While reviewing Zeo and aXbo last year, I found myself wondering what was the need for having a bedside clock hardware, since most of that computing could be done in a smartphone. Seems like the crop of solutions  that followed (e.g. WakeMate, Lark, Zeo Mobile) thought of the same. EASYWAKEme follows the pattern: wearable sensor (on wrist) that monitors movement as a proxy for sleep phase, provides intelligent wake-up alarm and longitudinal insight into your sleeping habits. Their ‘how it works‘ page explains it well.

Quick market analysis shows that price is going to be a very important factor since there is a wide range right now and consumers will tend to favor the cheapest. EASYWAKEme (£118), aXbo (starts at €179), SleepTracker ($149) are at the more expensive end compared to competitors like Lark (starts at $99), Zeo (mobile is $99), FitBit ($99), Jawbone Up ($99). WakeMate has already started the downward spiral at $59.

Activity sensors like FitBit, and more recently Jawbone Up are also chomping at the bit to include sleep monitoring as their value proposition. Cheaper solutions that are just smartphone apps are competition too. I actually bought the $0.99 SleepCycle iphone app out of curiosity (it had >20,000 reviews, most were positive) and ended up forgetting about it after a week. I now put it in the same category as placebo: it’ll work only if you already believe it does.

So the real question is whether body movement tracking and analysis is really a dependable way for extrapolating sleep phases. I still believe (based on scientific persuasion like this, and this) that it is. The ultimate hope is that these low-cost innovations can make their way back to help with serious issues like sleep disorders and psychiatric disorders. Current solutions like polysomnography are too cumbersome to be done outside of a clinical setting.

Disclosure: the generous folks at EASYWAKEme offered to send me a review unit, so I’ll be testing that hypothesis over the next few weeks. Look out for an update to this review in near future.

I first heard about MyBasis during a talk given by Bharat Vasan (founder?) at Bay Area Quantified Self gathering in June 2010. He referred to it as PulseTracer back then, and described its use for pulse monitoring. Based on the current description on their website, the product concept seems to have matured. Similar to BodyMedia, it now has 4 Sensors: Pulse, Temperature, Accelerometer, Skin Conductance (i.e. moisture). It is USB and bluetooth enabled; and comes with integrated social functionality (gaming, sharing, rewards, etc.). There seem to be smartphone, iPad and online applications that help provide analysis and understanding of the collected data.

MyBasis certainly has the concept nailed: A smart device with multiple sensors and long battery life in a familiar form-factor + Always-on and connected to desktop, mobile and online dashboards that simplify analysis of the aggregated raw data + Integrated social features that help make it sticky and viral. If they play it right, this can be a hit. Mainstream competition from products (like the lackluster Polar offerings) is uninteresting and hardly addictive.

But critics can say that there are always technophile early-adopters (like me) who crave anything that is novel and web-enabled. So before we get over-optimistic about the impending success of such devices, consider two important caveats.

First, it’s not about sophisticated monitoring or granular data. Whether they realize it or not, the key value proposition for an average end-customer is the personalized insight that results from it. Gathering 24X7 data from multiple sensors is great, but it’s all pointless if the user doesn’t understand the ultimate picture that results from all that data. Most users are interested in revelations into their health and lifestyle, not numbers. So the way MyBasis handles analysis is going to be critical. I was disappointed with MyZeo and FitBit for the very same reason. An interesting approach that MyBasis seems to have is the creation of a virtual pet that gives a quick proxy of your overall status. It may sound silly, but abstractions like these have shown promise in encouraging self-monitoring and positive behavior change in users (e.g. see UbiFit project at University of Washington).

Second, the technology and device needs to be so well-integrated with a user’s lifestyle that they essentially ‘disappear’. If someone needs to put a headband one (like for Zeo) or remember to find a USB cable and synchronize every week to prevent data loss, you can be assured that it’s not going to work out long term. As a species, we humans have remarkable lack of discipline even when it comes to things/habits that are good for us. So the offering needs to add minimal extra work and be seamless with your daily life. Neil Versel at MobiHealthNews calls it “passivity”. Example: FitBit gets a better grade than Zeo in this regard. I clip it onto my belt (almost sub-consciously now) every day and plop it on to the USB hub (always connected to my desktop) once in a couple of weeks. That’s it.

