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.

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.

Alzheimer’s Association created Comfort Zone service to provide location updates for family members through a device worn or carried by the affected individual. The hardware form factor ranges from a regular smartphone to a device that can be carried in pocket or installed in car. Each comes with a monthly service plan that is priced according to the frequency of location updates. For example: the once-a-day location update plan (for sprint phone) costs $9.99/month vs. every-15-minute update (for a qualcomm pocket device) is $64.99/month. The underlying LBS platform technology is from Omnilink.

Some of these devices come integrated with Comfort Zone Check-in – a website where a family member or caregiver can log in online to setup geographical ‘zones’ and customize the recipients and frequency of email/text alerts if patient exits their zone. It’s a great example of how healthcare IT should be used: focused solution with integrated hardware, serving a specific need. The service is augmented by a couple of valuable additions. In case internet is not accessible, there is a 24-hour call center available. Monthly plans also include the MedicAlert® + Alzheimer’s Association’s Safe Return® program, which is a 24-hour nationwide emergency response service for missing Alzheimer’s patients.

Comfort Zone is not entirely unique though; there are other places to get such location-aware services for healthcare use. Project Lifesaver, LoJack SafetyNet provide the technology and the real-world service to locate missing individuals. Some low-end solutions are also available in popular electronics stores.  But the online Check-in service is a differentiator for Comfort Zone. Keep in mind that Alzheimer’s is the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed. For a concerned caregiver, it is paramount to have a continuous, remote ability to know if the patient is safe. It enables more than one person to lead a normal, independent lifestyle.

Disease organizations are great resources, no doubt. They provide reliable helplines, confidential counseling, referrals, education and support for the affected individuals. Services like Comfort Zone are a perfect example of the technology-based evolution of such organizations.

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.

Companies like Cellnovo represent the key role IT is playing in the evolution of medical devices. UK-based Cellnovo began in 2002 as Starbridge Systems Ltd. to develop a novel micropump with only one moving part that made it smaller, more accurate and less expensive. Somewhere along the line, their conventional medical device transformed into a mobile health offering. It now consists of:

1. Pump: A small, waterproof device that can be easily applied, removed, and repositioned on the body. Also includes a built-in accelerometer that registers and stores user activity data.

2. Handset: A hand-held device that communicates wirelessly to control the pump and sends data to a secure website. User can manage dosage, schedule, log supplemental data like food intake, activities, emotions, etc. through this device. The look-and-feel has been compared to today’s appealing smartphones with icon-driven intuitive graphical display and touch screen ability.

3. Online: Websites customized for various participants that are usually involved in managing diabetes- provider, patient, caregivers, etc. Given the variety of people that can be involved in the care team (primary doctor, dietitian, diabetes nurse educator, eye doctor, foot doctor, endocrinologist, exercise trainer…), communication and coordination is an often under-served part of diabetes management. Seems like Cellnovo Online is an attempt to improve just that.

The overall concept is not new. OmniPod by Insulet Corporation (a public company) has a pump and handset. Big players like Medtronic, Sanofi-Aventis, J&J have shown signs of moving in similar direction. With the February 2011 series B financing round of $48.4 million, Cellnovo also seems to have enough runway in this space. As an interesting aside, combining insulin pumps with Continuous Glucose Monitoring System (CGMS) makes a terrific combo- uninterrupted sensing and coordinated, intelligent drug delivery. OmniPod does this.

Solutions like Cellnovo provide not just a way to deliver therapy, but a novel way to collect detailed data about given patient population. Analyzing aggregate data like that can lead to insights at multiple levels- clinical evidence (EBM), provider performance, population health, etc. An interesting decision fork in this evolution would be whether manufacturers leverage commercial computing hardware like smartphones or create their own (like Cellnovo). The former gives wider reach, while latter provides better, medical-grade control (something that FDA probably mandates).

