FierceMobileHealthcare, VentureBeat.