iOS8, Health Data, and Open Data
News is leaking out of Apple that iOS8’s primary feature will be health and fitness data. Rumors are that there will be a new app called Healthbook that will track a plethora of health and fitness data that iPhones and related devices (iWatch?) will be able to collect on the person carrying the devices.
This is interesting to me on a number of levels. We have been looking at this sector for a while and one of the things that has kept us (USV) from making investments in this space is the sense that all of this data capture is soon going to happen in the phone itself.
Once that happens, things can change pretty rapidly. The key will be APIs. And my big question is whether Apple will give its users an open API to send their health and fitness data to third parties they authorize.
I can see a button that says “auth with Healthbook” in my doctor’s office, my gym’s mobile app, my health insurers’s web app, and a host of other places.
So to my mind, the big question is not what Healthbook will look like but whether Apple will make it easy to get our data out of it. If they do, this will be a massive game changer for the quantified self, health, and wellness markets.
would you really invest in a company dependent upon the Healthbook API remaining open?
i think once they open it, they would not be able to close it given all the services that would be using that datathe question is whether they will open that pandora’s box in the first place
I think they will. It’s the smart thing. It will drive economics. Smart they certainly are.
They can have an API and still closely control who gets access. That’s the most likely scenario in my mind. It’s not really “open”, it’s “gated access”.
The fear from patient’s perspective is the lack of transparency to track the trail of my health data once it leaves my phone. App -> Doctor -> EHR -> Data Marketplace = I’m up for sale.
My guess is it will be as open as the App Store or iTunes.
Oh, perhaps you were expecting access to your personal health data records to be “Open” as the Android platform?
the Open Healthcare Alliance
yes, i was
Call me old school, but I consider my personal health information, even bio sensor readings , to be confidential. As owner of said data, I would want to define who gets access and use thereof. “Open” connotes unfettered unauthorized access. Even scarier are the prospects of data mining, analysis and aggregation of health bio data by big algo guys (Google,etc)
i was not suggesting publici was suggesting open in the sense that i can auth it to whomever I want to have it
Open access to your health info with standard data format is becoming the law of the land http://www.healthit.gov/blu…
The OAuth2 REST API they’re working on is very cool: http://blue-button.github.i…
Still in workgroup state, but yeah we’re pretty excited about where it’s going. Anyone interested can join the WG weekly calls: http://wiki.siframework.org…
Blue Button is not a law and will never be a law.
It is in the Affordable Care Act though. Both Blue Button and Blue Button+
That’s news to me, I believe that’s incorrect. To be sure, I just searched through http://housedocs.house.gov/… and didn’t see any mentions of “blue button”.ACA is focused on insurance not on data portability; HIPAA and Meaningful Use are focused on that. And I think anyone at ONC would tell you HIPAA will never legislate Blue Button as the de facto data transport mechanism; they’re trying to get people to adopt it without forcing them. (Same reason they don’t legislate which medical records format to use between C32, C83, CCDA, etc. though Meaningful Use does incentivize CCDA.)
Not legislated adoption but incentives to use it
If you mean general incentives for data liberation sure but still most of the lifeblood for that is in HIPAA, HITECH, and Meaningful Use. ACA didn’t add anything to the fire that wasn’t already there. And the incentives are for any kind of interoperability; if Blue Button is the winner, so be it. But HIEs and collaborative APIs among providers are starting to position themselves along that front too, so the race hasn’t even quite begun yet.And this is coming from a guy who is very critical but incredibly supportive of Blue Button: http://electronichealthrepo…
Blue Button is a powerful concept that is only beginning to gain actual structure. That said, it exists as less of a standard and more of a “commitment to openness”. BB+ is really just a consolidated CDA which has been around for some time. Meaningful Use stage 2 and eventually stage 3 are pushing the requirement to be able to exchange a document (CDA) using the Direct Protocol (http://bluebuttonplus.org/t….There are countless efforts underway today to help realize data interoperability but we are still very early on in real terms. It’s estimated that of the 220 Public HIEs in operation today less than 10 will still be running in 2017 (http://www.hiewatch.com/per…. The market incentives still haven’t taken hold and the business model for interop is still elusive.I have great confidence it will happen eventually. The faster risk shifts to providers the faster we’ll see interop take hold. That’s when the business case for “knowing more about your patient outside the clinic” starts to matter.
Look at how Passbook was implemented. I have a hunch it will be similar. It will be “open to other apps”. App to App is Apple’s world.
Happy Birthday… here’s an iTunes gift card for your blood test.
might rather have a Starbucks gift card.
You should try an AeroPress!
