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.

It’s a public private partnership that provides this educational program. The list  is impressive: CTIA,  HMHB, Johnson & Johnson, WellPoint, Pfizer and CareFirst BCBS, BabyCenter, George Washington University and MTV Networks among others. U.S. government partners include the White House Office of Science and Technology Policy, the Department of Health and Human Services and the Department of Defense Military Health System. The mobile health platform is provided by Voxiva and fifteen U.S. carriers have agreed to carry the program’s text messages at no cost for two full years.

91% of US residents have a cellphone, compared to 22% that have internet connectivity. Educating pregnant women and new moms with information they need to take care of own and baby’s health is a powerful preventive measure. So there is reach and utility in this idea, no doubt.

Note: Found interesting background about Voxiva. They started in 1999 with the idea that mobile phones were going to play an important part in health going forward. They now have a technology platform and provide mobile health solutions in about 14 countries (mostly developing countries like India, Mexico, Rwanda, Peru). They market and sell to public health agencies and government providers usually, but are moving into pharma and provider networks now. An insightful interview with their founder here.

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.

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.

• 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.

Sure all this can be a simple iPhone app (maybe there is already one out there) or even a one-line cryptic entry in your google calendar. My point is not to critique the utility of an independent website to track one’s sex life. I’m reflecting on the overall trend of niche health and wellness ‘trackers’ (read my previous posts about FitBit, Proactive Sleep, ZeaLog, Qwitter). Given the myriad sexual disorders (e.g. Erectile Dysfunction) and their probable causes, an application like this could provide rich history for clinicians. Overall, it underscores the importance of web 2.0 technologies in enabling consumers to keep granular, accurate health records.

Update: Few weeks after writing this post, I found a number of mobile apps (with integrated online version) that let you count/track anything you want. Few examples: TallyZoo, Dayta, Daytum, TheCarrot. There are also multiple websites that let you track and analyze anything- Graphomatic, Kibotzer, Track-n-Graph, Me-trics, LifeMetric, DailyDiary.

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.

Here is a simple overview of their offering: pay $500 to be tested for 10 common conditions or upgrade to $2,500 for all conditions (28 currently). The upgraded package has perks of genetic counseling, personalized updates and educational content for a year.  Beyond  that you pay $250/year to keep it going. What sets Navigenics apart (as I understand) is that they only tell you your results from the perspective of these 28 (and growing) conditions whereas others (deCODEme, 23andMe) let you ‘explore’ your results for every trait/condition they are continuously covering.

Regardless of what company it is, the question remains that how much can you learn from you genetic profile? If you are at 64% risk for Diabetes type 2 and 47% risk for macular degeneration, what can you do about it?  Well, the advice would mostly include one or more of- exercise,  dont smoke, eat healthy, avoid alcohol, sleep well, vitamins, lookout for warning signs etc. So why get the test; you should be doing all that anyways. I’m not knocking down genetic testing per se, just trying to find utility for it in a DTC model.

The future of healtcare is more personalized, for sure. I’m happy that the commercial foundation for it is being laid down right now. But personally, I wouldnt invest in these services till we firmly and clearly establish an end-to-end causal linkage between genes, diasease, and therapy. We havent even agreed on how important is the role of enviornment and habits (is it only genes that determine a disease outcome?) Heck, who said it’s genes- what about proteomics?

The price they charge includes collection fee for sample draw, ordering physician fee (i.e. lab order approval, result review, consultation) and a Personal Health Record (where you can view and store the results, among other things). Users pay upfront for the tests and have the option to receive a receipt to submit for reimbursement from an insurance company or a health savings account.

There are several other players in this direct-to-consumer lab testing, like DirectLabs, HealthCheckUSA, MedLabUSA. The benefits of these services are tangible- lower cost (specially for the uninsured, who don’t want to pay for the visit to the doctor), convenience, speed and privacy.

But not everything is that straight-forward. Most insurance companies will not reimburse patients for tests that were not ordered by a physician, so the target market is restricted to people who are health-conscious and rich enough to pay for self-initiated disease monitoring. Jury is still out on many aspects- who approves these tests medically? Who carries the legal burden? Is it okay to let patients self-diagnose themselves? what about misinterpretation of results? IMHO, there is a market and advantage for direct-to-consumer lab testing, even if the healthcare system doesnt recognize or reimburse for it yet. Also, these services would look pretty good as applications on PHR platforms like Google Health.

It’s not focused on healthcare issues, but I see potential for something like this in chronic conditions that affect an individual’s lifestyle. A good example is migraines. Those who have these terrible headaches would benefit from knowing exactly how many did they have this month vs. past 6 months and what were they doing when it started. So If one could log the onset/end of a migraine attack and the preceding activity conveniently, it’d be easy to spot a pattern (e.g. higher chance of migraine after cold shower).

Why not keep a simple diary bedside? or spreadsheet? Yeah, you can. But how many people do? And how many diaries can remind you to enter latest information in them and chart/graph your progress? It’d be a good idea to add some social networking features to ZeaLOG- finding comparative stats or just connecting with others in the same state as you are powerful motivators for using such tools (for example- Qwitter). ZeaLOG has twitter integration, but it’d be neat to have a mobile app too, especially one that syncs up intelligently with online data.