But the key point in all this is about the future of traditional consumer medical devices. The next-generation devices seem to be less conspicuous, continuously connected, more personalized and come with an integrated online component that becomes the window to interaction with multiple parties (caregivers, friends, insurers…like an evolved, niche form of social networking). The new value proposition doesn’t stop at just a hardware device, but becomes a continuous service for managing chronic disease.

One can argue that managing all chronic diseases requires understanding an ever-changing constellation of information continuously generated by a whole ecosystem of participants. This ever-connected disease management approach that removes the burden of keeping journals and pushes information to healthcare professionals can to be applied to many diseases besides diabetes. I’m sure a number of those are already underway.

Seems like there are three components of the overall offering:

1. A hardware device called “Spiroscout” – a small add-on that mounts the inhaler canister. Every time it is pushed, the location and time-stamp data is recorded.
2. Mobile app – a ‘diary’ to keep track of symptoms, triggers, medications, etc. Can also be used to view map of data received from Spiroscout, and to get sms reminders for taking medication.
3. Online website – a ‘dashboard’ of sorts. Can help summarize submitted data to figure out disease patterns and trends.

The hardware device is not out yet (website says it’ll be out this summer), and the mobile app is currently in private beta. So there is not much of real world testing that has happened. But I’m still positive about Asthmapolis, for a number of reasons.

First, it’s the right kind of ‘focused’ monitoring solution that can potentially be transformative for managing a specific disease (kinda like Regina Herzlinger‘s argument about ‘Focused Factories‘ as one of the ways to salvage the entire healthcare system). It’s better than trying to find a solution that can monitor multiple conditions (example 1, example 2). I think the mobile diary and online dashboard would be key engagement tools in this regard. The more focused and customizable, the better.

Second, it helps in medication adherence which is a big issue irrespective of the medical condition. I think that knowing whether you took your medications and getting reminders if you didn’t,  is more powerful than knowing when/where you took it. The mobile app reminders would be a great resource there (automated calls to landlines may be good too…for seniors).

Third, it helps understand the individual triggers and community impact of asthma. For successful asthma management, a patient should know his/her triggers and avoid getting exposed to them. That is not an easy task for a number of reasons. My initial reaction was that GPS may be a bit of an overkill. But with rapidly decreasing cost of location-aware technology, why not? Much better than using it to check-in to nearby McDonalds.

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.

With that background, Corventis becomes an interesting entrant to the MCOT space. Their technology platform consists of a bandaid-size wireless sensor patch called (“PiiX”) that detects, records and transmits physiological data to a portable hub (called “zLink”). zLink is a cellphone-size device that sends the data over wireless network to ‘Corventis Monitoring Center’, which is a staffed to do preliminary interpretation and urgent physician notification. They offer these capabilities in two forms: NUVANT (ECG based continuous arrhythmia monitoring) and AVIVO (non-ECG physiological paramters monitoring). Corventis has some big venture names behind it: KPCB, Mohr Davidow, DAG ventures. They recently got FDA clearance for NUVANT in January 2010.

Cardiac diseases are certainly the prime target for any wireless remote monitoring startup. Corventis is not alone. iRhythm’s Zio Patch is designed to diagnose cardiac arrhythmia by providing  up to 14 days of continuous recording. Once done, the Zio Patch can be mailed back to the company for analysis. Unfortunately, the Achilles heel for all of these companies is reimbursement. So far, private insurance companies and CMS are not convinced that such services are worth paying for. MobiHealthNews has an interesting post about this trend here.

I’ve written about a number of consumer-oriented ‘wellness’ services by startups that are using wireless sensors to detect simple metrics like activity and help you achieve a healthy lifestyle. Corventis, iRhythm are good examples of medical-grade services utilizing the same basic technical framework and abilities for managing life-threatening conditions. Once we get over the barrier for reimbursement, you can bet on the remote monitoring market for serious medical conditions exploding. We can wait for that to happen, but I’m personally convinced that as consumers take more charge in managing their conditions (and health insurance continues to spiral the drain from a cost and outcome perspective), there is a growing scope for remote monitoring services that consumers will pay for themselves.

