Big tech players are poised to disrupt the healthcare industry with new gadgets, but the road to full integration is fraught with peril.
By Elizabeth Fry
When Apple launched its HealthKit system late last year, the iPhone maker asked leading US healthcare provider Duke Medicine to integrate its electronic health records systems with the new Apple system. For Duke’s director of mobile technology strategy, Dr Ricky Bloomfield, that invitation was a great opportunity to track patients’ wellbeing outside clinic visits.
“If we can monitor their heart rate, weight and blood pressure while they are at home, we are more likely to catch the early signs of illness,” he says.
Bloomfield believes in the power of data to improve people’s health. Apple, which claims it can “revolutionise how the health industry interacts with people”, is also betting on the power of health data. So are a slew of start-ups and big Silicon Valley players including Google. All of them think making better use of data and technology can give people more control over their health, slash health costs and help develop new drugs.
But many people have tried to “fix” health over the years. The health industry has also proved notoriously resistant to change. Before the IT industry can do for health what it did for books and music and travel, there are plenty of puzzles still to solve.
“The belief that information will magically transform into personalised solutions is a huge problem.” Dr Evian Gordon
Fitness data explosion
Wearable fitness sensors produce data on everything from blood pressure to sleep patterns; health apps analyse it and present it in a form you can understand. These sensors and apps are suddenly appearing in everything from cheap smartphones to A$500 watches. They promise greater visibility over personal health and the potential for earlier, more targeted treatment when we get sick.
Samsung has launched a line of “Gear” smartwatches and fitness bands that can track how long you run, walk and cycle, and monitor your heartbeat. Google’s smart contact lenses monitor glucose levels in tears and help diabetics manage their condition. Jawbone wristbands tell you how many steps you’ve taken and how many hours you’ve slept. Apple’s Watch, rumoured for a March release, will reportedly feature at least 10 different sensors.
Apple’s HealthKit will help hardware and software developers use all this fitness and health data. Bloomfield calls it the best of the integration technologies out there right now. “Once mobile devices are HealthKit-enabled,” he says, “we don’t have to do anything to make their devices work with our system. Right now we make a big deal about it but in 10 years we will get alerts, have less formal communications with providers, less visits to doctors, more care at home and we can take advantage of data almost in real time to make better decisions.”
In both the IT and health industries, there’s now an optimism that big data is transformational. But the big question is how exactly will it do that? How can collecting and harnessing floods of data, from a mass of sources, help people understand and manage their disease better?
Dr Evian Gordon, chief executive of the publicly listed Australian company Brain Resource, understands the challenges better than most. Brain Resource has launched the first online cognitive test that matches patients to the right antidepressants; it also claims to identify people who won’t respond to these drug therapies and offers cognitive alternatives.
“The medical community has a vested interest in the status quo, but Google, Apple and Samsung can see an enormous opportunity and talk a good game about wearables.” Daniel Mahony, Polar Capital
Gordon is among those who argue that health data can be dangerously seductive.
“The obsession with data and the belief that information will magically transform into personalised solutions is a huge problem. If you look at where all the big money is going, the emphasis is on data and the sexiness of the devices, not the solution.”
He sees a huge difference between building an app on a mobile phone and coming up with an outcome. Making sense of the device sensors’ growing torrents of data leaves people exhausted and exasperated. Health experts and developers will need analytics, engines and algorithms to find useful patterns, and they’ll need intuitive ways to present the findings.
Gordon thinks Apple and Google have been smart to create platforms for creative developers – facilitating innovation, rather than doing it all themselves. But he warns: “It’s much harder than people think – even for the tech giants.”
Gordon should know. He’s built the world’s largest standardised and integrated database on the brain, he says, and has applied it to find answers for depression sufferers. He sees it as an important step. But he notes that even genome science hasn’t worked out how to extract useful information out of vast amounts of data.
According to Gordon, there have been at least 10 major projects to mine big data sets, all hoping a solution will pop up. “But there hasn’t been a single study that has replicated any psychiatric disorder. There are too many variables.”