+1 aeropress it’s the most fun way to make coffee you feel like you’re working for it
What’s Starbucks?I use them for an emergency wifi connection on freezing day. Almost never for coffee 😉
you guys are snobbier than me! I love pressed coffee, but gave my press to my daughter when she moved out on her own. I have a Saeco espresso machine. But, when traveling around and I am in a place that traditionally doesn’t do espresso-Starbucks is consistent.Best coffee I have ever had in the world was Italy.
Italy has the best of many things.I’m a long term La Pavoni user–> http://www.jlhufford.com/La…But yup in NY having so many choices does make us I guess picky.
Living in a city is very different, especially a city like NYC (or Chicago). Love the look of the La Pavoni, but wouldn’t have the patience to mess with it. But I like my sous vide device I got for Christmas
They are certainly a bitch to learn to use. Like driving an old sport car honestly and just that fussy to repair.Old habits for this won’t die for me I”m certain.I go to Italy once a year, the last three to Sicily and Friuli so I’m really in agreement about coffee, food and wine from there.
Next time I go to Italy I am definitely emailing you for the lowdown.
Please do.The most dramatic long weekend I’ve every spent was touring the natural wineries on Etna, starting with jeep trip and hike to the top.Old post–but oozes my love of the place–> Under the volcano in Etna http://awe.sm/s4wc1
magical place 🙂
There is an abundance of magic there but hanging out in Vigna del bosco topped the scales honestly.Sicily just has the edge on the marvelous.Even Marsala showed some strokes of wonder when i visited last September–Reimagining Marsala… http://awe.sm/iIrDW
It’s hard to choose, every corner in Sicily has something magical and unique. The west coast from San Vito to Erice and to Trapani’s “saline”, all the way down to Marsala, with its ancient arabic tradition mixed with italian culture and art is outstanding.
Yup…My view is very much through its artisanal winemakers and indigenous grapes. Hanging out in the vineyards and kitchens of these iconoclastic, inspired individuals, dinners amongst the vines under the stars. A unique lens into culture and people.Super lucky to do this with a small group of bloggers from 8 different countries who get together once in Sicily and usually once somewhere else every year.
Well drop me a line too, that’s where I live 🙂
count on it!
No knock on Italy, but you clearly haven’t traveled to Ethiopia. 🙂
The tazo teas are not bad at all.
Just spoiled I am I think.
More likely: “Here’s $25 off that new anti-cholesterol medication you don’t even know that you need yet.” 😉
At least it’s not $ off Viagra.
Or given the state of pharma…”… that you don’t need.”
I think Google must be on this track also. And they’ll be open. And work with many of the players in the space.
so when your doctor says, “please send me your health/fitness data” and you say, “i’m on apple so i can’t do that”, that’s not going to work for people so my bet is apple does open this data up via API
NB: Doctors won’t say that for a long time. Hate is the wrong word but: doctors hate any more data you bring in as a patient. We’re still in a world of 10-minute visits; physicians don’t know what to do with the data and don’t have time to deal with the data.** excepting obvious exceptions like docs who prescribe apps for diabetes, etc. (which is still a very low % of docs) Also it’s obvious we’ll shift to a better world; just speaking to status quo/near future+1 Apple will open this up via API though, just like Passbook
If you haven’t seen it yet, I find it quite an interesting picture of where we are with wearables.I think what this suggests is that there’s going to be a big need to talk the same language and find a common ground: APIs from different players will be key to this and Apple will have to make make a smart decision on the issue.As a doctor, my feeling is that patients will want to have more power on these data and will look for places where APIs from different devices merge to make sense of them, where they find benchmarks to understand their meaning with the help of peers and professionals.Interaction with local doctors, other patients, and availability of more and more refined self diagnosis tools from home will enable a very new way of taking care of our most valuable asset, health, based on prevention.Which will – by the way- become the most critical tool to face healthcare costs that will rise more and more in the next few years.
Sorry, some issues with Disqus login/upload, it was my comment 🙂
i totally agree with you
Great question…Let’s see if what is good for the world is good for Apple’s model.If they are we all win. If they aren’t what we want and could have now will crawl into the future.
Two thoughts:- Apple really needs to nail its marketing and the software’s UI/overall design. Some of their past bold software initiatives (iCloud, MobileMe and Passbook) have fallen flat IMO largely because the UI is very confusing and Apple has done a poor job at educating consumers about the initiatives.- I’d love to see an iWatch w/ 4G/GPS or the ability to sync Healthbook with other 4G/GPS devices. I hate strapping an iPhone to my arm during my runs, and the 4G/GPS would be crucial to me for accuracy purposes when tracking distance.
