Wearable Tech and Health – not quite there yet?

Wearable tech is revolutionizing healthcare delivery – at least that’s what the pundits have been predicting for a number of years. The array of devices that are under development or already commercially available is stunning.

Looking only at devices that are used by patients on a day-to-day basis, there are three different areas of usage for wearable tech:

  1. Continuous monitoring of chronic illnesses

Many patients with chronic illnesses need to monitor certain biophysical parameters that indicate how well they are doing, if their medications are working and when an exacerbation of their condition would warrant visiting a healthcare professional.

Wearable devices that can sense and accurately measure heart rhythm, breathing rate, or blood glucose levels enable continuous tracking of critical markers and can help alert patients and their healthcare providers early to any arising problems.

  1. Improving the lives of people with disabilities

This is an area in which assistive devices have had a long history (think: hearing aids, wheel chairs, etc.). Digital sensor technology is now making devices more accurate, more personalized and more helpful.

Some examples of new technology that improves daily living include:

  • eSight Eyewear: A device consisting of a high-end camera, video processing software and processing unit and highest quality video OLED screens which project a real-time image that allow legally blind people to see.
  • Sensimat Systems: A series of pressure sensors that are placed under a wheel chair cushion. The sensors use a proprietary algorithm to monitor the seating pattern of the wheel chair user, and send a notification via smart phone when it is time to change position to minimize the risk of pressure sores.
  • TAPS Wearable: Velcro touch pads that can be worn on top of clothing or on the wheel chair. Each pad is a trigger for a smart phone app to play a pre-programmed phrase. This helps people who have difficult speaking (for example due to ALS or cerebral palsy) to communicate more easily.
  1. Recovery and rehabilitation devices

Also an area in which assistive devices have had their place for a long time, digital enhancements now tailor these types of wearables more to the patient’s needs. A number of companies are working on solutions to increase patients’ mobility – typically using some form of exoskeleton, together with sensors and algorithms to help with movement and recovery.

 

How do these new technologies fit into our healthcare system and how accessible will they be to patients who can benefit from their use?

Our healthcare system is already set up to evaluate new assistive devices, and potentially pay for them. Device makers would have to prove that their inventions are useful and enable patients to live more independently and / or return to work earlier and save or reduce disability payments or insurance costs.

Those who develop the wearables have to figure out which ones of the many institutions that share healthcare costs in our country they should approach to be considered for funding.

Funding is more difficult for wearable devices used in monitoring chronic illness. In most cases, there is no precedent for continuous patient monitoring.  Not only the patient’s engagement in the process is required, but a whole new infrastructure approach to healthcare is needed on the provider side. Currently, neither private practices nor hospitals are set up to receive, monitor and act upon myriad patient data coming in through wearable devices.

Many barriers impede adoption of new technologies for patient monitoring:

  • Concern about the reliability of incoming data – how accurate is the wrist-mounted heart monitor, are there differences between different devices and who is at fault if the device either gives a false positive and triggers an unnecessary medical intervention, or a false negative that puts the patient’s health at risk?
  • Integration with existing technology – how will data come into the clinic, will it be compatible with currently used IT solutions, how can staff easily access the data and how will confidentiality and privacy be safeguarded?
  • Integration into existing work flows – who will review the data, at what intervals, and which actions should follow particular cues? Will healthcare professionals need special training on how to read the data? Is extra staff required? How can incoming data be standardized to avoid confusion?
  • And last, but not least, who pays for the extra time that clinic staff spends on continuous patient monitoring?

Many of us are still in the phase of excitement over the wealth of possibilities that wearable tech affords us for delivering better healthcare. The successful players will be the ones who figure out how the possible can be turned into the doable, and profitable, within the constraints of our infrastructure and funding environment.

What should patients know about their disease?

A recent survey by the Dana-Farber Cancer Institute showed that many women who had surgery for their breast cancer did not know basic facts about their own tumour, such as their HER2 status, their ER status, their tumour stage and grade. @DanaFarber

The lead author of the study, Dr. Rachel Freedman, expressed surprise and concern at these results.

http://www.dana-farber.org/Newsroom/News-Releases/many-women-lack-basic-understanding-of-their-breast-cancer-study-finds.aspx

Why should patients know or care about these things? I have been immersed in the field of healthcare and pharmaceutical market research for more than ten years, but when it comes to my own health, I find I am not really interested in learning about the intricate details of my ailments.

Professionally, I often talk with physicians who make treatment decisions on life-threatening diseases and marketing executives from pharmaceutical companies who promote therapies to treat these diseases. Both of these groups focus a great deal on the minute differences between this drug and that, between different genetic mutations and cellular targets and markers that guide therapy choices. This knowledge is essential to their livelihood and their job. Should it be essential for patients as well?