MyBasis is still in early beta, so my impression is based on what their website claims and not actual usage. I’ve signed up for preorder and will update this review when I get my hands on one. Seems like the cost is a one-time $199 for now. It would make a lot of sense to have  a subscription-based model of some sort though. Also, it’d be great to see such solutions go beyond just wellness and be tailored for medical-grade serious conditions like diabetes, hypertension, etc. All clues indicate that such applications are not very far in the future.

Established in 1995, the Center for Connected Health is another such example within Partners HealthCare in Boston. They’ve dabbled in a number of remote monitoring pilots- diabetes, dermatology, heart failure, etc. Healthrageous is their first spin-off. It started as a pilot project conducted in 2006 with EMC Corp. to give employees self-management tools for blood pressure. In June 2010, Healthrageous raised $6 million in a Series A funding led by North Bridge Venture Partners of Boston.

Having read enough of them, I think the marketing message around the concept of continuous care through remote monitoring has now been perfected from multiple angles. Read the descriptions from Welldoc, HealthBuddy, Telcare, iMetrikus, Hommed, Cardiocom, Gentag, BL Healthcare for example. Healthrageous also does a good job at describing the high-level value proposition.

But it seems that the transition from online paragraphs to a generally available, well-known and affordable solution has not happened. I searched for what product/service I could buy through Healthrageous to help a close friend manage her hypertension, but couldn’t find anything. There are some encouraging success stories on the website, but no explanation as to where can one sign up for becoming a success like that. I wish these websites were more transparent and lucid, maybe even at the risk of being less enchanting.

PS: Found two candidate consumer-oriented solutions for remotely managing hypertension. One is not available yet (Withings BP Monitor), and other needs an Apple iOS device to work (iHealth Lab’s BP3) and didn’t get great reviews. If anyone knows of other products/services, please share through comments below.

The Life Pebble hardware includes a single lead ECG, skin thermometer, and an accelerometer. The data collected by the system is streamed wirelessly to a USB Network Adapter over short distances. According to MobiHealthNews, the device is currently in clinical trials are few US hospitals and Toumaz has declared an intention to submit for FDA clearance in 2011. This continuous physiological monitoring capability is currently marketed for assisted living, rehabilitation and professional sports applications by the company.

If we can put aside the “who will pay for this?” question for a minute, this kind of technology has myriad applications in both consumer and provider space. What is chunky hardware today, will almost surely be a disposable, thin patch tomorrow. If we can have a reliable way to do real-time monitoring of key vitals, disease management is no longer confined to interactions in the healthcare setting.

What intrigues me is how the trend of medical-grade remote monitoring (which is moving outside of hospital setting with technologies like Sensium) will interact with the trend of consumer-oriented remote monitoring (FitBit, DirectLife, BodyMedia, Zeo, etc.). There will be a shakeout, obviously. My guess is that the winners then will be not be defined by which way and how much data they gather, but what they do with that data. Analytics and interpretation will be the differentiators.

ScanAvert is an interesting paid application of the same functionality. It allows users to scan the usual UPC barcode information on their supermarket items and cross-check the ingredients with their health profile. Consumers register and create their profile with facts like allergies, prescriptions, diagnoses, dietary needs, etc. ScanAvert uses data provided by Gladson (a major CPG product images and information provider) to do real-time checks on the ingredients of the item to detect incompatibilities. Now I know the usual critique would be that why wouldn’t the consumer just read the ingredient list or package label? And the counter would be that an average consumer may not find the information easily readable or understandable.

