Sandalbay Life

The personal wearable-sensor devices trickle that started with FitBit around 2008 is now starting to look like a flash flood. For every one offering that has got media love (like Basis), there are perhaps five other being incubated (like Node).

It’s an embryonic market, and one that is tackling complex health problems with commoditized sensor technology. Every smart inventor in a garage seems to be capable of doing something about it. So a few things are bound to start happening now:

  • Event Managers will take notice. Exhibit A: Quantified Self Conference
  • Doubts on where does this lead us or what we learn
  • Hardware and software platforms that unify the myriad devices start sprouting

Sandalbay Life exemplifies the last. It’s is a young startup (started last last year) at LA-based accelerator StartEngine. Not much information out there about details of the offering, but their aim is to provide a single software platform for manufacturers to leverage. Given the device and format proliferation, it makes sense that someone should try to manage the complexities of dealing with application and network security, cross-platform performance and reliability issues, etc.

“Providing the white-labeled consumer software for manufacturers to utilize”, as Sandalbay Life founder Neil Malhotra puts it in an interview, is smart, since so many of these offerings are from small players. But the big guys are noticing it too. Qualcomm’s 2net platform is going to be close competition. It too, is a cloud-based system designed to be universally-interoperable with different medical devices and applications and provide easy access to the aggregated data.

I’m also not sure how to align it with other platform approaches that are already out there. Biggest one being Microsoft Healthvault. Healthvault may not be white-labeled, but does provides a way for device manufacturers to contribute their data to a PHR. They do have API’s that let a developer get to the unified Healthvault data. Plus they have a fast-growing ecosystem of devices and apps that are integrated with it.

There are smaller, but committed players going at the aggregation value proposition from multiple angles: Digifit (cardio), WellDoc (disease management) for example. Open-source grassroots projects (OpenYou, Cosm, LockerProject, Sen.se) are surfacing too.

The play for sensor manufacturers to have a common platform for reducing their development cost is valid. Remaining value propositions (single app for consumers, unifying data from multiple devices, giving providers tools to create workflows and insights, etc.) all come with crushing competition. Plus the whole field of personal wellness tracking is too nascent – we need the devices to take a hold in the mass market before aggregating platforms truly become a viable business themselves.

2017 update: Sometime in the last few years, Sandalbay Life has recalibrated its offering to be more about wellness training programs. More about services than data aggregation.

Comfort Zone

It’s fantastic when a popular technology from another industry is leveraged to solve a lingering problem in healthcare. Location-based Services (LBS) have been around in the telecom industry for a while now. These services use information about the location from cellular networks to enable enhanced experiences in navigation, shopping, or social gathering etc. Now consider the fact that 1 out of 8 people over 65 have Alzheimer’s disease. It causes a progressive deterioration in judgment, abstract thinking, sense of time/place and behavior; giving rise to a number of safety issues like wandering.

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.

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Basis

The concept of sensor-based connected devices that help consumers manage a healthy lifestyle is certainly gaining traction. Consider FitBit, Zeo, DirectLife, miCoach, BodyMedia, GreenGoose as examples. It was only a matter of time before a startup in this space decided to go with a watch-like form factor.

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.

Cellnovo

People with type 1 diabetes need to take insulin in a similar way their pancreas would produce if it were normal. Older therapy used to be multiple daily injections, which were poor approximation of the insulin need. In Continuous Subcutaneous Insulin Infusion (CSII) or Insulin Pump therapy, a small device delivers a constant stream of rapid-acting insulin through a tiny tube; according to a programmed plan unique to each wearer. Insulin pumps are not automatic but they let patients make immediate adjustments, enabling them to lead a more spontaneous lifestyle.

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.

 

Bedpost

Here is a half-baked idea that adds another data point to my rant about how keeping a record of health-related activities is useful, and how web 2.0 technologies can help enable such a record. Bedpost is a web application (currently in private beta) that helps in keeping track of user’s sex life. I’ve not used the site myself, but they claim simple functionality- log in after the fact and fill in some fields about it. Thankfully, they also claim ‘zero social networking’ functionality to keep things private.

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.