Let’s draw an analogy to other areas of life.

When my car breaks down I bring it to the mechanic. What I am most interested in is: A) How serious is it? B) Is it fixable? C) How much will it cost to fix it and how much time will it take? I believe the mechanic to have all the knowledge about the different parts in my car and the tools that are needed to fix them, should they break down. I trust my mechanic to give me an honest assessment of the damage and the different options for repairing it (yes, I have an honest one). I don’t need to know anything else. Why should it be different for medicine?

DSC_0651

Or here’s another one:

When I decide whether to buy an Apple smartwatch or a Samsung Gear, I base my decision on things like what apps they offer, how the screen is laid out and which smart gestures they support. How the people at Apple or Samsung get the watch to have these features is irrelevant for me. All I care about is what I can and cannot do with the watch. And whether it looks cool. And how much it costs.

Samsung Gear S

And now back to medicine:

Is it fixable or will I die (soon)? How long do I need to take this therapy for? Will it make me nauseous? Does my insurance cover it? Will it prolong my life? How much of a hassle is it to take it? These are the types of questions that are relevant for a patient.

That’s hard to understand for someone who is focused on the science of medicine. But healthcare is more than science. Extending someone’s life or halting disease progression are only surrogate endpoints. The real endpoints are enabling patients to lead the life that they want, how they want it. These endpoints are, of course, immeasurable.

Confessions of a First Time Wearables User

Since I started my business in healthcare-focused market research, I have been paying attention to wearable devices. Wearables devices have great potential for monitoring health parameters and improving care for certain chronic conditions.

The business press has been making a big deal of wearable devices, predicting exponential market growth over the next few years.

Wearables market growth

I am interested in the user perspective – how useful are these devices, actually? Some statistics show that, similar to fitness club memberships, many people who purchase fitness tracking wrist bands abandon them after a few months of usage.

As an anthropologist, I believe the best way to learn about a certain area of life is to immerse yourself in it, to experience what it feels like and to understand how it works. So I started going to these meet-ups for people engaged in the world of wearable devices. They are awesome!

Run in Steve-Jobs-style corporate presentations by the inspiring wearables guru Tom Emrich, companies in the wearables space present their prototypes and the audience gets to try stuff out in the post-presentation mix-and-mingle. My favorite so far has been the mind-controlled beer tap.

I have met many people in the wearables community, and they are certainly very different in style and outlook to my usual clientele (executives from pharma companies). However, I have hesitated to take the plunge into trying a wearable myself.

I am a pretty fit person, working out two to three times a week, to maintain my health and my sanity, eating pretty healthy, and most of the time walking to public transit rather than taking the car. Whether I run 5 minutes less today than I did last week is not really important to me, as long as I get some exercise every few days. Competing with others along fitness goals does not interest me at all. But I realized that not trying out a wearable myself would deprive me of certain insights that could be essential for conducting the user research that I am so interested in doing.

So I bought a Garmin Vivofit last week. Three things enticed me to purchase this device rather than some of the other ones that are very popular (Jawbone Up, Fitbit, Fuelband).

  1. It shows the time. I am of a generation that still wears a wrist watch, and wearing both a fitness wrist band and a watch separately seemed silly.
  2. Its battery life is supposed to be one year. Charging devices is a big pain, and in my household we are competing for outlets and charger cables to charge the various cell phones, iPods etc for the next morning.
  3. It has a red progress bar that shows up after you have been sitting around for too long. My occupation requires a lot of sitting in front of the computer. I tend to get into a state where I push myself to concentrate only half an hour longer, then another, then another, and then become all tense because I have not taken enough breaks. So a little nudge to get up and walk around seemed like a very useful feature to me.

Garmin Progress Bar

Here are my first experiences with the device:

  • Putting it on is quite uncomfortable. You have to press down on this clip to go into these holes, and doing that hurts the inside of my wrist. Watch wristband makers have certainly figured that one out better. Maybe if you are a tough man you don’t mind. But I’m a lady.
  • The red progress bar is very useful. It has actually helped me take more frequent breaks when I am doing computer work, and I feel better after getting up and walking around for a few minutes.
  • The red progress bar is dumb. This so-called smart device apparently registers only walking activity, i.e. when I swing my left arm back and forth. I was frustrated to see the red bar show up after I spent an hour in the kitchen preparing dinner, and after I was in the back yard, raking and bagging leaves. Apparently, either the sensor or the algorithm don’t realize that these are physical activities.
  • The red progress bar can be fooled. Just for fun, I tried out swinging my arm back and forth for a minute while I was sitting at the dinner table, and it actually tricked the device into registering this as physical activity, so the red bar disappeared.
  • The dashboard that shows my steps and my sleep is kind of interesting. I have only worn the device for a few days, so can’t say yet how useful this data is going to be long-term, if at all, but it’s neat to look at in a narcissistic way – the same way I look at my Twitter account from time to time and delight in the fact that I actually have some followers.

