Apple HealthKit — Will It Bring About Patient-Doctor Paradigm Shift?

This is a companion piece to my last post, about the HomeKit Apple unveiled last week at the WWDC — complete with the same disclaimer: Having to send huge amounts of money to Loyola of Maryland for the next three years (I feel like I’m in the Weimar Republic and must carry tons of money to Baltimore in a wheelbarrow, LOL) to secure my youngest’s sheepskin has led to a part-time sales job at the Apple Store — which doesn’t give me any inside insights into their strategy. Rest assured that nothing that will ever appear in this blog about Apple will be gathered from anything other than public sources. I know only what you know, and the opinions expressed here are solely my own.

 

The other IoT developers’ kit that Apple unveiled was the HealthKit, combined with a new Health app that will be released along with iOS8.

They say the app will “give you an easy-to-read dashboard of your health and fitness data.”

The developers kit is designed to help health and fitness apps (… and wearables) work together.

Apple teases us that the package “just might be the beginning of a health revolution.”

Could it be the key to finally expanding interest in personal health data beyond those of us who are proud members of the Quantified Self, and could it be the catalyst in the revolution that I’ve predicted before: a new healthcare paradigm in which patients, empowered with data about their daily health stats, might become real partners with their doctors, improving their health while reducing the need for costly hospitalizations?

We’ll see, but I’ll be watching carefully, because — speaking of paradigm shifts — I wonder if the HealthKit and HomeKit, combined, may provide the tools (oops, originally typed fools.. LOL) to make my vision of empowered seniors, “aging in place” a reality.

     Emergency Card

Emergency Card

One feature of the Health app really resonated with me, because it offers an up-dated version of two sadly-dated “21st-Century Disaster Tips You WON’T Hear From Officials” videos that I did waaay back in 2007: one suggesting that you put your electronic health record on one of those new-fangled (LOL) thumb drives, and another, that you put an ICE (In Case of Emergency) listing on your cell-phone (pre-smartphone) directory. The Health App would combine that information on an “Emergency Card” that would be accessible to EMTs even from your lock screen. Neat!

Dr. Joe Kvedar, director of the Partners Health Care Center for Connected Health, my go-to guy for m-health analysis, struck a cautionary note:

“‘Expecting people to have an ‘aha’ moment because you’ve created a place where they can store data—you’ll be disappointed ….It needs to be much more compelling.’”

Apple seems to get it that privacy and security, always critical with any IoT device or app, would be of paramount importance when it comes to sharing one’s personal medical data:

“Patients could choose to share blood pressure readings with their doctor but not with another app, for example. Even so, patients are sure to be particularly sensitive about who has access to such information.

“’I think that the people doing these integration platforms need to have a privacy mechanism that is believable,’ says George Westerman, a research scientist at the MIT Center for Digital Business. ‘That takes not only a good policy but a brand people trust.’”

The prestigious Mayo Clinic is on-board, updating its app to coincide with release of Health, according to MIT’s Technology Review:

“The clinic’s app is expected to offer additional services, including ways to monitor  patients with asthma or diabetes. ‘If you see the glucose levels rising … you could interact with [the patient] if they had a question, intervene appropriately, and then decrease the need for an emergency room visit or a hospital admission, which we know drives up hospital and patient costs,’ says John Ward, Mayo’s medical director for public affairs.”

Truth to tell, I don’t always record my diet, weight and exercise exercise every day with Lose It!, and I’m well aware that most people who try QS apps don’t keep at them. However, I suspect the HealthKit, because of the mindshare and platform that it will create, may mean this will succeed where Google Health and Microsoft’s HealthVault have failed, and that it will eventually be cool to know what your health stats are — and to improve them.

 

 

 

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Apple’s HomeKit: will it hasten widespread smart home adoption?

Been too busy to comment until now on Apple’s HomeKit platform, announced last week at its WWDC event.

(PROMINENT DISCLAIMER! Having to send huge amounts of money to Loyola of Maryland for the next three years [I feel like I’m in the Weimar Republic and must carry tons of money to Baltimore in a wheelbarrow, LOL] to secure my youngest’s sheepskin has led to a part-time sales job at the Apple Store — which doesn’t give me any inside insights into their strategy. Rest assured that nothing that will ever appear in this blog about Apple will be gathered from anything other than public sources. I know only what you know, and the opinions expressed here are solely my own).

As the announcement aimed at developers said,

“HomeKit is a new framework for communicating with and controlling connected devices in a user’s home. Apps can enable users to discover devices in their home and configure them, or you can create actions to control those devices. Users can group actions together and trigger them using Siri.”

As I wrote when Google bought Nest last winter, the most immediate impact will probably be to boost public visibility and understanding of the IoT and smart homes.

