A breakthrough wearable? Sweat analysis for cystic fibrosis and diabetes diagnosis.

click to enlargeResearchers at Stanford University School of Medicine and University of California-Berkeley have developed a wristband equipped with a sensor that can capture and analyze perspiration. The design stimulates the production of sweat, with the embedded sensors and microprocessors detecting the presence of different molecules and ions based on their electrical signals. In the abstract’s words, this is an “electrochemically enhanced iontophoresis interface, integrated in a wearable sweat analysis platform.” The wearable was tested in two separate studies for detecting a key indicator for cystic fibrosis (CF)–a high level of chloride ions–and in comparing levels of glucose in sweat to blood glucose for diabetes. The data is transmitted via smartphone to a server that analyzes the results in real time.

The potential for this wearable is considerable. First, for CF, it changes a 70-year-old protocol–that sweat is stimulated and collected in a 30-minute procedure, then sent to an outside lab to be analyzed with the usual delay. Children being screened for CF have trouble sitting still for the lengthy test. The second is that the test can be done anywhere with minimal training, making it suitable for underserved communities and developing areas of the world. The third is in CF drug development. CF genetics have multiple mutations, limiting drug usefulness. A test such of this in real time could speed drug clinical trials and human response.

The glucose testing was preliminary in comparing the glucose in sweat with standard blood glucose levels, but also proved that the platform could be used for other perspiration constituents, such as sodium and lactate. The ultimate intent of the researchers is to incorporate the technology into a smartwatch for continuous monitoring, but they recognize two challenges: reproducibility, to see whether measurements are consistent, and mapping all the constituents of sweat.

The report was published on 17 April in Proceedings of the National Academy of Sciences of the United States of America (PNAS). Abstract and full report (PDF, 6 pages). Stanford Medicine News Center

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…)

CES 2017

The Consumer Electronics Show is half a century old this year and it click to enlargeis promising to be the biggest show yet. Here are some items that may be of interest to TTA readers.

The conference programme includes a Digital Health Summit and a Wearable Tech Summit (the organisers obviously haven’t been reading the TTA view on wearables so recently produced by Editor Donna). In the Digital Health Summit the top topics are going to be advances in genomics and precision medicine (not sure why this is digital health), Digital medicine and current trends such as “tele-everything”, wearables, aging, digital therapies (what’s that?) and VR. The wearable Summit top topics are the science of wearables, hottest wearable tech thus far and interactive jewelry.

There is a new “Sleep Tech Marketplace” presented by the National Sleep Foundation (no, really, I am not making this up) with 10 companies exhibiting everything from sleep tracking devices (Beddit), a system to mask noise during sleep (Cambridge Sound Systems), ultra thin earphones to wear in bed (Dubs Labs), a water mattress-topper to keep you cool while you sleep, an app to record your dream talking and snoring (Snail App) and a stress reducer.

If you are not attending between tomorrow and the 8th, then you could do worse than follow it on the official CES website or on engadget

Seeing into 2017: Fitness trackers’ chill, clinical and specialized wearables warm up

click to enlargeThe first in a series of brief projections for 2017. Fitness wearables aren’t even lukewarm anymore, and it’s visible in consolidation and the nay-saying articles. In late November, Fitbit bought one of the pioneers, Pebble, for a cut price of $40 million (TechCrunch). Fitbit shares are also cut price at below $7.50, whereas the 2015 IPO debuted at $50. Editor Charles’ favorite, Jawbone, is moribund; the springtime rumors of company sale and shutdown of the fitness band line have not been contradicted since [TTA 27 July]. Research/analytics company CB Insights calculated that 2015 wearable computing (a broader category) investment funding fell 63 percent from 2014 to a level comparable to 2012-13, in large part due to the cooling of the fitness segment.

A sure sign that fitness bands have chilled is negative play in the consumer press. ‘My fitness band has made me fat’, spun off the JAMA article [TTA 28 Sep], is now the theme of hilarious ‘dieters gone wild’ articles like this from the New York Post (warning, eye bleach photos!). But The Sun (UK) waves a warning flag that the information could be sold, sent to your employer or insurance company to profile and/or discriminate against you, or cyberhacked. All this can knock a pricey band off the Christmas shopping list. And no, it hasn’t shifted to smartwatches as most insiders predicted, as smartwatch sales have leveled off–as expected–until their functionality and appearance improve to justify their high price.