There is a paid service idea in this concept somewhere. I’m sure we’ll see one soon in healthcare.

• My Health – An application to store your basic health information (allergies, meds, diagnosis, emergency contacts, and a twitter-ish 140 char Health Log). Available as a 99¢ iPhone app or a free online dashboard.
• If Found+ – A 99¢ iPhone app that can display a short message and contact info on the wallpaper of a locked iPhone.
• My Emergency Info – Another 99¢ app that essentially does the same this as If Found+ but instead of a short message, you can show ‘summary health info’. (So how is this different if I choose to write health info as the message in If Found+? I’m not sure.)
• Close Call – A free iPhone app that apparently does the same thing as If Found+ and My Emergency Info. It displays important emergency contact info as a part of wallpaper on a locked iPhone. Don’t know how that is different from the other two 99¢ apps.

Polka is the first funded company created at the Lab2Market progam at UCSD Rady School of Management and they started around mid-2008. I think they are certainly on the right track since the fast-growing, 24X7 access mobile platform is ripe for healthcare information storage and communication.  Except that I’m lost at the product differentiation and pricing level. In terms of competition, there are other In-Case-of-Emergency category apps available for the iPhone like Easy I.C.E for 99¢, EMT ICE for $1.99, Health n Me Pro for $2.99. None of them do any better job at it, though.

There are rough edges to what Polka offers today (tried their online dashboard.. not particularly impressive) but that may be understandable given that they are relatively new startup. iPhone apps are fine, but I think online dashboard may be a stretch unless there is a really ground-breaking, never-before feature that they can offer. Why not integrate with Google Health/Healthvault for the online PHR-like functionality right out of the box?

September 2010 Update: Polka.com doesnt work anymore. Although the applications are still available on iTunes store.

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.

What a great startup idea. Service demand can be tapped easily since users are searching the web for highly specific keywords (almost all include the keyword “trials”, so bit of SEO and keyword advertising would direct the traffic effectively). Other sources are the rapidly growing PHR platforms like Google Health and Microsoft Healthvault- both encourage developers to write apps that provide such value-added services based on user’s health information. Supply is readily available on ClinicalTrials.gov, a government-sponsored online public registry of clinical trials in US.

TrialX.org is completely free for users (patients). They let investigators create free accounts to post their trial information directly, but charge a fee for providing access to the interested potential trial enrollee. It’s hard for trial investigators to find eligible patients who are motivated to stick around for the complete trial. TrialX solves both the problems for them.

Imagine the possibilities if this service gets integrated into CIS vendor products. A patient coming in for advanced  breast cancer treatment can be flagged right at admission and be given the option to enroll in an experimental drug trial right then, if they so choose. If nothing else, it’ll give the medical research community a much more real-time opportunity to advance the science.

September 2010 Update: Just read about another startup in the same space- MyTrus. They have little information on their website, so not much to discuss at this time.

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.

I do think that this is a viable model and solves a customer need. Especially for serious conditions like Celiac, Diabetes, Hypercholesterolaemia. Besides just niche recipes, meal plans and basic nutritional education, knowing how your food can interact with medications or where to shop for a particular ingredient can be very helpful in managing a chronic condition. Just ask a Type II Diabetic. MyFoodMyHealth current business model is B2C (subscription model) but they can be a valuable content provider for the numerous food/health related sites like foodnetwork.com, celiac.org, etc.

They are still in beta so maybe other features are in pipeline, but honestly, FoodFeed seems to be a solution looking for a problem. So here is a wild thought- why not transform it into a service for people with food-related conditions? Diabetes, Bulemia, Celiac disease, IBS… the list is extensive for the number of diseases that force patients to monitor what they eat and seek treatment/help accordingly.

Example- say a $9.99/month service for young diabetics who need to log, analyze and accordingly modify their eating habits. The service could take real-time user tweets via FoodFeed and provide the following: an online diary of food, instant ‘nutritional info’ tweet back, offer expert monitoring, and the usual host of social networking features. This hypothetical ‘service’ would be an interesting extension to huge online diabetes communities like Tu Diabetes, or Lunch Clubs. BTW, startups like SugarStats are already twitter enabled, but pursue it only as a way of data input.

September 2010 Update: FoodFeed seems to have closed shop permanently. Rest in peace.

Their business model is advertising, where interested companies can push their ads on specific WisdomCards that are most relevant to their target audience. With an average 40K visitors per month, I wonder how that model is working out for them.

They have various analytical graphs and trends, messaging, mobile edition and even twitter integration. I think the concept would have been much more powerful if there was a way to eliminate manual data entry by patients. So integration with blood glucose monitors that can sync data to the website would be great- perhaps using platforms like Healthvault?

Side note: Diabetes is perhaps one of the most well-represented diseases online. There are a ton of resources out there- David Mendosa has a good list here.

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.