Doro 2.0 smartphone QSs with Withings (EU)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/Doro-Liberto-810.jpg” thumb_width=”100″ /]Doro’s unveiling of their second smartphone, the Doro Liberto 810,  along with its ‘privileged access’ to two Withings devices–the Smart Body Analyzer (weight, body fat, heart rate) and Pulse Smart Activity Tracker–continues their moves into older adult-appealing mobile telecare/telehealth offerings, as tracked by founding Editor Steve since at least 2009.  Doro’s assertive move into Quantified Selfing as part of what they call ‘the world’s most liberating smartphone’, is more fully featured and was predicted by David Doherty earlier this year [TTA 25 Feb]. It is also not Doro’s first big alliance; late last year, Bosch Healthcare announced that Doro would be the mobile platform for telecare offerings in Germany and Sweden [TTA 16 Nov 2012]. Both the release and Mobihealthnews indicate that this offering will roll out to select European markets initially, but the latter states that a similar offering will debut in the US by early 2014. (For US readers, Doro is equivalent to GreatCall’s Jitterbug line) According to Mobile, the Liberto will be available in the UK in October.

In changing behavior, ‘wanna’ works better than ‘hafta’

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/07/carrot-cake01.jpg” thumb_width=”150″ /]The proliferation of apps, tracking programs and devices that promise to change your life through Quantifying Yourself and lead you to the New Jerusalem of fitness and health is fascinating in number and variety. Yet why do some apps and programs do their job of changing behavior–and others, equally well-intentioned, do not? It’s all about ‘wanna’ vs. ‘hafta.’  Tracking your caloric consumption quickly turns into a ‘hafta’ drag for most (MyFitnessPal), but if you plug into a lively online community (Fitocracy), make the app easy to use and the changes gradual, plus forgive a few lapses, the same activity can start feeling rewarding and ‘wanna’. It’s all about personal autonomy, reward and control. It may be carrots rather than carrot cake, but you’re doing the choosing. Must reading for those working to develop corporate wellness programs, sticky apps and engage users. Why Behavior Change Apps Fail To Change Behavior (TechCrunch) Hat tip to reader Sandeep Pulim, MD via LinkedIn.

Related: Our April discussion of employee wellness programs, Employee wellness: Carrot? Stick? Or something else?

An example of simplification helping to increase positive behavior–and perhaps outcomes–is the recent study of the Center for Connected Health’s BP Connect program. Mobile users took their blood pressure more often than the telephone hub/device users; these older users (median age 61!) found the mobile version both easier and more convenient in portability. Overall BP scores went down moderately. Connected Health Study Finds Mobile Health Improves Patient Engagement (HIT Consultant)

Can self-tracking drive you crazy?

Fine weekend reading. It’s isn’t often that this Editor picks up an article headline ‘as is’ for our readers, but on this fine Saturday morning she does not want to mess with perfection! Carolyn Thomas, a previous Soapboxer and a leading Canadian women’s heart health/health ethics advocate, takes on the Quantified Selfers and, in the view of this Editor, the Digital Health Hypester Horde (D3H) with a bristling critique in The Ethical Nag. Yes, Virginia, there can be such a thing as too much chocolate and too much QSing. Do you really want to live in a heightened state of endless anxiety, with your day depending on minor result twitches? She presents an exchange between a leading heart patient/advocate, Hugo Campos, on Twitter, endlessly self-monitoring via AliveCor, who is having a PVC (skipped beat) episode that is best explained by…anxiety. One early QSer of 40 different health measurements daily abandoned her very public quest stating “Each day my self-worth was tied to the data…I won’t let it be an instrument of self-torture. Any. More.” And there is the time bomb of genetic testing–genomics, a source of endless wonder in the D3H world. A must read (any article that weaves in quotes from Deming and Serres has to be!) Also thank you Carolyn for the citation of The Gimlet Eye’s commentary on the Thomas Goetz ‘diabetic paradox’ (canary in the mine) article.

Patient non-compliance=toxic healthcare system?

Updated 20 June

A decidely contrarian view. Medication and treatment non-compliance is listed as one of the top ‘evils’ that patients inflict on the system which negatively affect outcomes and increase health costs. The doctor/hospital/insurance company laments, Why don’t they do what we tell them to do, exactly? Can’t we punish the patient for this?  But what if non-compliance indicates a bigger problem to be solved in the system, comparable to a canary’s silence in the mine when toxic gases are present? Maybe it’s because clinicians don’t take the time to understand the patient’s life and how to fit the treatment. Victor Montori, MD of the Mayo Clinic, at MedCityNews’ ENGAGE conference last week pointed out that patient non-engagement can point to the following:

  • The treatment isn’t right for that patient to begin with, and asking him to do more of it is only going to make matters worse.
  • The medication and patient options aren’t adequately explained prior to the protocol starting or the prescription–after going home and reading the side effects of the drug, or talking to a friend, the patient opts out. Or the patient doesn’t understand or trust the drug, protocol or doctor.
  • The burden of treatment or change is too much (temporarily or permanently) to handle for the sick patient (e.g. additional monitoring, diet)

To Dr. Montori, the best health system is not a ubiquitous, authoritarian one permeating every facet of life, but one that actually shrinks in size, makes it easier for the patient to follow treatment, focuses on treatments that reasonably match a patient’s lifestyle so that the person is ‘able to fully play the role he plays in his life’–in other words, meets the patient ‘job to be done.’ Mayo doc: Stop blaming patients. Healthcare industry’s take on non-compliance is all wrong (MedCityNews) Video excerpt 01:50.

Update 20 June: Full video of Dr. Montori’s talk via YouTube, Patient Centered Care–The Right Thing to Do Right (29:03)

Previously in TTA: Type 1 diabetes self-monitoring as a perpetual Battle of Stalingrad in The diabetic experience: the fly in the Quantified Selfing ointment.

The ultimate in Quantified Selfing?

The Quantified Brain may be the ne plus ultra of QSing. Only a neuroscientist on a Mission from God (and a really good insurance plan) would be getting twice-weekly MRIs and weekly blood tests for hormonal and gene activity levels. Russell Poldrack’s year-long self-study is to correlate his diet and moods, mental state and outdoor time with the scans and blood testing to capture the fluctuations in brain activity and networking–and his physical state. Example: his psoriasis flareups with increases in stress and changes in gene activity. Finally a bit of QSing that doesn’t have a hint of the faddish about it.  The Quantified Brain of a Self-Tracking Neuroscientist (MIT Technology Review)

W/Me tracking wellness and ‘real age’ via stress

The W/Me wristband developed by California-based (where else?) Phyode turns colors based on key physical manifestations of mood, with the goal of helping wearers control them. It translates the data it collects into three scores: mental state, agility, and ANS age readable on a smartphone via Bluetooth. Mental state can be either passive, excitable, pessimistic, anxious, or ideally, balanced somewhere in the middle. Since this Editor can see exceptions in places like NYC and LA, one wonders if they are on a different scale. Perfect for your favorite QS-er along with their Jawbone or FitBit. W/Me is on Kickstarter and oversubscribed for a ship date of August.  Articles: PSFK/Boehringer Ingelheim blog, TechCrunch. Hat tip to TANN Ireland’s Toni Bunting.

QS’ing, Google Glass and other wearable tech on BBC’s Newsnight (UK)

Here’s one for UK-residents only owing to tech restrictions – unless other readers know how to access it via a UK proxy server – it’s an item on the BBC’s Newsnight programme yesterday (available via the BBC iPlayer for six more days) and it covers various forms of wearable technology. The 15 minute slot beginning at 34 minutes includes a report to demonstrate forms of the technology and a discussion about the associated ethics. The staggering conclusion is that it is awesome technology but we should worry about how the companies that collect data from it will use the information. Newsnight 3 June 2013. Heads up thanks to Mike Clark.

‘Nudging’ chronic condition-ers to QSing

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]TripleTree, a VC that funds many iHealthy companies, casts a hopeful eye (certainly not a Gimlet Eye) at the consumer-driven growth of health tech and finds the steam generated by the Quantified Selfers and Fitness Addicts, stoked by the Healthcare Digerati who are not Going Surfing USA, is cooling fast and flatly. The Big Bucks are betting on ‘nudging’ (or as Aunt Lillian put it, ‘nooodging’) those diabetics, overweight couch potatoes, smokers and consumers of 72-ounce sodas, those naughty 20 percenters who spend an estimated 80 percent of US healthcare money, towards the New Jerusalem of Healthy Lifestyles and Big Savings. Of course, as the writer points out, payers and pharmas are still gathering data and documenting that increasing physical activity or sensoring med reminders, despite their Quantum of Cool, actually gets everyone to this destination and not another. One increasingly popular Road to Perdition is to introduce the refractory to the Carrot und Stick Gauntlet located at the corner of Tech, Privacy and Cost [TTA 21 March.] But the intensely blinking Big Yellow Light is that the Diabetic Experience [TTA 5 April] points out that ‘nooodging’ people to do something they don’t wanna and has uncertain, variable outcomes is not necessarily Their Road to Damascus. Personal Fitness, Chronic Condition Management and Connected Health

While The Eye takes The Road to the Beach in a 1946 Buick Super woody, Editor Donna notes the listing at the end of the article of the dozen finalists for the iAward to be announced 30 May, including AliveCor, Healthsense (a telecare system!) and Qualcomm Life.