The data will be open as it is really of little value. The types of biometric data that can be monitored by a phone are really of little value for the average individual. This is the easy stuff for medical community. (But even here they screw up). Acute conditions like Heart Disease, Diabetese, and Cancer are the triumvirate that take down most people. The variables that go into the five year risk algorithm for cardio vascular disease (the most sophisticated algorithm of that we have) are self evident, as are those for diabetes and Cancer. Variables like age, weight , blood pressure , activity and stress all stiffen your cell walls and your body and thus your body.There is a Moore’s law for health. For the average person, the probability of dying (and most disease) double every eight years. Mistakes are cumulative.
Fred, a lot of data can be captured from a phone, but not all of it. Environmental data cannot be captured accurately, yet it influences humans. So my bet is that it is going to be mixture of the two, though consumption is going to happen on the phone. One thing that remains to be answered is where the logic is going to reside. For a while I doubt that a phone can do big data analysis.
in the cloud, of course!!!hi Ales, i hope you are doing well
I don’t think the point must necessarily be the value of the data from the medical point of view in the beginning.The big threats to health come from lifestyle: the way we eat, the way we (don’t) exercise, the consumption of drugs like drinks, cigarettes and the likes. Very simple things, yet so powerful.It’s all about changing the attitude and becoming aware of what you are doing with your body. So, in the beginning, I think wearables can be to health management what mobile has been to internet access: they can set the stage for a big change in lifestyle. Yet this something that big government awareness campaigns have a hard time achieving.The real medical value will come later, as more and more self diagnosis tools will become available, partly merging with wearables (new powerful cameras, new ecography-like scans) , partly creating a new set of tools that will use more refined information (from saliva, blood, etc).
Exactly. But the major impact over the next 30 years (given our population, disease profiles and health system) will be personalized medication via proteomics and nanotechnology. Look at what Nanthealth (LA based) is doing.
i totally agree
Hi Linnea & welcome to AVC! Great points. Do you think this data will eventually tie in with http://www.pazienti.it so that you bring your data to your doctor visits?
Hi William, thank you, I have been following the community here for the past 4 years but It’s my first time as a contributor :)You know, based on what we learned from our community of patients and doctors, my feeling is that the real engine of this is going to be patients and their needs, as opposed to doctors habits. (Which is already a big change itself)People who are interested in a more savvy management of their health and that of their family, are going to ask to doctors and other care providers for benchmarks to follow and push them to dig into the data (which for a long time will be less meaningful in terms of medical value and more in terms of motivational tools).This is going to be based less on in-office visits, and more on online interactions with healthcare providers of different types. A big change that providers, in most cases, are not yet ready or willing to face.So, to answer your question, I think it’s more going to be like – doctors will be dragged out of their office, online, and into data mining by more savvy patients 🙂
Agree with Linnea.A lot of our health data has to be still liberated from all the silos in the healthcare system – all the data sitting on local servers in the clinics/hospitals. Wearables are setting a great trend where data is collected outside of antiquated healthcare system and automatically placed in the cloud. This is a great example for patients of what’s possible and they will start demanding more and more of their medical/health data from their providers to be shared with them in the same manner. The government also realizes that that’s the only way to bend the cost curve of the healthcare system – freely flowing health data which will be crunched outside of any specific institution to extract better treatments, better diagnosis, etc. Meaningful use is pushing hard for this today, but it will still take some time to achieve enough compliance to make it possible. As we get our health data liberated and aggregated, the role of health providers will change. I see them acting as online consultants, with who you will share specific subsets of your data to get advice or even share it with communities of providers to crowdsource diagnosis or treatment. This will push providers to move significant part of their practice online and it will mostly be interventional treatments that will remain in the clinics. We live in very exciting times in healthcare and the further we go, the more exciting possibilities get.
Hi, Nikolai. So what I’m hearing you say, is- we need to “keep asking for our data”.Funny story- I was at a dentist listening in on his consultation with my wife, and was taking notes on my iPhone. The arrogant dentist tells me “do you mind putting the iPhone away and listening to what I’m saying?”. I said “no, I’m taking notes on my iPhone”.Good work with OpenCare. Keep it coming.
Yes William. According to HIPAA, health provider is obligated to release all your data in a format that is available to them. Meaningful use is pushing towards making this format digital and standardized.
should’ve put a Dragon on your head instead, less intrusive
Yep. Glad someone else has this view here too. I wrote a bit more about the need for physician+startup collaboration yesterday, which should help kickstart this shift toward more online interaction: http://noblepioneer.com/pos…Let the unbundling begin.
(I suggested to Nikolai he reaches to you, last week. I’ll hook you 2 up)
“doctors will be dragged out of their office, online, and into data mining by more savvy patients”. I like that.
