Detailing my “Smart Aging” through the IoT vision

The best-laid plans get canceled due to Summer vacation…

I was supposed to speak to seniors (and those who love or care for them!) today in my dear little burg, Medfield, MA, about my “Smart Aging” through the IoT vision. However, the talk has been postponed til September due to the small number of sign-ups. Oh well, I guess most revolutions start with a whimper, not a bang.

Because I believe so strongly in the idea, I’ve posted the talk (including presenter’s notes) to SlideShare.

Basically, it fleshes out what I’ve written in a number of recent posts, that I believe we can and must meld two aspects of the IoT, Quantified Self wearable devices that measure and record personal health and wellness data 24/7 and smart home devices such as the Nest thermostat and Ivee voice-activated base station, to create a new approach to aging. I defined smart aging as:

using senior-friendly home and health technology to cut your health and living costs,
improve your health and quality of life, and keep you in your own home as long as possible.

I predicted that it can “bring unprecedented health and happiness to our senior years — while saving us  money!”

While there have been efforts for a while to specifically use technology to improve aging, I predicted that

“Smart Aging will instead result from tweaking efforts underway as part of the Internet of Things to improve life for everyone, of all ages. As Joe Coughlin, director of MIT’s AgeLab, says, ‘Counterintuitively, making home automation mainstream and cool means that it’s likely to end up in the hands of older adults sooner than if home automation technologies were only designed specifically for older people.’”

(that’s why I suspect that wearables such as the Nike Fuel or prototype MC10 for jocks will be more important for seniors than anything specifically designed for them — and will face fewer obstacles to adoption).

I stressed that there are still important obstacles, not only the security and privacy ones that are essential for ANY IoT product or service, but also some that are specific to seniors, such as preserving their dignity and letting them control who will share access to their data.

I concluded that this approach will pay multiple benefits:

  • Improve your health & fitness
  • Cut your medical bills
  • Build your self-esteem
  • Cut your living costs
  • Let you stay at home, safely.

I’d love to hear your thoughts on this subject.

Will sports-star wearables make them cool enough for general public?

OK, first an admission of guilt: I don’t synch my Jawbone UP every day (although now that my wife and I are sharing results and challenging each other, that’s subject to change).  Evidently, I’m not alone: I read stats somewhere (can’t remember the source) that about 40-50% of all Quantified Self device users stop using them within the first six months.

But that’s not the big problem: that’s the fact that only a very small percentage of the population ever uses the devices at all, despite their benefits for health and fitness.

Part of the answer, IMHO, is making them sooo simple to use that you’d automatically use them (for example, I like the fact that the Lose It! app nags me every day if I haven’t entered my diet, activity, or weight), but the other factor is creating a cool factor about wearables. I read recently about a VC in Silicon Valley who always wears her Jawbone to cocktail parties because it starts conversations, but Silicon Valley VCs aren’t generally regarded as celebrities in the heartland, so I’m thinking more about sports stars.

biostamp

Now there’s a Boston-area startup, MC10, that might just make that breakthrough.  According to The Boston Globe, the company has a number of 1st-rank sports luminaries as investors/advisors, including former NBA star Grant Hill, hoop coach John Thompson III,  Indianapolis Colts quarterbacks Andrew Luck and Matt Hasselbeck, soccer star Kristine Lilly, and four-time Olympic women’s ice hockey medalist Angela Ruggiero.

The company’s first product is the translucent, stick-on Biostamp, due to be released next year. “The device, a barely visible 2-square-inch patch, is designed to stick on any body part like a second skin and record biometric data from heart rate and hydration levels to muscle activity and sleep patterns.”  It’s likely to replace the current, bulky and obtrusive devices for serious athletes. 

According to The Globe, there is about a dozen companies developing similar devices for jocks.

I’ve got a big collection of ball caps (primarily those of The Team That Shall Not Be Mentioned This Year, the one that “plays” [as it were…] @ Fenway Park), and an equal number of T’s from the same guys. Obviously, fans love to bond with their fav jocks by wearing their apparel, so I’m wondering whether the advent of Biostamps and similar devices will lead to fan apparel with similar devices built in, as worn by their favorites (hmmm: somehow I can’t see comparing my caloric intake with Big Papi …).