Those and other evident arguments aside, the service has obvious value for people with serious dietary issues (think gluten allergy, Celiac, Diabetes, Obesity, Prescription drug interactions). But I’m more excited about another aspect of the service- ScanAvert users can specify custom limits on a labels nutritional box values (calories, carbs, fat…) and get instant recommendation. To me, that is pretty useful for the rest of the population that doesn’t deal with any significant dietary restrictions. In fact, most of us end up buying food items without paying much attention to what it means nutritionally. Even those few that give a thought to the nutritional box items, the mental calculation done is only at a high level (“100 Cal drink…sounds low….I’ll try that”) and inconsistent (how many times have you checked the fat vs. saturated fat numbers?). I doubt most of the ‘normal’ population even knows what is their actual average dietary intake in terms of calories, fat, proteins, etc.

So if someone can setup a profile that puts a limit on the daily fat/protein/cal intake and have a real-time summary report given to them while they were grocery shopping, that would be an darn useful service, I think. Seems like currently ScanAvert can also suggest alternatives (if it detects incompatibility) and send alerts about scanned items that have been recalled. That makes the service even more useful.

It’s intriguing to think about expanding this service into a space where it can potentially be the long-term dietary record for an individual. Suppose one could combine that with a personal activity monitor like FitBit.  That would make a great ‘wellness solution’ for an individual to record, analyze, set goals and then get guidance on two important aspects:

1. Energy input (your food intake)
2. Energy output (your daily activity)

I also found some other apps that help manage food allergies (FoodContentAlerts, iCanEat/iEatOut), although they don’t have bar code scanning ability. This space just keeps getting more interesting every day.

Remote motion-sensor based alarm clocks are probably a nerdy gizmo for now. But it does provide a good use case of how everyday appliances are getting smarter and generating volumes of data. It’ll be very interesting to see how such data can be leveraged to further sleep disorder research- as I wrote in my Zeo post.

Note that there are other products out there that offer the same functionality: FitBit, WakeMate, SleepTracker, and the somewhat unique Zeo.

gDitty is targeted towards promoting physical activity in kids. The product combines an activity meter device (on belt or in pocket) with an online rewards program that motivates kids to move more. The program is in a private research trial mode, so details are unavailable. But it seems that data recorded by the device is uploaded to a custom website, and translated into points of some sort. Points can be then redeemed for certain virtual and real-world rewards like avatars, gift cards, etc.

Trends in childhood obesity are alarming, to say the least. Although I’m a bit skeptical about promoting reward-seeking behavior in younger generation. There is a lot of that going on already. Maybe induce loss aversion instead? We are wired to strongly prefer avoiding losses to making gains, Kahneman & Tversky proved that.

Behavioral psychology argument aside, I realize that encouraging movement through rewards is probably more applicable to kids age-group than adults. I recently met someone from Green Goose- it’s a startup in pre-launch beta mode with similar offering for adults. They deploy tiny activity sensors in way that helps track your daily activities (biking, brushing, water bottle, shower-head, key chain etc.). The recorded data is converted into points, and you get the incentive to transfer money into savings or compete with your friends.

October 2010 Update: gDitty is now rebranded as Zamzee. From some of the job postings online, looks like they are getting serious for a commercial launch.

Zeo system consists of a wearable headband that measure brain’s natural electrical activity. Although their blog has a high-level explanation of how it works, my understanding is that its a single-channel EEG, which seems to be a reasonable way to do sleep analysis in healthy individuals. That data is wirelessly transmitted to a bedside display and stored on an SD card.

Algorithms based on proprietary logic churn out a personal sleep score (called ZQ) to quantify the type of sleep you get. The display unit looks like a bedside alarm clock and shows current and past 2 weeks worth of sleep analysis. Also has some smart alarm clock features like SmartWake alarm that wakes you up at the most suitable time within half-hour of set time. You could upload the data to an online sleep journal through the SD card. The website gives graphs, trends and the ability log other supplementary lifestyle data that can affect your sleep. All that for $249. An additional $100 would get lifetime access to a personal sleep coaching program, which includes regular assessments, goal tracking, email tips etc.

There is no question that Sleep Science is a serious, mature field. Zeo can find its place as a useful adjunct for plenty of sleep-related disorders that affect people who are otherwise healthy. It’s not an FDA approved 11 channel medical grade polysomnogram, and it’d be a mistake to compare it to one. It’s perhaps a closer analog to Actigraphy where a wearable sensor measures overall motor activity during sleep. An actigraph unit is an accelerometer based device like the FitBit, WakeMate, SleepTracker or Axbo.