What’s in our crystal ball? Clinical-quality and specialized wearables will rise from these ashes.

  • Doctors are simply not interested in the current poor quality of data generated by current wearables–‘it’s worthless, Jim!’ ZDNet’s much-discussed article on this subject paradoxically stresses this, then focuses in on the clinical quality data generated by startup VivaLnk’s eSkin for temperature and stress. Clinical quality data is what is required for a health and wellness research partnership like the one recently announced by RTI and Validic.
  • Industry buzz is that Fitbit bought Pebble for its better IP, apps and stable of developers, not its smartwatch hardware, and that IP includes clinical quality measurement.  Other biosensor companies on the rise according to CB Insights are Thync, Thalmic Labs, YBrain and mCube.
  • In specialty wearables, there’s the recent funding success of Owlet, the High Cute Factor baby monitor sock. Lifebeam transfers multiple sensing technology to helmets and hats for richer data.

And if sensor patches develop with speed, in two to three years they may eliminate all of these!

Asia-Pacific telehealth set to grow to 75% to $1.79 billion in 2020: Frost study

Frost & Sullivan’s Asia-Pacific Telehealth Outlook 2016-2020 is projecting that telehealth (broadly defined as telemedicine, remote patient monitoring (RPM) and mobile health), will be growing from US $1.02 bn in 2015 to $1.79 bn by 2020. Driving growth in the region are an aging population, governments building out 3G/4G mobile networks and developing favorable policies and roadmaps. However, the study found that impediments included a familiar tune of poor clinician adoption, unfavorable regulations, lagging technology and (ta-da) payment models. What’s improved? Wearables in the region have made great strides, and payment models, according to F&S, are concentrated on patient and provider pay. Not so familiar is that many Asia-Pac nations are building a Smart Cities and Smart Nation infrastructure; telehealth is a key area almost always included in a Smart City plan. The study will set you back a smart $4,950. Marketwatch release. F&S feature page.

Telemedicine, telehealth and ‘Healthy India’

While we in the West and much of Asia/Pacific can parse the differences in wearables, tablets vs. smartphones and debate the accuracy of EHRs, far simpler issues dominate the application of health tech in places like India. Some are familiar–connectivity and preconceived notions of staff acceptance–and others are familiar to those of us who work in developing countries, such as interrupted power and a lack of trained people. Telemedicine and the reading of vital signs in telehealth has been part of the Indian scene for years–16 according to the article–but only in the past three years have remote consults been used more frequently. In the past year, over 100 patients have been saved by telehealth centers at two locations operated by Apollo TeleHealth in Himachal Pradesh, a province where the average patient travels up to 50 km for primary care and 250 km for secondary care. It is state-subsidized in a public-private partnership, but Apollo is already tracking over 15 months 3,000 teleconsults, providing emergency care to at least 200 people and saving Rs 15 lakh ($22,400 or £17,100).

The greatest impediment, according to the joint managing director of Apollo Hospitals Enterprise Limited (and the author), is the resistance to change–a familiar one. Telehealth services: A prescription of technology that saves lives, saves costs (Hindustan Times)

Aarogya Bharat, or Healthy India, is a ‘roadmap’ to enable India’s growth and prosperity by improving health for India’s population. Most Indians pay out of pocket, (more…)

Wearables for diabetes, more get thinner on a ‘smart skin’ diet

click to enlargeA team from the Seoul (South Korea) National University, University of Texas-Austin and wearable health sensor developer MC10 [TTA previous articles] have developed a translucent, thin graphene ‘cuff’ with sensors for blood glucose and a not-quite-complete metformin delivery mechanism for those with Type 2 diabetes. The graphene is ‘doped’ with gold to have it transmit blood glucose readings inferred on mechanical strain, skin temperature, and chemical composition of sweat. The mobile app calculates the metformin medication dose needed and the wristband administers it through an array of microneedles. This would not be a semi closed-loop system (dubbed here a ‘robopancreas’) which Type 1 diabetics now can use for insulin delivery, as there’s a delay in sensing and delivery. It also cannot in present form correct for excessively low blood glucose. IEEE Spectrum, Nature (abstract) Hat tip to former TTA Ireland Editor Toni Bunting

click to enlargeAnother wearable sensor bracelet with a distinctly ‘home-brewed’ feel is out of academia, from the Abdullah University of Science and Technology’s Integrated Nanotechnology Laboratory in Thuwal, Saudi Arabia. The research team pulled together office supplies–no, you are not misreading this: (more…)

