OMID TOLOUI

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That 5% represents an amount that is greater than the annual revenue of about 43% of the companies on the S&P 500. Still small when compared to their peers as a percentage of revenue. It's all relative.

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We draw simple lines between cause and effect and neglect to acknowledge the reality we can only improve outcomes when we apply digital health interventions to the right patients, to carefully chosen clinical problems, in the right setting. In other words, just as real water snake oil works when you apply it to the right patients under the right conditions, the same could be said of most of our digital healthcare innovations. Claims that extend beyond that more specific narrative threaten the credibility of the our industry altogether—and it’s our collective responsibility to work together to protect that credibility. We must preserve the hope that digital health technologies like remote monitoring can transform healthcare delivery by acknowledging and optimizing the complex contextual factors that enable their success. Digital health will only become our generation’s snake oil if we let it.

“Digital Health Will Only Become Our Generation’s Snake Oil If We Let It” by Sachin Jain 

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Well designed, succinct and compelling analysis from Accenture Consulting on virtual health and its ability (in conjunction with in-person patient care) to address cost and capacity challenges. The infographic above illustrates three common primary care scenarios and how virtual (digital) health can result in time savings that translate into avoided costs. 

Too often a focus on virtual (digital) health’s ability to improve patient outcomes and satisfaction neglects the economic value of time savings from increased efficiency. Not only does this lead to real economic value, but also greater quality of care as clinicians are afforded more time to focus on patient care for those that need it the most.

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The rising prevalence of chronic illnesses in an aging population puts pressure on the supply side of health care. Clinicians are not being trained fast enough to keep pace with the rate of service demand. In addition, given the rising cost of care, new models for reimbursing hospitals and other providers have begun to emphasize quality and efficiency rather than units of delivered services. And consumers are increasingly shopping on open markets for health insurance policies that require significant deductibles and out-of-pocket expenses. These trends underpin the need for a one-to-many model of care delivery that offers flexibility and transparency. Telemedicine is well positioned in this environment, particularly given patients’ growing comfort with technology in their consumer endeavors. The core technologies of telemedicine include those that collect data (such as wearable and ingestible sensors, and vital-sign and health-status monitoring) and those that enable communication (videoconferencing, text-messaging, mobile apps, and voice calls). These types of virtualized services will become an integral part of care delivery. Indeed, several commercial payers are now reimbursing providers for video-based visits, not to mention the CMS’s new telemedicine-friendly reimbursement code.

Nailed it. Joseph Kvedar provides a succinct summary of how telemedicine (i.e., mHealth, Digital Health) is key to the future of health care delivery. 

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...people will use more wearable technology. People with conditions such as diabetes, heart failure, liver disease or asthma will wear devices, skin sensors or clothes capable of detecting deterioration and bringing this to the attention of the patient or anyone else they choose, through mobile phones. This monitoring will help keep people safe in their own homes rather than just waiting for serious deterioration necessitating an ambulance or GP call, followed by admission to hospital for several days.

Prof Sir Bruce Keogh (head of the NHS in the UK) gets it. 

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ANDY O’CONNELL: One of the really interesting issues that comes up in both the JC Penney case and in the one that we fictionalized is this issue of, in a sense, honoring price sensitive consumers, their approach to shopping. And it did seem as though JC Penney was trying to really push consumers away from being very price sensitive. And consumers responded very negatively. And are there are other ways of weaning consumers off of this sort of weekly or daily discounts, but still honoring their price sensitivity and continuing to play in the discount space? JILL AVERY: I think it’s challenging because I think the retail industry has changed dramatically with the growth of e-commerce. And over the past 10 years, we’ve seen an explosion of discounting across all channels. We’ve done this to ourselves in the retailing channel. We’ve trained customers to wait for the discount, to look for the sale. So when we say that customers are unprofitable we have to take the blame for that partially ourselves. We’ve trained them to be that way. I think the retailers that are doing this well today are being very strategic and selective about their discounting. They’re deciding which segments of customers most need a discount to buy and then they’re only discounting merchandise, or they’re only discounting during certain time periods when they’re sure that they’re attracting a large portion of that segment. Discounting almost on a daily basis across all customer segments, as we saw in the JC Penney case, turned out to be a very unprofitable strategy for most retailers. It becomes a horse race to see who can discount down to the bottom.

Great case study and discussion from the Harvard Business Review Podcast on the shifts that took place at JC Penny during Ron Johnson’s time as CEO.  I’ve pasted an excerpt from the transcript where there’s discussion on how the retail industry has “trained customers to wait for the discount, to look for the sale.” Ultimately, Johnson’s attempt to rid JC Penny of its traditional discounting strategies and “retrain” its core base of customers utlimately led to his ouster. 

Go here for the full transcript and a link to the podcast recording.

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Three out of every ten Oscar members have ordered the Misfit. It is particularly popular amongst younger members: 39% of 18 to 24 year old and 42% of 25 to 34 year old members have gotten the device. Out of all Oscar app users, 80% have gotten their Misfit, a whooping 87% of Android users (iPhone users, up your game!). Members who order the Misfit are more likely to make use of other unique Oscar features: Misfit owners are more likely to consult Teladoc than non-Misfit owners. Finally, members, who order the Misfit seem excited to get it: in general, it takes eleven days after a new Oscar member joins for them to order their Misfit.