Accurate or not, Zeo is yet another proof that healthcare is slowly being transformed by sensor-based, portable devices that are capable of analyzing data in a consumer-oriented way to enable individual patient to manage their conditions better.

April ’10 Update: I ordered a Zeo from Amazon in March’10. Been using it for couple of weeks now. The hardware looks and performs well, but I have my complaints. The sensor in headband is bit bulky to sleep with, and I don’t think I’ll get used to the headband anytime soon. The fact that I need to replace the sensor pad every 90 days feels like a hidden cost (they are $24.95  for a pair without S&H) that was not disclosed completely in the marketing.

Software-wise, it’s bit less intuitive than I expected. I’m still wondering what the data tells me. I know Z-score is a overall indicator, but what about the breakdown? Are my 49 minutes of deep sleep enough?  The fact that I woke up 7 times – is that normal? In the end, I’m asking the question- what does this $250 device do for me…  Probably not much because I’m not the target audience for it. People suffering from sleep disorders would perhaps be more receptive.

May’10 Update: Returned it. Sorry Zeo.

June’10 Update: Learned about the Zeo API. Mobile fitness companies RunKeeper and Daily Burn are the first to integrate their services with Zeo. Neat strategy to promote it as a platform.

July’10 Update: Found out about NeuroVigil: another startup in the sleep-monitoring space. Their technology is also based on a single-channel EEG wireless sensor. They claim to be able to send the data (and its analysis) to any mobile device. NeuroVigil’s founder, Philip Low gave an interesting talk at TEDMED in 2009.

Nov’11 Update: Noticed that Zeo now has a cheaper, smartphone-based mobile ($99) solution and original clock has been re-packaged as bedside solution ($149). Smart move, since it makes them more relevant in comparison to other solutions like EASYWAKEme the market.

I was fortunate to see a demo last month. At the core of the offering is a set of remote sensors- a heart rate monitor (worn as a strap around torso) and a stride sensor (clips on to shoes, and measures stride pattern, distance and speed). These communicate wirelessly to a central unit called ‘Pacer’ (MSRP $139.99) which connects with your mp3 player and gives audio feedback about things like calories burned, distance, workout progress etc. Another peripheral that communicates with both sensors is the ‘Zone’ (MSRP $69.99) which is worn on wrist, and gives constant visual feedback (using colors) about your heart rate zone. Pacer connects and syncs to the personalized website, zone doesn’t. Coupled with all that hardware are workout ‘plans’ for your goals like run faster, get fit, loose weight, learn to run or to reduce stress.

My initial impression is that it all sounds too complex and too expensive. But maybe this is legit functionality for people who are serious about running. For the novice consumer who wants to track daily physical activity, I like the simple approach of FitBit. For those who run regularly, the Nike+ Ipod offering is another (much) cheaper competitor. Either way, miCoach is yet another sign that consumer-oriented wellness monitoring solutions are becoming mainstream. Next logical phase would be moving similar technologies and frameworks to tackle real disease management and prevention.

• VISICU (a remote ICU monitoring technology company acquired in 2007)
• Digital Pathology (commercial offering in 2009)
• Motiva (Remote patient management and education delivered through television)
• TeleStation (In-home hub for two-way communication between provider and patients with chronic diseases, integrated with wireless measurement devices)
• LifeLine (focused on preventing falls and medication errors for seniors)

The list above is not comprehensive by any means, it’s just what I could recall right away. Without making this a post about Philips’ strategy, here is the latest addition to my personal list of innovative Philips Healthcare IT offerings- DirectLife activity monitor. It tracks your physical activity (through a triple axis accelerometer) to calculate calories burned. Results show up on a personal webpage (detailed) and on the device (simple indicator lights).

It’s like FitBit, but with some design differences – DirectLife is waterproof and needs USB-based sync (FitBit is wireless through a hub). Most importantly, DirectLife comes with a coach- a real person to provide inspiration and assistance to meet your target weight or activity level. The device (hardware) is $99, but coaching is a monthly subscription of $12.95 (first four months free).