PS: I had a discussion with Corventis founder, Darryl Drinan a few weeks ago. He had three insightful comments for anyone thinking about getting into the remote monitoring space:

• If you have a choice, focus on therapeutic service, not diagnostic
• Product alone is not enough, always tie it to a service
• Patient education is a big problem (if you need to do it for them to use your device, you are hosed)

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.

GlowCaps fits the standard pill container, and uses short-range wireless communication to talk to a gateway hub at home that is connect to the internet. There is also a reminder light (looks like a night light) that plugs into any standard power outlet. If the bottle isn’t opened at the appointed time, the cap and night light start blinking to remind the owner to take the medication. If after an hour, the pill is still not taken, GlowCap starts start playing jingles as well. After yet another hour, it’ll send a message to Vitality’s system which can then place an automated phone call or send a text message with a reminder. Brilliant.

Beyond having a ‘smart lid’ for bottles, Vitality has integrated functionality that keeps caregivers in loop. There are social support features (shareable weekly email reports), refill facilitation (refill reminder calls) and physician interaction tools (printed monthly reports to you/doctor). So it hits all the major interaction points for a patient’s medication regimen. Last month AT&T put out a press release about GlowCaps running on its wireless network. So the Vitality gateway now has mobile phone technology, and I assume that precludes the need for an ethernet connection.

Every clinician knows that medication adherence is a huge problem ($100B figure has been thrown around as the cost of poor adherence in US). More than a consumer product, this is a fantastic service that can change medication packaging in general. And looking at the Managed Care (enhance the personal/medical record), Research (change patient behavior) and Pharma (reduce brand-switching) focused pages of their website, I think Vitality knows that. It’s definitely the next stage in evolution of the standard pill dispensers (like ePill, Philips).

Their CEO David Rose has an interesting background in creating internet-connected everyday devices at his last company, Ambient Devices. Somewhere in a press release I read his quote about “…providing minute-by-minute adherence data to motivate healthy behavior.” If you take the word ‘adherence’ out, that may be a basis for a lot of future medical solutions and an adage for next-generation of medical device companies.

Feb 2011 Update: GlowCaps was acquired by the billionaire surgeon Patrick Soon-Shiong. He is the director of UCLA’s Wireless Health Institute.

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.

Yes, I’m thinking the same thing. Why would you want to tweet something like that? And who the heck wants to be spammed by other peoples weight info?

Those obvious questions aside, its the trend that I find interesting. As the commodity devices that measure one or more of our vitals become web-enabled, ‘wellness’ goes beyond just being about purchase of a product. It gets transformed into a service. Withings is already compatible with a growing list of partners like DailyBurn, FitOrbit that provide fitness and personal training services. They also integrate with the big PHR platforms – Google Health and Microsoft Healthvault. So in theory, someone struggling with obesity could very well use the regular measurements from Withings device, social support from twitter followers, professional coaching through FitOrbit and health record from Google to try and achieve their ideal weight.

‘Connected Appliances’ are what Withings team envisions. They are not alone. I’ve written about several  analogous monitoring devices with some sort of web-integrated service (Read about Zeo, FitBit, Directlife, BodyMedia…). Although most of these focus on ‘wellness’ currently, they are setting an important precedent for managing ‘health’ conditions in a similar way. Consider the ‘how-does-work’ visual from the Withings website:

Now replace ‘weight’ with ‘Blood Pressure’ or ‘HbA1c‘ and you get the framework for managing health conditions (hypertension or diabetes, respectively). Take J&J’s spinoff, SymCare, for example. They are following the same framework for evolving the traditional glucometer. Lookout for more medical devices to move in the same direction.

January 2011 Update: Not that Withings team is reading Multiplyd for product strategy, but they just announced a Blood Pressure Monitor. I think that takes them one step closer to serious medical condition management tools company. Wellness is not going to be a sustainable product category for long, so this is a smart move.