Sounds like the “house call” of the future. It’d certainly save time and worry for me (and others) if more tools and tests for self-diagnosis of chronic conditions were made available at home. If I could then transmit the results to the doc and get a prescription refill, lots of time and money saved on all sides.
There’s already tons of that starting to happen:- Get your medications delivered: http://pillpack.com- Text a doctor immediately: http://firstopinionapp.com/- Take your health history anywhere: http://stayinyourprime.com (this is us)
Interesting. I remember in college I had my pediatrician send me a letter about “moving on” and getting my records. They wanted me to drop by the office to get them because of HIPPA. I of course didn’t live near the pediatrician at the time and never did it because it was too much hassle.Though I was aiming more towards testing your own issues, like what if you could shine a gadget you own in your eye and determine whether you have pink eye, an allergy, or something else and then get your doctor to send you the prescription for the correct eyedrops?
Oh in that case are you following the Qualcomm Tricorder XPRIZE? http://www.qualcommtricorde… Because you should be.Also yeah getting records electronically is only a recent regulation from the government (a HIPAA update September of last year) and it’s still incredibly difficult. Hence why we try to do the heavy lifting for you. Let you focus on what’s more important.
Prime is way cool.
You’re way cool.
.In the military in the 1970s, when you were assigned to a new unit, you went and picked up your medical files and your personnel files and brought them with you to your new unit.If you had a damn good platoon sergeant, he would look at your files and remove all “bad” info — like those shots for VD when you were overseas.Personnel files were supposed to turned into your new unit unopened and sealed with a signature across the seal. I had many a file handed to me as a company commander with the signature clearly forged. I never really cared as I just sent them over to the AG office.So sometimes the more things change the less they are changed.Today cattle can be identified via RFID chips which will shortly also be addressable.We humans are not far behind.JLM.
as long as i don’t have to put a brick in my arm: https://www.youtube.com/wat…
.”One step closer….”Pretty damn……………………………………..funny.Of course, you will want to have a GPS chip planted in your children these days, if you are prudent.I do admit to having put GPS chips in my children’s cars.JLM.
I connect with my closest friends using the Find My Friends app. Less intrusive, but really the same reasoning.
.I agree but it wasn’t around when I needed it.JLM.
I’d love to see a tech company applied to a doctor’s office here. Because I don’t like the framing of the movement as: doctors kicking and screaming into a new world. It’s not like doctors don’t want to help people. If there are newer and better tools and models for them to help people, we should be selling them on how much better doctors they will be with those tools/models. It’s not about dragging. It’s about unbundling.An example of what I mean: doctors acting more like product managers in any modern startup. Doctors would need to be more T-shaped: diving deep into one area (medicine; no change there) and surface-level in many other areas to keep them dangerous (running quick analysis, generating proactive analytics, interacting with other teams; this is where docs would need to change).
Tyler–first off, congrats on seeing you surface in this area.An important one and one of personal interest.Two inputs–Aggregating info and carrying it around is one step. Trending that info to be thinking of this prior to seeing your doctor is the big step:–>Scenario. Go to doctor for a physical. Come with the trending of all of your blood work over the past few years, and links to research that shows that you are not testing for proteins that you should be that are indicators. Result–better conversation, change in what you do next.–Suggestion. Input is still a nightmare for doctors but some, mine especially are both innovative in their thinking and very open to info sharing. Get some partners on the doctor side–Center for Health and Healing in NY is a great one.Congrats again and let me know where you are heading with this. Personal and professional interest.
Thanks! Feels good to have some steam behind us now. Turns out innovating in healthcare is incredibly difficult, who knew.We have a lot of exciting stuff to announce coming up in the next few months. One of those exciting stuffs is similar to what you’re talking about, which has been one of our goals from the very beginning: http://blog.stayinyourprime….There are a lot of steps in between where Prime is/what’s possible right now to the scenario you’re talking about but each individual step is pretty major. Even just recognizing you’re in the doctor’s office during a scheduled visit and sending a push notification linking to just your last 12 months’ blood work and a summary of major ups/downs is a big improvement for most people. Linking that to external sources (research, devices, etc.) is another step but one that is certainly coming (in Prime and elsewhere).I’m glad you have forward-thinking docs. Really glad.I’m always around and love chatting: [email protected]
Cool.The world is ready.And aging (ugh!) and being fanatical about my health is a huge driver.And generally, as the world gets more demanding of their health needs, the value of info as a tool is top of mind.A lot of walls to break down. There is value though to both sides even as you make incremental leaps.