Scanadu Scout emerging for crowdfunding

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/05/scout1.png” thumb_width=”150″ /]The Scanadu Scout [TTA 30 Nov 12], so widely touted as a ‘medical tricorder’ going for the Qualcomm Tricorder XPRIZE, listed on Indiegogo’s crowdfunding platform yesterday, and is already 3x oversubscribed at $311,000 with 29 days to go. Scanadu connects to your smartphone via Bluetooth LE and from a forehead readng calculates temperature, respiratory rate, blood oxygen, heartrate, blood pressure and stress. However it has no FDA nor CE approval, thus is being ‘quantified’ as a research tool not a vital signs monitor, so you too can be a Scout.  $199 now is the entry price but multiple package deals are still available, but you’ll have to wait till March 2014 at the earliest. Complete with glowing videos. Indiegogo, Wired UK.

News Flash: The Gimlet Eye just texted Editor Donna with a better name; the Scanadu Nirvana, for the altered state the hordes of Quantified Selfers (QSers) are undoubtedly in.

The diabetic experience: help on the way?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/04/IV-AA370_DIABET_G_201304051645212.jpg” thumb_width=”175″ /]Last week’s article on the limitations of QSing outlined the precursor ‘fly in ointment’: how diabetics have been living long-term with monitoring and self-management. Type 1 diabetes is the ‘Battle of Stalingrad’ for life. The ideal is to create a device that replaces the non-functioning pancreas, which releases insulin in the amount and time as needed to closely balance blood glucose and avoid devastating seizures and blackouts. Technology available for the past few years in Europe is just now (to this Editor’s amazement) in FDA approval in the US (Medtronic’s insulin pump.) Closer to the ideal is an insulin pump that connects to a continuous glucose monitor, which is being developed by Johnson & Johnson’s Animas division. The market, according to the JDRF, is 3 million people in the US. For Diabetics, a Longtime Goal Is Within Reach (Wall Street Journal)

The diabetic experience: the fly in the Quantified Selfing ointment

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]Quantified Selfers (QSers) maintain that their obsessive practice not only is the be-all and end-all of leading a Healthy Life, but if only more of the hoi polloi would do it, we’d avoid doctors and healthcare costs, the seas would part and we’d bounce to the Gates of the New Jerusalem with a gleam in our eye, driving our Fords with Allergy Alert SYNC. Well, this Eye has gazed Gimlety on this entire Movement for quite a while, to the raised noses of the Healthcare Digerati, and now has found a fellow nay-sayer and nose lower-er in the unexpected pages of The Atlantic. The Eye now slaps the Head for not thinking of the following.

Who were the early adopters of QS? Diabetics. From the late 1970s on, patients were handed glucose meters in the doctor’s office, stacks of reading material and told to go forth and self-manage. Are they happy? Empowered? In control? Au contraire, mon frere!

The fact that diabetics have been doing this for years, and that they largely loathe the experience (author’s emphasis), not only serves as a caution to the vogue of self-tracking. It also offers an opportunity, serving as an object lesson in what works, and what doesn’t work, when people track their health.

Loathing Can Be Quantified as in the 2012 BMC Health-published survey where diabetics told researchers that self-monitoring was the enemy, a Sisypheian task, a perpetual Battle of Stalingrad. No wonder why they are DEPRESSED. The sheer tedium of every day, several times a day, pricking fingers with crude monitors, making the decision on to eat, what, to inject or take pills, meds that get you sick, and never, ever being ‘in balance’, feeling wrong, guilty and scared, would depress The Eye more than sitting through a Jim Carrey movie. Fine to take away a few steps with LifeScan’s VerioSync and iBGStar to send the metering to the smartphone, or to Telcare’s system, and know that hovering in the future may be the non-invasive glucose meter and fully automated insulin pumps that work with your smartphone, but… Thomas Goetz’s point: don’t expect QSing to be a panacea as hyped, do expect that emotional baggage is in the trunk of the car, and that tracking for people is WORK that is really to be avoided. And as Editor Donna continually reminds The Eye, only undertaken when it is a solution to an unavoidable job to be done. And if they don’t see the job… The Diabetic’s Paradox

Health tech grows…but where are the investors?

Health tech, digital health, wireless health, telehealth, eHealth, mHealth, connected health…while the terminology proliferates, the hype curve grows ever steeper and the conferences/cocktail parties ever buzzier, where is the investment? David Doherty’s identified 16 billionaires investing in health tech, but David Shaywitz writing in Forbes, who’s been up and down the biotech curve, is noting that VCs who should be gravitating to digital health, aren’t.  This is even though they have the most experience scouting the territory: the medical problems to be solved, the stakeholders, the development curve. This isn’t to say that some are actively investing and others are observing the waters–he cites PureTech Ventures, Venrock, Fidelity Biosciences as the former–but when he cites a principal of a major biotech VC openly tweeting a withering view of most ‘digiHC’ (another term!) as without a real business model, ‘more sizzle than steak’ and ‘merely a bubble’ equivalent to (US) cleantech….it’s ‘perception is reality’ time. So before mHealth starts connecting to genomes, some successful exits need to go on the scoreboard first. Life Science VCs: Definitively Indefinite About Digital Health