Beyond that, the ability to leverage Siri’s growing versatility will probably be a major factor in promoting IoT ease-of-use (given my pre-occupation with use of smart-home technology to encourage “aging in place” among seniors, it will be very important in getting the tech-averse and those who have trouble typing on a smart phone to use HomeKit-compliant devices. And then there’s the companion Health Kit, also announced at WWDC, which I’ll review in my next post.).

As you might expect given Apple’s overall zeal for close hardware and software integration, the developer’s kit emphasizes protocols and standards compliance — which should in turn enhance overall security and privacy protections, benefiting all players:

“Home Kit provides seamless integration between accessories that support Apple’s Home Automation Protocol and iOS devices, allowing for new advances in home automation. By promoting a common protocol for home automation devices and making a public API available for configuring and communicating with those devices, Home Kit makes possible a marketplace where the app a user controls their home with doesn’t have to be created by the vendor who made their home automation accessories, and where home automation accessories from multiple vendors can all be integrated into a single coherent whole without those vendors having to coordinate directly with each other.

Home Kit allows third-party apps to perform three major functions:

  1. Discover accessories and add them to a persistent, cross-device home configuration database.
  2. Display, edit, and act upon the data in the home configuration database.
  3. Communicate with configured accessories and services to get them to perform actions, such as turning on the lights in the living room.

The home configuration database is not only available to third-party apps, it’s also available to Siri. This allows users to give commands like, ‘Siri, turn on the lights in the living room.’ If a user creates a home configuration with logical groupings of accessories, services, and commands, Siri can make it very easy to accomplish sophisticated operations with voice control.”

Most important, individual IoT apps and devices can come together into “scenes,” in which a variety of actions (such as starting appliances, turning up the heat, etc., when you wake). IMHO, this emphasis on inter-operability is critically important to public acceptance of the IoT.  As I’ve written before about my IoT “Essential Truths,” two critical things we need to do is to ask “who else could use this data?,” and to democratize innovation. As I understand the above description, it will be like the iPhone ecosystem, where Apple will review all apps and decide whether they can be sold on whatever “store” the company creates for the IoT, but developers will be encouraged to run wild with their imaginations to create both new hardware and to come up with innovative mashups of data from all the various devices that will help integrate them into a comprehensive ecosystem in which, for example, an action by one device may trigger a follow-on action by another device.

The framework, logically, uses a home metaphor to organize all the components into a hierarchy:

  • Homes (HMHome) are the top level container, and represent a structure that a user would generally consider to be a single home. Users might have multiple homes that are far apart, such as a primary home and a vacation home. Or they might have two homes that are close together, but that they consider different homes—for example, a main home and a guest cottage on the same property.
  • Rooms (HMRoom) are optional parts of homes, and represent individual rooms in the home. Rooms don’t have any physical characteristics—size, location, etc. They’re simply names that are meaningful to the user, such as ‘living room’ or ‘kitchen’. Meaningful room names enable commands like, ‘Siri, turn on the kitchen lights.’
  • Accessories (HMAccessory) are installed into homes and assigned to rooms. These are the actual physical home automation devices, such as a garage door opener. If the user doesn’t configure any rooms, Home Kit assigns accessories to a special default room for the home.
  • Services (HMService) are the actual services provided by an accessory. Accessories have both user-controllable services, like a light, and services that are for their own use, like a firmware update service. Home Kit is most concerned with user-controllable services.A single accessory may have more than one user-controllable service. For example, most garage door openers have a service for opening and closing the door, and another service for the light on the garage door opener.
  • Zones (HMZone) are optional groupings of rooms in a home. ‘Upstairs’ and ‘downstairs’ would be represented by zones. Zones are completely optional—rooms don’t need to be in a zone. By adding rooms to a zone, the user is able to give commands to Siri such as, ‘Siri, turn on all of the lights downstairs.'”

As Fast Company observed, the HomeKit’s greatest contribution to the smart home may be streamlining interaction between various apps and devices through Siri:

“By opening up Siri to control third-party peripherals, the smart home experience will become infinitely more seamless. Up until now, controlling a smart device has meant unlocking a mobile device, launching an app, and then making adjustments–a bit too much friction for lowering the volume of the TV or dimming the lights.”

Apple has already lined up a great assortment of partners: iDevices, iHome, Cree, Honeywell, Haier, Philips, Kwikset, Netatmo, and Withings. Hmm: no Nest?

Still to come, of course, is to find out what Apple itself will develop in terms of smart home hardware, such as the long-rumored iWatch (again, I know nothing about this beyond what we’ve all read in blogs, etc.).

No matter what shape the company’s IoT strategy takes, the fact that the world’s second-most profitable company, and leading retailer,  has made such a public commitment to the IoT and smart homes should dramatically speed public adoption, and, perhaps equally important, create public awareness. After all, remember how quickly and dramatically the iPhone transformed the cell phone paradigm — and our lives.