Well, in my personal experience as a doctor and with other healthcare providers, I think they/we are very quick in picking up new technologies as long as they don’t interfere with our doctor/patient relationship, something that has only recently started to change after over 2.500 years of paternalistic approach and a huge information gap.I think that doctors, as Nikolai puts it, are going to be more and more online consultants than in-office professionals in the near future, at least to a large subset of the population (e.g. people that don’t need specialised, highly skilled surgical treatment); I can see how this can scare many of them.It’s not about not wanting to help people, it’s about being used to a different way of doing it and not feeling the need to change it. That’s where – I think – patients will be very important.
Maybe I”m spoiled and fortunate to simply not work with doctors who aren’t both innovative treatment wise (natural and super tech conscious) but also working to open the areas of information.My strategy is always, tech or any segment, start to change the world by partnering with those who want to. The others will follow as the market demands.
It certainly is the only way.At the same time, I have seen a strong acceleration in the numbers of open minded doctors as the numbers of savvy patients explode.That’s why I focus on patients, on their demands; doctors will follow.
That’s the smart path.Would be really great though if there was central spot to sort through the apps like @tyler:disqusAlso–gathering data from my side I get, are there API to suck the data out on the other side from all these proprietary systems–I doubt it!
I’m with you, but “central spot” is a bit subjective. Is the healthdata app the central spot or the scheduling/CRM app the central spot, or other? Dunno…too early to tell.
I think we’ll see some bundling before we see unbundling there. Maybe not bundling on the Facebook level but someone like Prime or otherwise will get consumer attention and build a network which devs will understand as the place to go for health data.
This has to start with the client, you and I in the center.We are the hub. It’s the opposite of CRM in my opinion.This is ALL about people taking control of not only the data, not only how it is collected and how ‘allows’ testing but what you do with it.This is as much a revolution of controlling our bodies as just about anything that preceded it.
There are scheduling apps that are emerging which are also yours and put you at the center. Those same apps could also contain your data.
That’s cool.I can understand how that can be great intellectually, struggling to figure out how to architect something like that.
On the devices side: http://validic.com is the best company I know of for getting data from devices (as a developer).On the doctor interaction/health record side: no one has built that yet and I wrote about the need for that a couple days ago: http://noblepioneer.com/pos… — good convo on the USV post: http://www.usv.com/posts/th…
Someone is building it… 🙂
Definitely no argument on starting from the patient experience and working backwards. Same reason we made Prime http://stayinyourprime.comMaybe we’ve just had different experiences then. As both a patient and as a healthcare startup, most docs I’ve met are not very open-minded about picking up new technologies. Similar to the conversation a young person has with an older person and they say “oh I’m just not tech savvy” and refuse to try new things.
“we are very quick in picking up new technologies as long as they don’t interfere with our doctor/patient relationship.”I think in many respects, certainly in large, high pop areas like NYC, the doctor/patient relationship has already been compromised. The healthcare industry has turned into factories, perhaps less so in specialized areas, but certainly at the GP level. Will enhanced data contribute to more depersonalization and/or lead to greater efficiencies and care? I presume that will vary be practitioner. On a personal note, I ask for copies of all my lab reports so I can trend the data on my annual physicals. Data aggregation and analysis should never be a substitute for in-person interaction. Medicine is hardly an exact science and neither is data interpretation.
I don’t see any correlation between the density of the place and the quality of care.I think there is a correlation between those who can afford the higher priced plans and the availability of choice of doctors certainly.Dollars is a determination. Density not at all that I can see anywhere.”I think in many respects, certainly in large, high pop areas like NYC, the doctor/patient relationship has already been compromised.”
Perhaps I need a new PCP, but difficulty booking, overbooking, long wait times, shorter examinations/consultation, greater involvement of nurse practitioners has become increasingly more prevalent, and anecdotedly with friends/family too w/ their PCP’s, irrespective of their chosen medical plan. I believe this is driven, in part, by NYC’s higher overhead, low reimbursement rates for med procedures, higher cost of malpractice insurance, etc., translating into disproportionately greater economic pressure for NYC physicians, many who track revenue per hour, revenue per patient visit, etc. A lot of high end NYC physicians are not accepting subsidized plans as part of ACA (Obamacare) to a far greater extent than smaller and rural markets. Why? Cause the reimbursement sched isn’t clear (and likely low), while the required reporting is too cumbersome. It’s economically not worth their time, at least at this juncture.