I see a lot of guys and gals around Boston with gray hair wearing the same gear, so I suspect the same approach might be a more productive way to get seniors to wear such devices than to design ones specifically for them.

This niche bears watching!

 

The New IoT Math: 1 + 1 + 3 — Jawbone UP24 now controls Nest thermostat

A chance conversation about the IoT the other day turned me on to this elegant proof-of-concept that what I call “Smart Aging” to help seniors be healthier and avoid institutionalization is possible: my Jawbone UP bracelet could now control my Nest thermostat (if I had one: with three heating zones in my house, I’m gonna wait until the NEST price drops before I’ll buy them…).

That, ladies and gentlemen, is exactly what I’m talking about with my concept of “Smart Aging” for seniors, which would combine:

  • Quantified Self devices such as Jawbone UPs, Nike FuelBand, the congestive heart failure necklace,  or the Biostamp sensor (more about that one in a future post!) that will easily and unobtrusively monitor your bodily indicators and, if you choose, report them to your doctor, both to improve diagnoses, and to encourage you to adopt healthy practices such as a daily walk.
  • smart home devices such as the NEST or the voice-activated Ivee hub.

Even better, if device manufacturers get it about one of my Essential Truths about the IoT:  who else could use this data?, they will allow free access to their algorithms, and someone will realize that 1+1=3: the two devices are even more powerful when linked! In this case, the Jawbone UP is powerful, and so is the Nest, but something totally new is possible when they are linked:

“By connecting your UP24 with your Nest Thermostat, the temperature of your house will automatically adjust to a temperature you prefer – the moment you go to bed or wake up.

“Through UP Insights, we have shared the fact that an ideal sleeping environment is cooler, between 65 and 72 degrees. With the Nest integration, we no longer just tell you this fact. We make it a reality. Once your band enters Sleep Mode, your thermostat will kick down to your ideal temperature. And when you wake? You guessed it. Your thermostat will automatically adjust to a warmer temperature… all without leaving your bed.”

Nest-2_thermostatJawbone_UpHow cool (or hot, depending on the season…) is that?

I particularly like it for seniors because of one UP feature: instead of setting a precise wake-up alarm, you also have the option of creating a 30-minute window when it it should vibrate to wake you, with the exact time determined by what the UP determines is the ideal point in your natural sleep cycle.  Some working people on extremely tight morning schedules may not want to take advantage of that option, but for seniors, answering to no one but themselves, that would be an added benefit: get the best possible sleep, AND get up in a warm house (oh, and while you’re at it, why not link in some Phillips HUE lights and a coffee pot plugged in to a Belkin WeMo socket, so that you’ll also have fresh-brewed coffee and a bright kitchen?).  Sweet!

Do the math: one IoT-empowered device is nice, but link several more of them, and 1 + 1 = 3 — or more!

Smart Toothbrush: another example of “just because you can do something doesn’t mean you should”

I absolutely love my current Braun electric toothbrush, because it (unlike the first one I had, which basically just spun around) has a timer that reminds me to brush each quadrant of my teeth for 30 seconds.  In the past, I never thought about what amount of time was optimal for brushing, let alone monitored how long I actually did so. As a result, I’m confident that I’m really keeping my teeth clean.

smart toothbrush

However, I just don’t get it about why I should transfer that info via Bluetooth to an app. Shouldn’t we be content with the bare minimum of technology that gets us to adopt better health practices, and, where relevant, to transfer that information to our doctors so they can get a better idea of our daily practices and state of health?  Maybe I’m nitpicking, but I do think it’s relevant to relay to your doctor potentially highly-variable data such as your daily Fitbit or Jawbone readings (as patients at certain MGH or Brigham & Womens’ practices can now do), but it seems to me that in the case of toothbrushing, it should be enough to simply provide feedback that lets you know you’re brushing enough, and leave it at that.

Thus, the “connected” toothbrush to me seems to violate one of my “Essential Truth” of the IoT, that “just because you can do something doesn’t mean you should do it.”

Again, I realize I may be splitting hairs here distinguishing between reporting some health data and not other. What do you think?  Let me know!

Apple iWatch: could they really make wearables acceptable to mass market?