Anyway, it has been a very interesting experiment so far, and definitely proof of the value of ‘walking in the shoes of’ to really understand something.

The true potential of wearables is difficult to tell at the moment. There could be all sorts of useful applications that have not yet been developed or that have not yet gained broad acceptance. After a lot of enthusiasm in the media, there seems to be a bit of a backlash now.

Here’s a recent page from The Atlantic, with quotes of tech opinion leaders all questioning the enthusiasm for wearables:

Atlantic article

And here’s an article written by a health IT consultant about the more technical challenges of integrating mobile health monitoring devices into electronic medical records.

http://medicalconnectivity.com/2014/11/04/challenges-using-patient-generated-data-for-patient-care/

While I share some of the skepticism, the wearables space is certainly an area worth watching, and with great growth opportunities for companies who ‘get it right’. I am excited to be part of this journey.

Doing Business on a Global Scale

Today, it was reported that “Chinese court finds GlaxoSmithKline guilty of bribery”. This raises the question: Is the Chinese government really cleaning up? Or did they just not bribe the right people? Why is GSK in the spotlight and not others?

Having lived and worked in Russia, and frequently discussing their country’s state of affairs with friends from Columbia, Iran, China and India*, bribery and favouritism seems to be a fact of life in a number of countries including BRIC and the Middle East.

Most people here in Canada and presumably also in the US would agree that bribery is bad. In fact, the US has very strict laws forbidding US businesses to engage in such practices abroad. I agree that one should uphold one’s moral standards in contexts which challenge them.

But I’d like to add a word or two to explain why bribery is so rampant in some countries. It is not a lack of business ethics, as one might suspect, but rather a reaction to the conditions under which businesses have to operate in these countries. What is really lacking there is the rule of law.

For someone who has lived in the ‘West’ all their lives, it is difficult to image what the absence of rule of law looks like, and what it does to you. Imagine business where you sign contracts but you cannot enforce them. Where you accumulate wealth, but where it can be taken from you at any time. Where you apply to the authorities – police, judges, lawmakers – for help, but they do not serve you. All and everything you do, your success and failure is dependent upon knowing the right people, forging the right alliances, and often money changes hands. If you run a profitable business, others want a piece of the pie, or they won’t let you do your work.

If you make the wrong move, if you get in the way of someone more powerful than you, then you go down – accused of bribery, tax fraud, unsanitary working conditions etc. etc. Maybe you are guilty, maybe you are not. If you are lucky, you can pay your way out of it. Otherwise, you may end up in jail like Mr. Khodorkovsky, or worse.

Yes, people pay bribes and they should not be doing that. Yes, people defraud on their taxes and they should not be doing that. Yes, people let their employees work in unhealthy and unsafe conditions and they should not be doing that.

However, those that get singled out and publicly blamed for their wrongdoing are not necessarily the worst culprits. They are simply the ones who did not play their cards right, who ticked someone off. So how did Glaxo get into this mess?

* Thanks to Toronto’s multicultural community!

DSC_0596

Man vs Machine

So, Big Data. The market research industry continues to struggle with the concept. It was one of the buzzwords of 2013. Some have come up with a big data offering. Some are searching for a point of view on it. Some counter with small data. Many still have only a vague sense of what we are talking about.

I have asked many colleagues and clients what this concept means to them, in the hopes of developing a brilliant solution that would make me wildly successful. Well, this seems to be taking some time, but anyway, I’d like to share with you what I have learned so far. As I am working in the healthcare sector, this is my focus below.

1. Big Data (in Pharma) is IMS data

For some of my pharmaceutical clients, all they can think of when asked about large data sets is IMS data. IMS captures and sells information about the prescribing behaviour of physicians at the pharmacy level. Through this data, pharmaceutical companies track the sales of their products.

2. Big Data (in Hospitals) is Patient Records and Interaction Statistics

Healthcare providers, particularly hospitals and other large organizations, capture myriads of data on patients flowing through the system. The analysis of this data is largely off the radar screen of traditional market research, and falls under the discipline of health informatics.

3. Big Data is Social Media data

This is a view that many market researchers adopted when social media first appeared on our professional horizon as another form of human expression. Last year’s MRIA NET Gain conference, dedicated to big data, featured a number of presentations in this area.