I don’t mean to be oblique nor am I an expert.For as long as I can remember (some 25 years in the startup world), my insurance carriers have changed and I’ve simply bought whatever I had to to keep the doctors I trust.I still hold to that.I can’t attest to your finding though or to your conclusion at least from my experiences.My doctors are really terrific, the best I could find when I moved back here. And as a consultant and NY State being a must cover state, my carrier (then Oxford) as the owner of my own company, covered them.My fiancee just had to switch to an Obama care plan and while pricey, the options to get her physicians was there as well.In my experience it is not the insurance or Obama care that is the issue, if there is one.There is a strata of specialists here that don’t take any insurance at all.That is the gap. That is where income elite comes in.It’s not a matter of population density it’s about the market segmentation that wealth naturally brings. That exists everywhere.I can’t argue against your findings. They are just not corroborated from people that I know .
Glad to hear you haven’t had a similar experience, Arnold. A lot of tangibles and intangibles involved in selecting a PCP that makes one comfortable. As I said, I’m likely going to explore an alternative when I get back to NYC, though you did provide me w/ a little halftime entertainment this evening:). I’m actually out in Seattle for a few more weeks before heading home. It’s fun to see such fan passion in a relatively small market.
I’m here to entertain ;)Seattle is a great town. I worked there a long time ago at the beginning of my career as a marketer for the Pike Place Market and Bumbershoot festival, a ghostwriter for a prof at UBC and publishing early software programs from parent through the Library of Congress.Fond memories and this conversation is driving me to book a trip and revisit.
Yes, Seattle is indeed a great city. I’m actually staying right above the Pike Place Market on 1st Ave. Spectacular views of Puget Sound. I never attended Bumbershoot but I did bike through Hemp Fest when I was here the early part of the summer. Felt like I was in a 60s time warp….quite entertaining.
Its getting harder and harder to get the graduating medical school class to go into primary care medicine. (And you know what that means) One reason is that Primary care providers practice less and less medicine. Acting like a consultant? Im not sure this is going to help. Years ago (before I was born), there was a beauty to the practice of primary care medicine and it attracted the best and brightest, sadly the sun has set on that era.
I know this may sound extreme, but what if primary care could be managed in a different way from empowered, smarter (healthier) patients and less skilled professionals (not MDs) that work together? MDs should focus on some parts of treatment of patients with chronic or acute illnesses and on surgical treatment. If you have a look at WHO data on the ratio of MDs per 1.000 people it’s striking how it’s grown especially in Europe and North America. Do we really need all these doctors? Or, let me put it another way: can we afford all these doctors?
Most are speciality and not Primary Care.The question is -do we need Primary Care to be done by doctors, and how many specialists of various types per person do we need.
Seems like apple will make siri be your primary care dr.
I hear you. I believe what you are saying, but it is not happening anytime soon in the US. We have created a paternalistic healthcare system. First thing first, we have to empower the patient with a tool for communicating with their doctor. When it come to your doctors appointment, life is a three minute pitch. I’m finishing up an app to help with this.
The are about 800K Doctor/physicians in the US. Truth is there is no one practice of “doctor”. There are specialists, hospitalists, and primary care providers. The specialists have little in common across specialties, who have very little in common with the hospitalist, who have very very little in common with primary care physicians.
true. i’m talking about within a practice. just imagining how to strengthen teams inside a practice as they already exist and as they will likely exist as they have to collaborate with more tech people (internally or externally)
Great points, Linnea. Worth noting that progress here isn’t just about patient demand and willing providers. We also need to get the big payers (particularly the government) to reimburse providers for these types of interactions; or at least to support payment models that make it worthwhile for the provider. Some doctors are slow to change — but the government is even slower…
It certainly is a very compelling point, and it will be very interesting to see what different business models emerge for this new kind of medical interaction. I do think that in the early stages, this will be an area where patients pay out-of-pocket in one way or another; however you are already starting to see innovative players, like Kaiser Permanente, that put a strong emphasis on prevention and invest a lot in it. Eventually, the single most effective action governments (and insurances) can take to cut healthcare costs is investing in prevention and in new models that involve less skilled and less expensive professionals (you don’t need doctors for many of these interactions). So I think somehow, we will get there 🙂
+1 all of that. I pay for One Medical Group in SF and already pay out of pocket for all my regular visits since it’s so much cheaper and so much less hassle than insurance. Being primed for paying for other things out of pocket; tried http://firstopinionapp.com the other day and could definitely see myself augmenting primary care with that if I didn’t have One Medical.
Hope you have catastrophic care insurance. No one “really” insures themselves for primary care.
yep, i do.