The WSJ had a piece this week speculating on the rumored Apple iWatch (Disclaimer: I work part-time in an Apple Store. In that capacity I don’t know anything you don’t know — including whether the iWatch will actually ever happen! My sources for this blog are limited to publicly-available ones.).

The Journal notes that none of the smart watches released so far have had major penetration, and, as a further cautionary note, I’d point out that most people who start using a Jawb0ne UP, Nike FuelBand, etc. stop using them in several months (HELP: I recently read the data on that claim, but I can’t find the citation. Can you help me find it???).

HOWEVER, as I speculated recently in my posts on Apple’s soon-to-be-released HealthKit and HomeKit, the company has shown time-and-time-again over the past 15 years that it knows how to create disruptive devices (even though Clayton Christensen was skeptical, LOL!) and create huge new markets that make tech devices mainstream.

Given my new-found pre-occupation with “Smart Aging” through a combination of Quantified Self and smart home devices, I really like the idea of a smart watch for seniors. I haven’t worn a watch since I got my first Palm Pilot (wow: remember when they were cutting edge??), but seniors do, and I suspect that if they could get immediate feedback on their vital signs from something that was not only functional but fashionable and didn’t require any technical savvy, they wouldn’t feel stigmatized by wearing the watch, a critical factor in its widespread acceptance.

Let’s see what happens!

 

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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Human energy for the Internet of Things

OK, I’ll admit it, I’m a cheap Scot (living in waste-not, want-not New England, to boot!), so I hate to waste anything.

That’s why I was so excited to read about this Columbia U research project on harvesting human energy (MIT, among other institutions, has also been researching this subject for years), especially as a way to power wearable devices.

This could really be a win-win for my pet project, using wearables and the Quantified Self approach to help seniors become empowered partners in their health care: get them moving, providing power for the devices reporting on their health indicators! Sweet!

The EnHANTs (Energy Harvesting Active Networked Tags) study, the first extensive one of human-generated energy, attached flexible tags – so called EnHANTs – across a range of everyday objects and participants, allowed the researchers to actually document how much energy various human activities produce. 40 people participated over 9 days, including activities such as walking, running and cycling.

Toss these out during your next trivia night:

  • people generate enough energy to continuously transmit data at a rate of 1 kilobit per second
  • walking “generates the same quantity of power – about 150 microwatts – as indoor lighting”
  • “Periodic motion – such as writing with a pencil – produces more harvestable energy (10-30 microwatts) than the acceleration involved in a 3-hour flight (5 microwatts)”
  • “Taller people generate around 20% more power than shorter people” (um, have you seen the Red Sox’ Dustin Pedroia in action? I’d question that one…)
  • “Walking downstairs – as it involves higher acceleration – generates more energy than going upstairs. 95% of the total harvestable energy you produce is generated in less than 7% of the day.”

The ENHANTS project aims to not only document human energy production, but to harvest it:

“EnHANTs are small, flexible, and energetically self-reliant devices that can be attached to objects that are traditionally not networked (e.g., books, furniture, walls, doors, toys, keys, clothing, and produce), thereby providing the infrastructure for various novel tracking applications. Examples of these applications include locating misplaced items, continuous monitoring of objects (items in a store, boxes in transit), and determining locations of disaster survivors.

Recent advances in ultra-low-power wireless communications, ultra-wideband (UWB) circuit design, and organic electronic harvesting techniques will enable the realization of EnHANTs in the near future. In order for EnHANTs to rely on harvested energy, they have to spend significantly less energy than Bluetooth, Zigbee, and IEEE 802.15.4a devices. Moreover, the harvesting components and the ultra-low-power physical layer have special characteristics whose implications on the higher layers have yet to be studied (e.g., when using ultra-low-power circuits, the energy required to receive a bit is significantly higher than the energy required to transmit a bit).

The objective of the project is to design hardware, algorithms, and software to enable the realization of EnHANTs.”

Coupled with some of the research I’ve cited earlier about batteries the size of a grain of sand or harvesting energy from “ambient backscatter” makes me confident that, in the near future we’ll be able to have effective wearable devices for reporting health conditions that will require little or no external energy sources.

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!