The entry of Philips in this lifestyle-tracking arena makes the proposition more legit for mass adoption- now the HR departments of large enterprises  can think of offering it as a health benefit, maybe health insurance companies will pay attention too. FitBit is a great device in itself, but what’s needed is a “wellness service”, much like what DirectLife is starting to sound like. My prediction is that we’ll see proliferation of such services in the next few years- maybe even a lower premium option in your medical insurance if you choose an integrated activity tracking service.

They smartly target three different segments using different pricing/marketing strategies: Consumers (as GoWearFit), fitness clubs (as BodyBugg) and clinical researchers (as SenseWear). The specifications, features and services differ for each offering and a good comparison table can be found here. All that detailed health info does come at its price- their consumer product starts at $199.95 for the hardware and a $12.95/month subscription to the online personal manager tool.

The company has been around for more than a decade and has certainly come a long way. BodyBugg is used by contestants on NBC’s television show The Biggest Loser, you can find GoWearFit in Dick’s Sporting Good Stores, and there are a bunch of peer-reviewed publications and studies done using SenseWear. I’m a fan of products that let consumer manage their own health, and BodyMedia is certainly doing the right things to ride that growing trend.

Tying the mandatory monthly subscription seems like a walled-garden approach, though. Integrating with electronic records would be a fantastic growth opportunity- think of all the apps that can be built on top of such monitoring data if it were available on PHRs (like Healthvault or Google Health) and/or the outpatient Electronic Medical Record with your physician. Perhaps a more affordable pricing strategy would also help, since insurers are still a long way from paying for such devices.

October 2010 Update: It’s been a while since the original post above. A lot has changed. Externally, there are number of start-ups that compete with BodyMedia now (like Fitbit and others). Internally, seems like they’ve built up a solid management team. Apparently ‘GoWearFit’ brand has been decommissioned- they have focused the consumer offering to the parent BodyMedia brand. BodyBugg is now showing up as a trademark of 24 Hour Fitness USA, Inc. and they offer a program called Apex Fitness based on it. SenseWear is still out there.

January 2011 Update: BodyMedia just announced a deal with Sprint to enable cellular connectivity in it’s products. A smart evolutionary step on BodyMedia’s part. And of course, another evidence that wireless network operators are really serious about consumer healthcare as a vertical. Tomorrow’s devices will take anytime, anywhere connectivity as granted.

Fitbit is a startup trying to leverage the rising wellness trend- they manufacture a small device that you can wear throughout the day to find out how much physical activity you did, how well you slept etc. The tiny device sells for $99 and contains a motion sensor (like the Nintendo Wii) that converts 3D motion data into useful interpretations about your lifestyle. In a 7-day period, whenever you are in range of it’s base-station, the data is automatically uploaded to the Fitbit website where you can get detailed view into the past data and summarized reports. There are also some social networking aspects built in (like collaborate on fitness goals with your co-workers, friends)The tracker measures the intensity and duration of your physical activities, calories burned, steps taken, distance traveled, how long it took you to fall asleep, the number of times you woke up throughout the night and how long you were actually asleep vs just lying in bed. Regardless of data accuracy and clinical efficacy, I think the concept is brilliant. We are slowly moving away from the I’ll-use-what-my-insurance-pays-for mentality to a more proactive mindset where consumers are taking thier wellness matters into thier own hands.

Fitbit represents the impending wave of consumer-oriented, internet enabled service providers that effectively combine hardware and software to provide a compelling solution around a healthcare issue. The future holds great potential for similar lifestyle-management solutions that can help affected individuals manage their chronic diseases (heart failure, diabetes, hypertension, asthma, etc.)

18th December 2009 Update: Got my FitBit in mail today! Will use it over next few months and report back.

October 2010 Update: Still using it. Satisfied with the battery performance, easy of use. Unsatisfied with the analytics and interpretation provided. They now charge $49 for a premium account that gives in-depth analysis of your data. I’ve not signed up yet. Google Health partnership was announced recently too. Fitbit will share 3 things: calories burned, steps taken and daily distance with Google Health.