WelcomeI fundementally disagree mostly because when a family is faced with a major set of potential illnesses, this becomes really complicated how to maintain. Doctors usually want to order too many tests.For basic care I can see this happening though – but I think the driver is going to be the fact that the era of many independent practices is ending for hospital driven clinics of all types. It is cheaper under obamacare to do what you are asking for these types of practices(fun factoid about obamacare)
I think it’s more likely that there will be an intermediary that tracks your health data coming out of these sensors and flags out of range situations and notifies your doctor and facilitates the office visit….kind of like how Lifelock monitors your financial data for identify theft. Relying on either patients or doctors doesn’t seem likely, at least not at population scale. The payers (gov’t and commercial/employers) will incent you to sign up for a service like this because they are footing the bill when your health goes off the rails.So I don’t think doctors will be dragged out of their office by savvy patients….I think doctors and patients will both be dragged into the digital health age by the financially-motivated payers.
Keeping healthy boils down to the basics which are already well known and have been for quite some time. It doesn’t require sophisticated tracking devices, fitbits, toys, apps, and all sorts of reinforcement and feedback to keep up exercise and proper eating. Which just simply isn’t that difficult to do without all of that if you have willpower.
Many (if not most) people don’t have willpower and awareness. Otherwise the market for weight loss and fitness aides would no longer exist. A lot of the apps are just an embodiment of these old systems and basics anyways. I have not bought a fitbit or fuelband but I find it pretty neat to see my daily activity that’s logged on the M7 motion co-processor on my iPhone. It’s like a journal of the rhythm of my life.
We implemented wearables support in Prime in December and came to the same conclusion after “fail fast” internal testing. I’m glad we did it so we could at least confirm the hypothesis.Our hypothesis was: there are many wearables and sensors out there and they’re primarily valuable only to people who A) have a *need* to track something already, and B) *know* about that need.I have no doubt solutions will be created for the general population who don’t fit those two criteria too but there needs to be a much stronger value proposition and much better customer experience for that. I think the ideal futuristic situation most people like to daydream — full body vital monitoring that’s completely non-invasive and allows for preemptive health care, like catching signs of a heart attack before it happens or discovering cancer the moment it starts growing — is still a long way off. But we will get there.EDIT: added another sentence.
Your answer is so dead on. The debate here seems logically very focused on dealing with the health problems once they’ve been fostered by poor lifestyle and the business opportunities that remote/mobile health will create therefore.But if we go back for one second on the broader lifestyle issue, I can’t help wondering if Apple were not the new “1984” – we all more or less realize that we are becoming real slaves to our smartphones and the false sense of “connection” they give us. Yes we are connected digitally 24/7 and always on the look out for the next notification and yet we are and less present to others in the world. There is no holistic well-being without a healthy mind too I guess…. oh well.
Bernard, have you seen this?http://www.youtube.com/watc…We won’t achieve “health” until we increase wellness / consciousness / whatever you want to call it – whereby Americans actually connect their mind’s thoughts with their body’s physical feelings, and vice versa. Sadly, SickTech is big business.
Those are the deepest, most careful, and mostinsightful remarks on evaluating new businessdirections I ever read from a VC and one of the bestotherwise.Yes, maybe in part I’m impressed, e.g., the partabout “deep”, because I don’t know anything aboutthe future of health data on mobile. “Deep” aside,the post is careful and insightful.”Careful”: “the sense that all of this data captureis soon going to happen in the phone itself.” Nice.Maybe important but likely easy to miss.”Insightful”: “Once that happens, things can changepretty rapidly.” Also “The key will be APIs.” –Nice again. Also, “I can see a button that says’auth with Healthbook'”. Yup: For health data muchof the old stuff on capabilities, access controllists (ACLs), authorization promises to becomeimportant.Of course, then, there will be the old considerationof ‘data security’ in relational data bases whereaccess to some table X is not a security (privacy,etc.) problem and access to table Y is not butaccess to both tables X and Y is — no doubt muchmore along these lines was worked out by peopleinterested in security for databases.For health data, data security does promise to be anissue. E.g., “my health insurers’s web app” — somaybe the insurers’ server farm gets hacked ashappened at Target, etc.?There may be a ‘network effect’ for such an API: Somany of the apps use the API because there are somany iOS8 devices in use, and that’s because thereare so many apps that use the iOS8 API.But it might be relatively routine to clone such anAPI in which case it would not be exclusive to iOS8.Then there could be extensions of the API not byApple meaning that the ‘network effect’ might beweaker. So, some devices that gather data mighthave their own APIs that apps use with no longer anyrole for Apple.Broadly ‘monitoring’ complex systems is a big areaand with more data, e.g., from this API, the’Internet of things’, etc. potentially much biggerthan now. E.g., now we take monitoring seriously insome parts of