NEXT: Apple’s Health Kit.

 

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Ivee: helping seniors “age in place” through Internet of Things

Posted on 28th May 2014 in aging, home automation, Internet of Things, seniors, SmartAging

I’m still not certain I buy the oft-expressed view that seniors are inherently anti-tech (I’ve seen too many of them at various Apple Stores buying iPads so they can do FaceTime with the grandchildren…), but it’s true that, as you get older, you’re less likely to want to squint at tiny displays, or tap tiny virtual keys, etc. And, truth to tell, if you can simply give a voice command to do something you’d otherwise have to do manually, who wouldn’t choose the easy way out (hey, I know I’m late to the game, but I’m just starting to use Siri to dictate texts).

iveecover iveeThat’s why I think the voice-activated assistant ivee can be a wonderful tool to help seniors age in place, by serving as the easy-to-use access point for a growing array of smart home devices, including hubs, thermostats, and, soon, locks and lights (including the Phillips Hue — why shouldn’t seniors be able to pick from 6 million different combinations of light colors???) from a variety of vendors that can control various home functions — and, BTW, some of those devices can also let nervous adult children know you’re OK.

ivee will work with both open and proprietary communications standards.

ivee meets one of my acid tests for IoT devices for seniors, in that “she” doesn’t give off any kind of sterile home nursing vibe that would stigmatize users — when she isn’t following your every wish and command she serves as an attractive clock. But speak to her from 10-15′ away, and she’ll:

  • adjust the temperature
  • turn on the lights
  • tell you stock prices
  • tune your radio
  • tell you the weather.

Interestingly, Interactive Voice, ivee’s parent company, doesn’t mention the senior market anywhere on its site, but I think it could be the killer device for seniors who want to stay in their home.

Whether or not your Mom and Dad are tech averse, why not get an ivee to control your own smart home devices, and then let them ask you how the heck that thing works — it won’t be long until they’ll ask for one of their own, and you’ll have launched them on the road toward safely and easily controlling their home — and aging safely in place.

 

New #IoT Health Paradigm: Partnership Between Doctor and Patient

With all the Internet of Things emphasis on making “dumb” things “smart,” we shouldn’t ignore how it will make all of us smarter as well.

Nowhere will that be as important as in healthcare, where I believe it will produce a dramatic paradigm shift in which patients will become empowered and will be full partners in their care, improving health, and cutting costs. Today’s post follows up on one I wrote recently focusing on seniors’ health care, which I believe will dramatically improve due to the IoT.

I was provoked to write by the annual report from the Partners (appropriately enough….) Health Center for Connected Health (full disclosure: my wife directs the women’s physical therapy program @ Brigham & Women’s Hospital, part of Partners, although her particular service isn’t working with the Center), which reports on a wide range of initiatives to address key issues such as reducing re-admissions, improving access to care, and helping with the transition from hospital to home.

IMHO, there’s an inevitability to this shift, because the current health care system is unsustainable, at least in the US. Costs are too high, many physicians will retire in the next decade, and the number of seniors is increasing dramatically. Oh, yea: we ain’t getting what we’re paying for either: our health is lousy compared to other nations.

But something amazing happens when people start to track and report their own health indicators, either on their own or as part of the fast-growing Quantified Self movement. As Dr. Joe Kvedar, founder and director of the Center  for Connected Health, says, “People can and do take very good care of themselves when you give them the tools to do so.”

We’ve got the essential tool for this transition right in our hands: the Center for Connected Health has found that 70% of patients in one of Partners’ community health centers have smartphones.

The apps  — there are now more than 100,000 health care ones! — and related devices such as Fitbits, Nike Fuels or Jawbone UPs to monitor health via smartphones still aren’t fully accurate, but they’re still valuable because they do accurately demonstrate personal activity trends, so you can compare your activity from day to day.

And they do change behavior:

“Can trackers really change behavior in people? Last year, Dr. Rajani Larocca, a primary care physician at Massachusetts General Hospital, conducted a six-week lifestyle program for 10 patients with diabetes ages 50 to 70 that included weekly sessions to encourage exercise and healthful eating; each participant also was outfitted with a Fitbit Zip tracker.

“‘Every single person increased their activity,’ Dr. Larocca said. ‘People felt more knowledgeable.’ Eight months later, about half the patients from the group still wear a tracker.

“Researchers at the Center for Connected Health in Boston have been giving activity trackers to subjects for six to nine months, then studying changes in their behavior. Dr. Kamal Jethwani, head of research at the center, said he saw three distinct groups of people among study participants.

“About 10 percent are ‘quantified selfers’ with an affinity for this kind of feedback; just by looking at the numbers, they are motivated to be more active. An additional 20 percent to 30 percent need some encouragement in addition to tracker data to effectively change their behavior.