Perhaps too much of consumer directed health tech focuses on how novel it all is–which can sell in the short term–with an emphasis on low-cost apps and Quantified Self trackers. But neither right now, with a few exceptions, have the push from the physician–and their advocacy requires multiple steps to achieve: awareness, trial, validation and support. Also from ForbesDigital Health Strategy: From Novelty to Necessity. An overview of how this can work for apps is what Happtique has accomplished to date in establishing standards, a certification program and a platform to facilitate physicians in prescribing apps and backing them up with patient educational materials. App Prescribing: The Future of Patient-Centered Care (Health Care Blog)

‘Leading the charge in wireless health’–to where?

CNN’s visit to Quantified Selfing Land (though not said) is travelogued in a ‘What’s Next’ blog on innovation, with a piece on and by USC’s Center for Body Computing head Leslie Saxon, MD. What is so surprising to this Editor is that the video piece (note: may not be viewable from all countries)  is so theoretical and future-oriented. Even though real companies and tech are here–AliveCor’s always smart and dapper Dr. David Albert, Sonny Vu’s Misfit Shine, UnderArmour athletic wear, Zephyr–the glossy way it’s presented is that it’s ‘swell stuff that will transform the future.’ Have our ‘grizzled veteran’ readers heard this song before, let’s say about 2006?

What is more disturbing is how dismissive Dr. Saxon’s article is of evident skepticism and of her own colleagues who are, after all, going to be part of and help drive this change. She dismisses medicine as “working from a 2,000 year old paternalistic doctor-patient model” as if nothing has happened in the past few years. Oddly she juxtaposes a 2007 conference with last week’s Congressional hearings leading with “The reactions interested me because, in my experience, where there is anger, there is also fear and irrationality.” Aside from being an extreme and disparaging view of her colleagues’ (and users) motives (and perhaps some bad editing), it simply wasn’t there in the hearings. Based on reports extensively compiled here, it was exactly the opposite–acceptance. (more…)

Quantified Selfing: security and statistics

It was inevitable, but now there’s concern about your QS data’s security and hacking. With healthcare organizations having security breaches rather routinely (wander over to the Privacy Rights Clearinghouse), the Federal Government routinely fighting off ‘denial of service’ assaults and Facebook, Apple, Twitter and Dropbox joining the hacked club, how long will it be before a fitness or telehealth company is breached? Or hospitals/providers which use insecure messaging, Skype and data files? Or those 600-odd practice EHRs? From the article, Avi Rubin, the director of the Health and Medical Security Lab at Johns Hopkins University: “Any system that consists in large part of software is hackable. At some point, someone will hack a major repository of healthcare data. And it won’t be pretty.” World’s Health Data Patiently Awaits Inevitable Hack (Wired) Hat tip to David Albert, MD via Twitter

QSers also assume that tracking devices are accurate. What happens when it’s two different devices, different totals? Doesn’t matter much with pedometers, but blood glucose is a different matter. Scientific American takes on ‘informed interpretation’ of data and the sticky issue of whether a monitoring regime does more good than harm. Writer Hilda Bastian: “Human health isn’t about simple mechanics and tinkering with a few measurable levels….There is, though, potential for harm, including unnecessary and pointless anxiety. There’s value, too, in contemplating the meaning of where we’re going with this, and the consequences of adults focusing so much on our selves in this particular way.” “Every Breath You Take, Every Move You Make…” How Much Monitoring Is Too Much?  Hat tips to Carolyn Thomas, The Ethical Nag / Heart Sisters and TTA Soapboxer, and George Margelis, via Twitter.

Quantified Selfers keep on reinterpreting Pew

The Quantified Self has its own blog (dog bites man) and just cannot believe the recent Pew Internet Life study [TTA 29 Jan] that unsurprisingly revealed, despite the explosive takeup of smartphones in the US, that most trackers are still using their heads (49 percent) or paper tracking (34 percent). So the two QS writers question the questions, and how potential QSers may not define ‘self-tracking’ as ‘fit(ting) neatly into health’. However, survey leader Suzannah Fox of Pew details the screener and specific questions–and being plain and straightforward, there’s not much wiggle room. How people interpret ‘tracking’ may be where the problem is–that long-term, over time tracking is a quite different pursuit than getting an immediate reading (e.g. blood glucose) to make a quick decision on what to eat and dose. (see Rajiv Mehta’s comment) The state of self-tracking

Updated 25 March   Related: Laurie Orlov on Pew induces chest pains in the body of the health tech market and the low single digits of app participation over age 50. (Reinterpret this: 3% of those aged 50-64 and 1% of those aged 65+.)