Oscar Health Plan recently shared some data on their partnership with Misfit, where they provided their members with free wearable fitness devices (Misfit Shine). They integrated the Misfit Shine with the Oscar app and rewarded their members for staying active by offering up to $240 per year just for walking. The data provides some unique (and somewhat expected) insights into adoption/uptake.

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Patients will use the Apple Watch to answer quick multiple-choice questions about their mood, symptoms, possible treatment side effects (like headaches or nausea), and more. The provider will also use the device to capture activity and heart rate data to help them anticipate potential issues before they worsen and intervene sooner. While the Apple Watch itself offers no specific sleep tracking features, sleep tracking will be an important part of the study. As the Apple Watch charges at the patient’s bedside overnight, patients will keep their iPhone close to them as they sleep — likely on their bed — and an app on the smartphone will estimate the patient’s sleep quality (probably via the phone’s accelerometer).

MD Anderson Cancer Center at Cooper equips breast cancer patients with Apple Watches

The Apple Watch as a digital health platform shows great promise as a means of presenting snippets of information in order to bring about behavior change. While I’ve owned almost every major activity tracker, I’m finding the combination of color graphs, retrospective and comparative data periodically presented on my wrist to be particularly compelling. By periodically presenting visual data to me throughout the day and providing me with positive feedback “in real time” (as opposed to when I fire up an app on my iPhone), I’m finding myself to be a lot more cognizant of my level of (in)activity.  

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No Sleep ‘Till Discharge: Sleep, Sensors & Hospitals

It’s been about a year since we welcomed our second child into this world. It was a blessing and a wonderful event that brought with it great joy – not to mention a period of general exhaustion. I had anticipated how sleepless the hospital environment would be, and I was eager to quantify how non-conducive a hospital is to proper sleep – so when my wife's contractions intensified, I made sure to grab my Basis Health Tracker as we rushed to the hospital.

A Little Primer on Sleep

Sleep is vital to the healing process. It helps regulate hormones and is inextricably linked to one's immune system. It assists in the healing and repair of our hearts and blood vessels. Chronic sleep deficiency is linked to increased risks of heart disease, kidney disease, high blood pressure, diabetes, and stroke. In fact, our bodies react to sleep deprivation the same way that they react to stress. This process leads to immune system impairment – and when our immune system is not operating at optimal levels, we have a diminished ability to fight off illness or heal.

Hospitals Monitor Everything But Sleep

Sleep is important to both mental and physical health, as well as healing in general. As such, it surprises me how little monitoring or tracking of sleep occurs in inpatient facilities like hospitals. After all, patients come to these environments to convalesce and recover following acute trauma, surgery, or in the case of my wife and I, the delivery of our newborn daughter. This is especially baffling given the many other biometric signals being continually monitored within the hospital via telemetry or manually recorded on a periodic basis.  

The results of my hospital sleep analysis (according to my Basis Health Tracker) were as expected: interruptions were frequent with very little sleep. The stay confirmed what I hold to be true about inpatient hospital stays: sleep is scarce and interruptions are uncoordinated.  While almost everything else seemed to be tracked (blood pressure, heart rate, temperature, calories consumed, fluid in-take and output, etc.), one key metric seemed to be sorely missing: the amount and quality of sleep.

Leveraging Digital Health & Wearable Sensors

Data on the amount and quality of sleep, which is so vital to recovery and health, is not regularly collected during inpatient stays. Ironically, measuring and monitoring it could arguably be facilitated with greater ease than many of the more complex biometrics (e.g., blood pressure or temperature) currently being collected within hospitals. For example, most activity trackers today (e.g., Jawbone, FitBit, Misfit Shine) utilize a 3- or 6-axis accelerometer as their main component. These devices are rather small, can be worn comfortably, and also have Bluetooth wireless connectivity. Incorporating a wirelessly-connected accelerometer within the standard hospital ID bracelet, for example, could help doctors and nursing staff gauge not only the total length and quality of sleep, but also track movement and steps taken, which are conducive to the avoidance of complications like pneumonia, deep vein thrombosis, and bed sores.

Alternatively, a generic 3-axis accelerometer with some form of wireless connectivity, coupled with an algorithm to measure deep and light sleep cycles, could be used to help coordinate interruptions to a patient’s sleep cycle. This could allow patients to selectively be engaged while they are awake, as opposed to being awakened repeatedly during an inpatient stay. More information on accelerometers in an earlier post here.

The technology needed to establish basic sleep monitoring is both simple and cheap. Working it into the existing operations of a hospital, however, is more complex. Yet anyone who has ever spent a night in a hospital will attest that a greater emphasis on sleep duration and quality is needed. Furthermore, the benefits of better sleep in the hospital would extend beyond improved clinical outcomes to better patient satisfaction, a metric that’s becoming increasingly important as competition increases between hospitals and health systems.