“But most of the subjects observed by Dr. Jethwani don’t understand the data and need help making sense of it. For them, he said, social motivation from a friend or joining a team or workplace challenge may be more effective.”

As I wrote in my post about seniors’ health care, as soon as we have effective mechanisms to feed the data to doctors the quality of care will improve. It’s like with so many inanimate things whose real-time status we’re able to really observe for the first time with the IoT: doctors will no longer have to rely on our self-reporting (“um, I think that about two months ago I felt out of breath a lot”) or the measurement of vital signs in the artificial setting of a doctor’s office. Instead, they’ll have access to longitudinal data about how you actually live (in fact, Partners introduced a system last year that allows people to electronically upload data to their medical records gathered from devices such as glucometers, blood pressure cuffs, bathroom scales, and pulse oximeters.

It’s a bright — and healthy — new day!

Gotta go now: my Jawbone UP tells me I’ve got to walk to CVS and the post office to meet my 10,000 steps per day target….

PS: If you’re ready to test the waters, check out the Center’s Wellocracy.com site to learn about self-monitoring devices and how to use them!

 

Seniors and the Internet of Things: Empowerment and Security Through Smart Aging

I was quoted extensively in a Sunday Boston Globe feature on the IoT. It was in a special section aimed at seniors, and I’d been really passionate with the reporter about the IoT’s potential to transform seniors’ lives through new products such as bedroom slippers with sensors that can detect minute variations in a senior’s gait and alert a caregiver by app in time to avoid a fall, or a gorgeous necklace that can detect the onset of congestive heart failure). However, the article just ended up as a general introduction to the IoT.

Too bad.

necklace that monitors for possible congestive heart failure

While I was doing the interview, it dawned on me that this might really be a wonderful niche in the Internet of Things.  You see, I spend part of my time caring for two seniors who have faced serious health challenges, and it has really opened my eyes to the potential benefits of ambitious IoT programs for seniors.

We don’t have any time to lose: I’ve heard that a third of all doctors in the US will retire in the next decade, while they and about 10,000 others will turn 65 each day. There is simply no way that we can sustain this loss of medical professionals just when they are needed more than ever without fundamental change in the health care system!

To me, what the IoT represents is an opportunity for a fundamental change in the doctor-patient relationship, with empowered patients becoming full partners in their care through self-monitoring.  It will end the historic pattern, driven by necessity, of placing most emphasis on encounters in the doctor’s office, where the patient is forced to recall his or her symptoms, perhaps from several weeks ago, with no objective way of measuring them (not to mention factors such as “white-coat hypertension,” that may be induced by the very setting of the encounter. My blood pressure always goes up in my doctor’s office because she’s on the third floor, and I go up the stairs quickly rather than taking the elevator). Instead, the patient will generate a constant stream of data, and, over time, we will evolve efficient ways of reporting the spikes in readings to the doctor in a way that might actually trigger preventive care to avoid an incident, or at least provide an objective means of judging its severity to improve the quality of care.

Let’s also not forget about the benefits to seniors living alone and their families living miles away, of smart home devices.

I’m going to make this a major focus of my future IoT work, in large part because my personal experience working with seniors’ health needs has sensitized me to the wide range of issues that successful IoT solutions for senior must address:

  • ease-0f-use, especially for those who aren’t comfortable with technology or who face issues such as diminished vision or arthritis
  • non-stigmatizing: hey, grey hair is enough of an identifier: seniors don’t need other things that would further identify and isolate them
  • privacy and security: seniors are already targets of enough scams and efforts to exploit them: they don’t need to become even more vulnerable, especially regarding something as critical as their health
  • affordability: especially with devices that they might be expected to pay for entirely or in part. That can be difficult on a fixed income
  • can they encourage mutual support? I’ve seen first-hand how mutual support from an exercise group can encourage frail elders to keep exercising. Done right, I suspect apps that let you voluntarily share data might be very effective motivators
  • fostering independence: smart home apps that might help seniors manage household functions easily, as well as ones that could be monitored remotely by their adult children, might increase the chance they could stay in their homes independently for longer, an important factor in both reducing hospitalization costs and fostering self-worth.

What other factors do you think might be relevant to creating effective IoT devices for seniors?  Let me know.

The other day I had an e-mail exchange with one of my fav IoT pioneers, Dulcie Madden of Rest Devices, maker of the PEEKO “onesie” for babies, which (among other things) can reduce the possibility of SIDS among babies. Years ago, I was a day-care teacher, and now that I help care for seniors, I’ve noticed how similar their needs can be. IMHO, infant care and senior care are two of the most promising areas for life-improving IoT solutions. For both social and economic reasons, they should be a priority.

Let’s go!