Health tech innovations are doing little for baby boomers

click to enlargeWonder why the duck is upside down and sinking? Maybe it’s looking for all that transformative tech! Versus The King’s Fund sunny article above is Laurie Orlov in Boomer Health Tech Watch. Her POV is that as of right now, health tech innovations are not moving the needle for obese (39 percent) and chronically diseased US baby boomers. They aren’t downloading health apps and wearing wearables. Workplace wellness programs? Au contraire, they make us feel less well (Harvard Business Review) and anxious that we’re getting spied on by the company. Maybe we realize that All That Data isn’t secure (healthcare being a Hacker’s Holiday Camp), so we’re not playing the game. And the cost of care that the ACA was supposed to level off? Not if you’re a self-insured Boomer struggling to pay an ever-higher monthly premium, or even in a corporate high-deductible plan, paying increased deductibles, restricted networks, ever-higher treatment costs and fighting your insurer at nearly every turn. Add to that safety risks of procedures, mistakes compounded by EHRs [Dr Robert Wachter, TTA 16 April]  and (not mentioned) hospital-acquired infections. No wonder investment has cooled. Health and tech innovations do little for baby boomers

NHS England announces 7 “Test Beds”

NHS England has announced a series of “Innovation Test Beds” that will be used to “harness technology to address some of the most complex issues facing patients and the health service”.

“Front-line health and care workers in seven areas will pioneer and evaluate the use of novel combinations of interconnected devices such as wearable monitors, data analysis and ways of working which will help patients stay well and monitor their conditions themselves at home”, according to the NHS press release. (more…)

Blood biomarkers to diagnose mild TBI; more studies on TBI, concussion

An abundance of studies pointing the way to digital health opportunity. A surprise on the early morning radio news in NYC was mention of a report on a blood biomarker that could confirm a diagnosis of concussion, published in the Journal of Neurotrauma. Once found, it wasn’t exactly as advertised but the research is worth reviewing. First, it applies to mild TBI. The biomarker is the extensively studied glial fibrillary acidic protein (GFAP) versus another biomarker, S100β. The key finding by the central Florida-based team is that in a general trauma population, GFAP out-performed S100β in detecting intracranial lesions as diagnosed in CT scans. Scrolling down in the article is a link to the abstract of a meta-study of 11 biomarkers in concussion, by the same lead researcher and another team. The current featured articles in Neurotrauma are a stunning review of studies around concussion and TBI, including two very interesting articles on why air evacuation can do more harm than good (unless absolutely necessary) for TBI patients (altitude lowers oxygen levels) and how mild TBI suffered by retired NFL players has long-term negative metabolic and pituitary effects. All paywalled unless you have library access or a friend with subscription access; however some of the citation articles are open access. But for health tech developers looking for problems to solve better, cheaper and faster, here it is–a lot more promising than yet another me-too wearable. 

Telegraph takes a quick look at CES 2016 trends, including wearables (updated)

click to enlargeIt’s hard to believe that with the end of the year, the Next Big Event for many is the Consumer Technology’s Association‘s CES 2016 in Las Vegas 6-9 January. The Telegraph notes six trends in this breezy overview of what’s going to be The Next Big Things at the show: connected cars (lots of automaker concepts including the hush-hush Faraday electric), cybersecurity (especially irking this year with healthcare taking three of the top seven-Healthcare IT News), drones (buzzing at a location near you, despite the FAA), wearables (most impacting digital health), virtual/augmented reality (with utility in rehabilitation not mentioned here), and the ever-annoying, ever-cloying Internet of Things. On wearables, the show floor has apparently tripled in size since last year, and the article highlights the Mimo baby sleep monitor and the Qardio ECG monitor. (Unfortunately this Editor missed the November New York CES preview as she was attending HIMSS Connected Health, and due to other commitments won’t be going to Vegas, Baby.) Six predictions for CES 2016: drones, cybersecurity, wearables and more (Telegraph)

Update. During CES, Parks Associates will hosting their 7th annual CONNECTIONS Summit on 6-7  January (Wednesday – Thursday). The most health tech related session is ‘Wearables: Healthcare, IoT, and Smart Home Use Cases’ on Wednesday 10:30am-11:45am, with a panel including executives from Honeywell Life Care, Care Innovations, Qualcomm, Independa, IFTTT and Lumo Body Tech, hosted by director Harry Wang of Parks whom this Editor counts as a Grizzled Pioneer, Research Division. Separate registration required. Information and full agenda here.