It’s safe to assume that most people don’t look forward to a hospital stay. That said, I look forward to the day (soon) when digital health technologies are leveraged to ensure that, if we ever have the bad fortune of ending up in the hospital, we can at least have an ample amount of uninterrupted sleep.

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Fitbit is filing an IPO and these graphs from their S-1 (located here) give some good insight into the current status of their business. 

Update: A nice tl;dr version of Fitbit’s filing by Rock Health. 

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This is just another set of data that we’re confident our physicians will take into account as they make clinical and medical judgments,” Dworkin said. “We don’t really, fully know and understand how patients will want to use this and we’re going to basically stand ready to learn by what will happen.

Over the weekend Cedars Sinai updated its online medical records system, turning on access to HealthKit for more than 80,000 patients. 

via Bloomberg.

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Positioning. Positioning. Positioning. 

via the New Yorker

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The heart rate sensor in Apple Watch uses what is known as photoplethysmography. This technology, while difficult to pronounce, is based on a very simple fact: Blood is red because it reflects red light and absorbs green light. Apple Watch uses green LED lights paired with light‑sensitive photodiodes to detect the amount of blood flowing through your wrist at any given moment. When your heart beats, the blood flow in your wrist — and the green light absorption — is greater. Between beats, it’s less. By flashing its LED lights hundreds of times per second, Apple Watch can calculate the number of times the heart beats each minute — your heart rate.

Great explanation. Similar technology is being used in other popular heart rate tracking wearables (e.g., Basis and Fitbit). 

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Movies and Music Make Room for MedTech at SxSW

Few events can bring together innovators in film, music and interactive technology to showcase their talent, promote new ideas and unveil emerging technologies. South by Southwest (“SxSW”), the mega conference in Austin, Texas that recently concluded manages to do this each year. The conference is short, but intense with a plethora of speakers, parties, shows, and competitions showcasing innovation at its finest.

New this year, the conference included a Health and MedTech Expo to highlight companies that are pushing the limits of technology in a healthcare setting. Yet another testament to the increasing mainstream adoption and compelling nature of Digital Health. Over 60 companies were involved in the expo which included more than 40 panels and presentations.

The Impact Pediatric Health Pitch competition was a particularly interesting part of the new expo, demonstrating up-and-coming digital health and medical device companies had allowing them the opportunity to pitch their innovations to a panel of medical executives and investors.  Each finalist presented technology products that were designed to positively impact pediatric health and solve unique medical issues.  Here are a few of the finalists I found to be unique and compelling: 

FlowBrush Inc. - A toothbrush and electronic spirometer combination.  Children with asthma blow into the device each morning before brushing their teeth and then use the device as a toothbrush.  The lung function data is transmitted to the FlowBrush database cloud for daily analysis and the software automatically displays alerts for problematic readings and care coordinators review the data. If action is needed, these care coordinators call the parents to start early interventions.   This proactive monitoring allows for the early identification and prevention of full-blown asthma attacks and can save lives.

Bloom Technologies - A modular wearable sensor that monitors physiological changes during pregnancy, providing women with personalized feedback and insight about their health and bodies.  The company is working to develop a system that can measure maternal heart rate, activity, cardiorespiratory fitness, energy expenditure, stress, fetal movement, fetal heart rate, and contractions.  The information gathered from the device would help doctors and patients monitor prenatal health in a more comprehensive manner, with the ultimate goal of reducing preterm births and other complications.

Neuro’motion - A video game designed to help kids control their emotions.  In the game, players wear heart rate monitors and cannot continue to play if their heart rate rises beyond a given threshold.  The idea is that heart rate increases are triggered by emotions like anger and frustration, so players must learn to stay calm to compete. In clinical trials, the game seems to translate to real-life situations, helping kids control their emotions.  

Technology continues to fundamentally change how we approach wellness and the management of our health.  These companies, along with the other finalists, are using technology and design in revolutionary ways to make a difference for a segment of the population not often discussed in the Digital Health realm: kids.  It’s promising to see mainstream events like South by Southwest create an arena for creativity, discussion, and collaboration in healthcare and medical technology and even more exciting to see that focus extend to important sub-populations, like children. The digital health revolution continues...

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The Periodic Table of Digital Health, care of CB Insights.

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From Wired.com: Fitness Trackers vs. Smartphones: Why Wearables Win. 

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“Functionalized particles in the blood are able to selectively bind to targets in the blood that have adverse health effects. The binding of the particles to the targets allows the targets to be selectively modified or destroyed by energy from outside the body such that the adverse health effects are reduced or eliminated. The energy is generated by a wearable device which is able to direct the energy into the subsurface vasculature of the wearer of the wearable device. Further, one or more of the functionalized particles may be magnetic, allowing a magnetic field generated by the wearable device and directed into the subsurface vasculature to concentrate the bound targets in a lumen of the subsurface vasculature proximate to the wearable device.” - United States Patent Application #20150065821 

In other words, Google filed a patent for a wearable device that can kill harmful particles in the body using magnets and nanoparticles. This is one “moonshot” we should all hope is successful.