A New Meaning for Connected Health at 2016 Symposium (Part 1 of 4)

Posted on November 3, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Those of us engaged in health care think constantly about health. But at the Connected Health symposium, one is reminded that the vast majority of people don’t think much about health at all. They’re thinking about child care, about jobs, about bills, about leisure time. Health comes into the picture only through its impacts on those things.

Certainly, some people who have suffered catastrophic traumas–severe accidents, cancer, or the plethora of unfortunate genetic conditions–become obsessed about health to the same extent as health professionals. These people become e-patients and do all the things they need to do regain the precious state of being they enjoyed before their illness, often clashing with the traditional medical establishment in pursuit of health.

But for most people with chronic conditions, the opposite holds true. A whimsical posting points out that we willingly pay more to go to a masseur or hairdresser than to a doctor. I appreciate this observation more than the remedies offered by the author, which fall into the usual “patient engagment” activities that I have denigrated in an earlier article.

Understanding health as a facet and determinant of everyday life becomes even more important as we try to reverse the rise of costs, which in many nations are threatening economic progress and even the social contract. (Witness the popular anger in the current US election over rising insurance premiums and restrictions on choice.) We have to provide health solutions to people who are currently asymptomatic. The conventional focus on diagnosed conditions won’t serve us.

It’s thus commendable that the Connected Health symposium for 2016 has evolved to the point where participants can think not only of reaching out to patients, but to embedding their interventions so deeply into patient life that the patient no longer has to think about her health to benefit. This gives a new meaning to the word “connected”. Whereas, up to now, it referred to connecting a patient more closely with their clinicians and care-takers (through data collection, messaging, and online consultations), “connected” can also mean connecting our healthful interventions to the patient’s quotidian concerns about work, family, and leisure.

We can do this by such means as choosing data collection that the patient can enable and then stop thinking about, and integrating care with the social media they use regularly. In her keynote, Nancy Brown, CEO of the American Heart Association, pointed out that social connections are critical to health and are increasingly taking place online, instead of someone dropping by her neighbor for coffee. The AHA’s Go Red For Women program successfully exploited social connections to improve heart health.

If you want an overview of what people mean by the term “connected health,” you would do well to get The Internet of Healthy Things, by Dr. Joseph Kvedar, leader of Partners Connected Health and chief organizer of this symposium. For a shorter overview, you can read my review of the book, and my report from an earlier symposium. Now in its 13th year, the annual symposium signed up 1200 registered attendees–the biggest number yet. This article looks over the people and companies I heard from there.

Exhausting the possibilities of passive data collection
Glen Tullman, CEO of Livongo Health, offered basic principles for consumer health in a keynote: it must be personal, simple, context-aware, and actionable. As an example, he cited Livongo’s own program for sending text messages to diabetes patients: they are tailored to the individual and offer actionable advice such as, “Drink a glass of water”.

A panel on consumer technology extolled the value of what analysts like to call data exhaust: the use of data that can be collected from people’s everyday behavior. After all, this exhaust is what marketers used all the time to figure out what we want to buy, and what governments use to decide whether we’re dangerous actors. It can have value in health too.

As pointed out by Jim Harper, Co-Founder and COO of Sonde Health, providers and researchers can learn a lot from everyday interactions with devices–diagnosing activity levels from accelerometers, for instance, or depression from a drop in calls or text messages. Similarly, a symposium attendee suggested to me that colleges could examine social connections among students to determine which ones are at risk of abusing alcohol.

Lauren Costantini, President and CEO of Prima-Temp, said in a keynote that we can predict all kinds of things from your circadian rhythm–as measured by a sensor–such as an oncoming infection, or the best way to deliver chemotherapy.

Spire offers a device that claims to help people suffering from anxiety, with a low barrier to adoption and instant feedback. It’s a device worn on the body that can alert the user in various ways (buzzes, text messages) when the user’s anxiety level is rising.

Does the Spire device work? They got a partial answer to this in a study by Partners Health Care, where people had an option of using the device on its own or in conjunction with a headband from Muse that helps train people to meditate. (There was no control group.) Unlike the Spire device, which one can put on and forget about, the Muse purchaser is expected to make a conscious decision to meditate using the device regularly.

The Partners study showed modest benefits to these devices, but had mixed results. For instance, fewer than half the subjects continued use of the devices after the study finished. Those who did continue showed a strong positive effect on stress, and those who discontinued use showed a very small positive effect. Strangely there was a small overall increase in tension for all participants, even though they also demonstrated increases in “calm” periods. There is no correlation between the length of time that individuals used their devices and their outcomes.

Jonathan Palley, CEO & Co-founder of Spire, said participants often liked their devices, but stopped using them because they have learned from the devices how to identify stress and felt they could self-regulate and no longer needed the devices. I believe this finding may apply to other consumer devices as well. The huge rate at which devices are abandoned after six months, the subject of frequent reports and agonized commentaries, may simply indicate that users have reached their goal and can continue their fitness programs on their own. Graeme Moffat, VP of Scientific & Regulatory Affairs at Muse, reported that many purchasers use their headband for only three months, but come back to it over time to refresh their training.

We’ll look at some more aspects of integrating devices into patient lives in the next section of this article.