Beyond the wearables hype
Collecting data is no slam dunk either. Wearable fitness trackers still have a long way to go before they live up to the hype. The main challenge today says Benjamin Ruegsegger, AllianceBernstein’s senior US analyst, is that consumer wearables mostly track simple things such as the number of steps taken and sleep activity. Fitness gadgets carry little in the way of redeeming functionality and, partly because of that, typical consumers don’t use the product for more than six months. He thinks the next generation of wearable fitness trackers should be able to distinguish between types of activity – running, cycling, swimming, basketball and so on. That may increase the product’s use and longevity.
Daniel Mahony, healthcare fund manager at UK-based Polar Capital, adds: “The medical community has a vested interest in the status quo, but Google, Apple and Samsung can see an enormous opportunity and talk a good game about wearables. They want to sell these devices as consumer products because they are not subject to regulators who stand in the way of progress.”
There is still a big gap, though, between cool consumer gizmos of the kind developed by Google, Apple and Samsung and the medical-grade patient monitoring needed to really change things. The latter will move more slowly because it requires regulatory approval. That’s why Jawbone and Fitbit have chosen to stay in the consumer space for the future.
“The closer you are to the consumer, the quicker the time to market,” says Ruegsegger. He believes the smartphone has definite longer-term potential on the medical side, but as the market is very fragmented, it’s not been widely adopted as a gateway to medical monitoring.
A few companies are building those sophisticated medical-grade devices that will bring doctors into the information loop. One such product is Vigilant’s Bee+ insulin injection tracker. The Bee+ cap fits most insulin pens and sends data on how many units of insulin have been injected to an app on a smartphone. This record can then be easily shared with a patient’s doctor.
There are even digestible sensors that can be taken along with prescription pills and are powered by the enzymes in the stomach. These send data through a person’s mobile phone back to the doctor and log a patient’s reaction once the medication is ingested.
Silicon Valley meets Big Pharma
The overwhelming need to make sense of data and devices has driven technologists to partner with conventional health industry players. That’s part of the thinking at both Apple and Google. It’s also why the famous Mayo Clinic has teamed with IBM, whose Watson “cognitive computing” technology is designed to extract useful conclusions from data. It’s why Intel has partnered with the Michael J Fox Foundation to find better treatments for Parkinson’s disease.
Following the same pattern, Google signed a deal with global biopharmaceutical firm AbbVie for new treatment options for neurodegenerative issues when it decided to move into anti-ageing treatments. It also joined with Novartis for the smart contact lens project.
These alliances make sense. Neither the IT world nor existing health players can find the answers on their own. The existing health players, in particular, are under enormous pressure to change as health costs rise and populations age. Pharmaceutical giants – “Big Pharma” – are being forced to reinvent themselves and become personalised integrated solutions companies. “They won’t survive unless they adapt,” says Brain Resource’s Gordon.
As conventional medicine lets people survive traditional killers including cancer, diabetes and heart disease, the challenge to beat neurological diseases such as Alzheimer’s and Parkinson’s becomes more urgent.
Deborah Rathjen, who heads Australian biopharmaceutical company Bionomics, believes it will take a convergence of different disciplines to bring about solutions – especially in the neurological area, where research is lagging. “Measuring what’s going on in the brain will be critical,” she says.
There’s also a whiff of evangelical zeal about some of the technologists. For them, applying technology is more than just a way to make a buck; it’s a way to give consumers power over their health and health spending.
“Big Pharma has had everything their own way for a long time,” insists Polar Capital’s Mahony. “It used to be that pharma had the information and the consumer had none. But that has changed.”
How optimistic should we be that constant monitoring and data mining can make us healthier? Duke Medicine’s Bloomfield argues that it’s a central principle in statistics that more data will produce better, more reliable results. Call it a healthy optimism.
Jawbone’s “digital nudge"
The idea that continuous health monitoring can help people achieve healthy lifestyles is now mainstream says Andrew Rosenthal, who manages the wellness platform at wearables maker Jawbone.
“From our perspective, health is what happens between doctor visits. People want to understand themselves and data is a big part of that. It provides a context that wasn’t possible before,” he says.
The health industry has long been trying to get people to change bad behaviour. Yet the incidence of diabetes, obesity and liver disease is growing fast in the developed world.
According to Rosenthal, Jawbone and similar devices are a perfect way to give us less than healthy folk a digital nudge.
“We’ve combined our understanding of what [really] happens in your life through actual data, with the ability to drive change through tactical action,” he says.
This article is from the March 2015 issue of INTHEBLACK.