To our Readers: Are you attending CES? Interested in contributing some insights? Contact Editor Donna.

47% of UK adults prefer virtual visits: Aviva Health Check study

Insurer Aviva’s latest Health Check study headlined the following findings about UK adults’ growing preference for digital health options, including a growth in acceptance of wearable monitors:

  • 47% are willing to be diagnosed digitally instead of face-to-face with their GP
  • 67% would use wearable technology to monitor long-term medical conditions such as diabetes or heart failure–especially those who are overweight (68%) or obese (71%)
  • The majority already using healthcare technology report improved health–63% of all age groups using a physical activity monitor say it has improved their health, rising to 66% of those with a heart rate monitor
  • Three in five (60%) non-users would use a physical activity or heart rate monitor in the future, while 52% would consider using a sleep pattern monitor
  • 55% agree the NHS should provide free technology to help people play an active role in improving their health
  • Younger age groups are most open (of course) to use of monitoring. 15% of those 25-34 use a physical activity monitor (compared to 8% overall) while 9% of 25-34s use a sleep pattern monitor (vs. 4% overall)

Aviva has an interest in digital health through its recently established customer partnership with babylon‘s UK-based telemedicine app [TTA 26 May]. The study was conducted by ICM Research for Aviva UK Health in August 2015. Respondents were invited from ICM’s online panel and 2,004 interviews were conducted amongst a nationally representative sample of the UK adult population.

The full study is available here to our Readers. Aviva release.

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…)

Medstartr Momentum 2015: did you miss it? (Video)

Let’s go to the video. Monday’s Medstartr Momentum/Health 2.0 NYC event was a Broadway Showstopper at Microsoft’s NYC Tech Center. Now available is a (so far) uncut video on medstartr.tv (scroll down to 11/30). There’s no play/skip bar on this, only a pause, so you may want to investigate a linked Health 2.0 NYC Livestream video page which has segmented the sessions and these have a play/skip bar.

Speakers included Susannah Fox, the CTO of HHS as well as 24 panelists, and 5 Momentum Talks representing Patients (Regina Holliday) Providers (Cheryl Pegus, NYU), Partners (Amy Cueva, MAD*POW), Institutions (Wen Dombrowski, MD, Northwell), and investors (Peter Frishauf.) There were four pitch sessions through the day featuring early-stage companies organized around Wearable Health Tech, Hospitals 2.0 and Pharma Tech 2.0. Hat tip to founder Alex Fair, his team, Steve Greene and the 15 sponsors who made it happen. TTA is a long-time media sponsor of Health 2.0 NYC.

Smartphone measures heart and breathing rates without wearables

Researchers at MIT are working on a project to measure the heart rate and breathing using a smartphone’s accelerometer in the user’s pocket or bag without the need for wearable sensors. When the user is at rest the slight movements due to breathing and heart beat are measured using the smartphone and used to derive the heart and breathing rates.

According to a paper published recently, in a test with a dozen participants (a very small sample for this type of test) the heart rates measured using the new method were within one beat when compared to FDA approved sensors they were using simultaneously. The measurements of breathing rate were about a quarter of a breath of the approved sensors.

The aim is to sense when someone is stressed by using the heart rate and breathing and then help cope with the situtation by suggesting, say, breathing exercises or calling for help.

A brief article on the work is published on the MIT technology Review and the full paper is available here.

Does current digital health meet baby boomers needs and wants?

The answer, according to health tech industry analyst Laurie Orlov (Aging in Place Tech Watch, Boomer Health Tech Watch) is…not really. Despite its massive size (76 million in the US), spending power (by 2017, 70 percent of US disposable income), breadth (1946-64) and need (despite living longer, by 2030 37 million will be managing more than one chronic condition), most health apps, especially fitness apps, don’t resonate with boomers despite over 50 percent having smartphones. The reasons are many–they’re complicated, often hard to follow, view, and abandonment across all ages is still high. Even among Fitbit purchasers, abandonment is fully one-half. As income decreases, smartphone access also becomes a cuttable budget item. Much more in this paper published by the California Healthcare Foundation.