For those who do not want to develop their own proprietary solutions, subscription-based social media analysis tools are available and used by both end clients and market research vendors.

4. Big Data analysis is a different way of saying Data Mining

Some sectors have worked with large data sets for some time. I am thinking of scanner data in retail, and loyalty programs (Air Miles, Petro Points etc.). Fifteen or so years ago, the statistical techniques used to sift through such data sets were called ‘data mining’.

This practice is still ongoing, and the size of data sets ever increasing with more and more customer touch points being added. Some think of this type of analysis, when hearing the words big data.

5. Big Data is Data that is created by Machines

This type of big data is rarely mentioned and obviously not in the forefront of a market researcher’s mind. However, it has grown exponentially and is increasingly viewed and used as a source of customer information.

For market researchers, the question (and the fear) is to what extent human analysts are still needed, and to what extent ‘the machine’ can do it on its own. And how we can make sure we are still needed.

We say: “You need an expert to interpret what your data means.” We say: “A consultant is needed to guide the analysis process.” We say: “Meaningful data analysis is the development and testing of hypotheses, and only people can come up with those.”

And we are right.

How many times have I looked at the results of a statistical analysis and said, “This does not make any sense.” And then we discarded the analysis and started fresh, because results need to make sense. To another human. To your client. They need to lead to actionable insights and recommendations.

So we are still needed. But…

But many, many processes are now automated, from data analysis over producing charts even to highlighting key insights in charts. Far fewer people are needed to work with the data then before. Take a look at www.beyondcore.com – will get you thinking.

Some companies function with very little market research, in the sense of interactions between real live researchers with real live respondents. Machine-generated user data that streams back from devices guides the refinement of these products. New Apps are developed by split testing and seeing how early users interact with certain features, following the logic of clicks. Service companies integrate their customer interface and CRM software with their enterprise management system. Automated cues let managers at different levels know how they are performing, and notify them if there is a problem.

Technical skills are essential for survival. How can you tell a successful agency these days? If you look at their ‘careers’ page, most of the open positions are for developers (i.e. IT people). Those who win in providing business intelligence are either companies who are focused on the digitalization and automation of data collection and analysis, or companies who make intelligent use of available software products and platforms within the research process.

Do you know what Hadoop is? A wireframe? CSS? If not, perhaps it is time to google it right now…

Man vs Machine

 

The Right to Choose

Recently, the CBC reported on a ten-year old girl, Makayla Sault, who was diagnosed with acute lymphoblastic leukemia, a cancer of the blood. The girl experienced severe side effects from the chemotherapy she was receiving and decided, together with her parents, to discontinue therapy.

Now, the Children’s Aid Society is getting involved with the intent of convincing the family to complete the course of therapy. The parents and the community they live in also fear that Makayla may be forcibly removed from home and given therapy against her will.

Do parents have the right to choose whether or not a potentially life-saving treatment is given to their child? Does the child have a say in this decision? Does the state have the responsibility to act in what is perceived as the best interest of the child, against the parents’ and the child’s wishes?

Let’s consider all the factors.

Deadliness of the disease. The form of leukemia that Makayla has can progress very rapidly and lead to death within a few months, if not treated. If it was a slower progressing disease, would it seem reasonable to let the parents decide on the course of treatment?

Chance of cure. If treated, there is a high chance of long-term remission or cure for a patient with acute lymphoblastic leukemia. Some quote the likelihood of treatment success as 75% or even higher. How does this information influence your view on the case? Does the parents’ decision seem responsible? Should the state step in?

What if treatment success was estimated at 50%? …at 30%? …at 10%? How would this influence your view on whose right it is to decide what to do? With a low chance of remission or cure, would it seem reasonable to allow parents to, basically, let their child die without having to go through the agony of chemotherapy?

Cultural context. The news coverage focused in on the point that Makayla and her parents belong to the New Credit First Nation, based in Ontario. Her family decided to try traditional remedies instead chemotherapy, and their local community has shown great support for their decision. The interference of the Children’s Aid Society is seen by some as another attempt of a government agency to take away native children, as had been done during the era of forced residential schooling.

How does the cultural factor influence your view on the case? Does being First Nation give Makayla’s parents more of a right to decide her destiny than being of Irish decent, being Jewish or being Iranian? What if the family belonged to a religious group that was viewed as being ‘extremist’? Would you feel the same about the case or different?

To what extent is the state responsible for the well-being of our children, and to ensure their well-being in the face of parental opposition? Laws and mechanisms to protect children against abusive parents certainly seem appropriate. How about protecting children against well-meaning but ill-informed parents? How about protecting children against well-meaning, well-informed parents who adhere to a different belief system? Difficult decisions.