August 2011 Update: Bought the Withings BP Monitor, using it to keep tabs on someone on the other side of the planet. It’s working very well so far. Very easy to use. The graphs and analysis functionality is not quite mature yet, but it works. I’ll definitely recommend it to others.

In an effort to understand what is unique about Zumi Life, I stumbled upon this interview with its CEO. Crunchbase tells me that they started with $700k seed funding in 2007 and got a Series A infusion of $1M in April 2008. With that context, several questions come to mind. Zume Life needs manual input for all the data it needs from the user- and that assumes the user to be reliable enough to put it in. If Zuri had a sensor to automatically capture the critical vitals (like Zeo, Bodymedia, DirectLife, FitBit, LifeShirt and scores of other devices), that would make it infinitely more useful. But I understand that there is no automatic sensor for your mood or for what you just ate, so somethings need to be captured manually. Which is why there are services like RememberItNow, Reqall, Zealog, Polka etc. Still, why not get the medication list for Zuri from PHR platforms like Google Heath? If we assume that the chronically ill and overworked individual remembers to input their care regimen in one place, why wouldn’t they use a simple paper sticky note or a smartphone reminder app? Even a simple Google Calendar or 30Boxes event can be configured to deliver reminder emails that show up as audible, sms alerts on your phone. So is there really a need for a dedicated hardware device in a world that is slowly converging mobile computing platforms? Zuri reminds me of the device that is made to do twitter only.

The price tag was also a bit of surprise. Although there is no official mention of pricing on the Zume Life website, I found a PCmag article from Sept’09 that quotes $35/month or $300/year for the service, and $4.99 for the iPhone app. That sounds way too much money for a basic alerting and journal-keeping service that is 100% manual entry based.

Of course, it’s easy to criticize others idea. I don’t have the complete facts on the service, its utilization and its founder’s vision. The overall trend of using patient-oriented hardware devices integrated with web and mobile dashboard/analytics to manage chronic conditions is for real. I just think sensors are a key aspect of such devices and that pricing can be Achilles heel for adoption.

Early 2010 Update: ZumeLife has closed operations and is no longer in business.

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.

In general, I really like the idea of using personal mobile computing devices in treating/preventing chronic conditions. As devices and sensors get smarter and cheaper, it’s logical that they start playing role in helping individuals deal with chronic, lifestyle affecting conditions like migraines, sleep disorders, allergies, dysmenorrhea, depression etc.

Proactive Sleep provides a ‘smart alarm clock’ for iPhone/iPod Touch. Some features: customize what music to fall asleep to, and to wake up with, a dynamic ‘vigilance game’ that you need to complete to turn the alarm off, and a sleep diary to note your observations and sleeping habits. Nothing earth-shattering there. The features may be simple, and its not my intention to critique Proactive Sleep per se. What I want to emphasize is that applications like these are a step in the right direction overall.

For a number of chronic disorders with no established cause (like migraines, insomnia), keeping an accurate log (diary) can be extremely useful for prevention and treatment. Integrating such ‘digital diary’ into daily lifestyle can be much more convenient and smart way of keeping track of such conditions. Proactive Sleep is a bit too manual, in my opinion (e.g. you need to document everything in your sleep diary yourself). What would be awesome is to combine it with a smart sensor (like the FitBit) to automatically record your sleep habits. That way its even more Health 2.0.

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.

Remote Patient Monitoring (RPM) is a subset of telemedicine that includes devices and software that enable healthcare providers and educators to diagnose, monitor and follow up patients remotely. There is a lot of potential in smart fabrics to enable RPM, especially for chronic diseases like Asthma, CHF, Hypertension, etc. I’m personally very excited to see companies enter this space and solutions becoming more and more mainstream.

Currently VivoMetrics is focusing on clinical research and sleep apnea study market. Their next generation product is supposed to be lighter, more comfortable and with the ability to transmit data wirelessly. Also in the works is a partnership with OBS Medical to incorporate their Visensia® software as a predictive tool.

September 2010 Update: LifeShirt and VivoMetrics websites don’t work anymore. Seems like they ran out of runway.