MindMaze

Switzerland-based MindMaze created news early 2016 when it raised a $100 million round of funding at a pre-money valuation of a Billion dollars. It is creating virtual reality products related to neural recovery.

The medical-grade product (!imaginatively called MindMotionPRO) embodies the usual inpatient medical device: a set of CPUs and monitors attached to a metal framework on wheels. It has optical motion sensors (like Microsoft Kinect) that recognize patient movements, along with sensors to record physiological signals like EEG.

The application is amazing: using immersive virtual reality on half-paralyzed (hemiparetic) patients to trick their brains into jumpstarting control of the paralyzed half. This ‘mirror therapy’ was proposed in 1990s, and modern VR tech is a perfect match for it.

MindMaze has been approved by regulators (CE Mark) in Europe, which is a big deal. Whether that justifies a unicorn status is no longer a question in my mind, mostly because the reality-distortion of unabashed venture capital investment is now a given in most new corners of tech. Who knows what the actual $ business potential is. Looking at the immense spread of what VR can do in healthcare (surgeon training, mental health, patient education, etc.), a solid-start means a good chance of survival.

Limbix

The idea is certainly not new. Using VR immersion as a part of mental health treatment has been a subject of academic research and debate for a couple of decades. What usually makes news are opinion articles and university research projects.

I’ve seen commercially-oriented companies (like VirtuallyBetter) but none that gave me the impression of a true ‘VR platform for Psychiatrists’. Limbix seems to be the (?)first silicon valley outfit to tackle the workflow, documentation and content needs involved in integrating immersive VR therapy to mental health. Their website is terse, as usual for a startup, so most of this is my gut feel.

Using VR (or AR) to help patients overcome anxiety, phobias and other mental health conditions is in care delivery future. Reminds me of the optimism in late 90s when PACS technology was washing up on the shores of film-based radiology field. Limbix is to be filed away as a representative attempt at a viable digital health niche.

Update: Right after I wrote this, my network pointed to PsiusAppliedVR which look similar.

 

Phrazer

The last mile problem exists everywhere. Systems may get digitized, products and services may evolve to perfection, but the last link to individual is key. Whether it is the local cable provider laying the actual copper wire to your doorstep or the company that makes a better mouse/keyboard to control any given software, the constraint brings a dose of reality to digital value propositions.

Overcoming language barrier in a healthcare interaction seems like a last mile problem too. Hyper-specialization is getting to be the norm in all domains so it may not surprise you to know that ‘Medical Interpretation’ is a formal career. It comes with training, certification, professional organization and above-average growth prospects. Phrazer may change the need for a human medical interpreter – it is an interactive device that allows collection and communication of clinical information between patient and provider regardless of language differences.

Phrazer content seems to include disease protocols, best practices, patient health education. It can be integrated with local workflow EMR and be used to collect information and consent from the patient. See video below for a demo.

The idea is neat, but ahead of it’s time. Especially given that a human workaround (albeit expensive and scarce) exists in the form of a medical interpreter. I can see it being applied in large primary care setting where patients have the time and ability to hold a device and interact with it. Not so much for emergency or acute care environments. If time is short, clinicians are trained to follow protocols and dont have luxury of waiting for interpretation most of the times.

It’d be interesting if they can partner with patient tablet vendors like Phreesia to create a combined offering. But since this is a last-mile type value proposition, integration with other end systems like pharmacy, scheduling, registration etc. is going to be critical. Not any easy feat, given the myriad combination of systems and vendors for all those other systems. If Phrazer lands a major partnership with a large EHR vendor or IDS, that would give them enough runway towards market adoption.

Glooko

In March 2009, Apple hosted an event to introduce the iPhone OS 3.0 software. What I really found interesting back then was a prototype showcased with Lifescan (a J&J company), where they demonstrated how a user could manage her diabetes using an iPhone-accessory glucometer. It was a much needed evolutionary conceptual leap for a widely-used consumer medical device category.

Turns out that Lifescan apparently did nothing with that concept. Anita Mathew (who gave the demo on Lifescan’s behalf in 2009) decided to take it forward on her own and founded Glooko. The company currently sells MeterSync, a cable that connects your iPhone to five popular glucometers in the market. Users can download the ‘LogBook’ app from iTunes store to document, analyze and share their data.

I’m not an investor (yet), but if I was, I’d put my money in Glooko. This is exactly what the future should start to look like for conventional consumer health devices. Instead of being isolated products that store a limit amount of quarantined information, they need to provide a service that enables longitudinal disease management. For a patient with long-standing diabetes, he/she needs to know how much insulin to inject for covering the meal they are about to have, not what their blood glucose number is. It reminds me of Theodore Levitt’s famous MBA quote “People don’t want to buy a quarter-inch drill. They want a quarter-inch hole.”

For Glooko, the long-term sustainability is directly proportional to how useful and sticky it’s users find the logbook iPhone app. The hardware (Metersync) may be critical at first, but end user experience and market differentiation will come from the software. There is competition, of course. Agamatrix  has been in the market with it’s iPhone compatible glucometer, and last year they announced partnership with Sanofi-Aventis that gives them the much-needed commercialization ability. Instead of augmenting diagnosis, another company Cellnovo takes a similar approach with therapeutic insulin pumps. Perhaps we’ll see a synchronized gluocometer-insulin pump offering or an intelligent, symbiotic ecosystem for diabetes devices in future.

I’ve talked about the ‘last-mile’ of remote patient monitoring in the past. Conventional medical devices produce digital manifestations of physiological parameters, but the information collected hardly goes beyond the device itself.  We need consumer-oriented medical devices to become monitoring services that automate/transform the last mile for consumers. The future is arriving piecemeal, and sadly enough, it’s not being delivered by the incumbent behemoths of the medical device industry. Withings BP Monitor (which I can personally validate since I use it) enhances the value proposition of a regular BP Monitor for hypertensives. Zeo does the same for people with sleep disorders. Granted these offerings are perfect yet, but all vectors are aligned in the right direction. As for Glooko, look out J&J.

 

EASYWAKEme

Sleep monitoring related offerings started surfacing in the consumer market couple of years ago. More recently EASYWAKEme, another European startup, has thrown it’s hat in the ring.

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.

July 2012 Update: Used the unit several nights. Not scoring high on usability, mostly because of underlying BlackBerry OS inelegance. Overall, the concept seems to work. I woke up fresh most of the mornings I used it. Some gory details below:

  • Alarm setup is a pain due to BB limitations. Very tricky to use the trackball to setup wake time. Can’t see the cursor lot of times. Aarrgh..
  • If I don’t exit the app after pressing sleep, the BB stays on. More than once it ran out of juice by the morning.
  • Buggy..even when on “silent” mode, the alarm tone still came on after 3 minutes
  • There is no way to shut the alarm immediately on BB! Had to run out with it to avoid waking up my wife. Why can’t i shut the BB alarm with one keystroke or with the button on EASYWAKEme device?
  • The device vibrations don’t stop until I hold the button down long enough to shut it off. Not sure if that is intentional design. But quite irritating in the morning…
  • The BB’s final step of putting app in “sleep” mode is not intuitive or written well in manual. Also, that should be a button right next to the place where you set the alarm, and not a menu option.
  • I would have liked it if shutting off the device or just pressing its button in some way shut off alarm on BB. Without that, the user is forced to hunt down their BB in morning to shut the damn alarm.
  • Battery lasted only 2 days during my trial.