medicine, e.g., a hospital ICU, forthe electric grid, the stock market, other parts ofthe economy, the systems on an airplane, car, house(e.g., smoke detectors, carbon monoxide detectors),IP networks, computers (if only Windows TaskManager, but Microsoft has done a lot ininfrastructure for instrumentation), server farms,etc. So, with more data on a person’s health, maybeGoogle’s contact lens that measures blood sugar, cando more monitoring, and some of that might bevaluable.After monitoring, a standard, broad next step is’control’: What is ‘control’ in this context? Youhave a system (person, car, airplane, in principlethe economy, etc.), work with the system over time,and then get to make decisions over time to’control’ the system.’Optimal control’ is how to control the system toget the most that want from it. ‘Stochastic’ meanssomething that varies over time in a way that mightbe unpredictable. ‘Stochastic optimal control’ isoptimal control when some aspects of the system arestochastic.Supposedly one classic problem in ‘deterministic'(i.e., not ‘stochastic’) optimal control was how todescend to the moon for minimum fuel.Why relevant to health? Suppose someone wants tolose weight. Then their body is the ‘system’;their ‘controls’ are what they can do for food,exercise, sleep, medication. Maybe the person wantsto lose the weight as fast as possible withoutgetting weak, fainting, or hurting their health;then an ‘optimal’ control would tell them what to dowith the controls they have — food, exercise, etc.– to achieve this goal. Similarly for some otherhealth issues.So, if we can monitor to collect data on the body,then we have a shot at using that data for optimalcontrol of some aspects of the body.There have been some hints that the new FED ChairJanet Yellen is interested in deterministic optimalcontrol.For stochastic optimal control and economics, thereisE. B. Dynkin and A. A. Yushkevich, ‘ControlledMarkov Processes’.Dynkin was a Kolmogorov student and long at Cornell.For stochastic optimal control, an old applicationwas how to execute the release of water at damsalong a river given that both the demands for thewater and the rainfall are at least somewhatunpredictable. Some of my grad school research wason stochastic optimal control; once I gave a seminaron the subject; and subsequently some students didtheir research in that direction, including onreleasing water from dams.Usually the main issue in control is getting the’plant dynamics’, that is, for any relevant inputswhat the outputs will be.Commonly the applications of optimal control were to’dynamical systems’, e.g., airplanes, rockets, wherethe plant dynamics were from a system of ordinarydifferential equations which were essentially fromNewton’s second law of motion (force equals masstimes acceleration). The plant dynamics for a human,say, what happens (for a particular person) to theirblood sugar and insulin levels if they drink a 12ounce bottle of Coke may be described by suchdifferential equations; maybe the deterministicoptimal control would be some form of Coke timedrelease!But differential equations need not be involved, andin some cases could use just tabulated data (thatis, big tables, one big table for each output, andeach table in terms of all the relevant inputs). Orthe plant dynamics might be from some statisticalmodels.For stochastic optimal control, a big issue isgetting sufficient information on the relevantstochastic processes.One issue might be giving medical advice without amedical license.
An open API could change the economics of health care to become more “Google like” in a business model. What happens if you can give drugs away for free, and monetize the data around the drugs?
The average drug requires 4-10 billion of VC.
4-10 billion? When drugs cost $100 a pill, and you see changing economics of health care in the US-and then a world population in places like India and China where they don’t even make $100/month, new business models might be made possible monetizing data around the drug rather than just delivery.Additionally, we need reforms at the FDA (which is another topic) and we need to put customers in charge of paying for their own health care (instead of outsourcing it)
The $ number is shockingly high, but accurate.
Per drug?? If that’s true there is the core of the high cost of health care right there. Don’t blame the insurance companies, blame the FDA.
Per Drug. In medicine, they call phase II and phase III, the valley of death.
I know of drugs that were $30M, then failed. But, billions boggles the mind.
The scenario of an open API for health data is a game changer for individual health, but even more so for big data mining that can better treatments and diagnosis for whole populations.
Along these lines — and I know this sounds gross — a few providers have told me that the most effective self-measuring device will live in our toilets. There’s a huge amount of important data that could be captured there (signs of digestive diseases, cancer screens, infections, low nutrient absorption, protein levels, etc.). This is important clinical data that providers can act on.The health & fitness, quantified-self craze is a truly wonderful thing. But unfortunately there isn’t all that much that providers can do with the data — other than to cheer you on.I think this sector will get much more interesting and be a true game-changer when the data being captured can be acted on by providers. A lot of that stuff is coming soon.
In medicine there is a name for people who buy things like this – “the worried well”.
Did you order/ activate one yet?Have you looked at 23 and mehttps://www.23andme.com/
Check this one Fred. http://www.scanadu.com/Scanadu Scout is a sensor that people hold to their temple. In less than 10 seconds, it will collect data on vital signs, including pulse, heart rate, respiratory rate, blood pressure, temperature, and even emotional stress.
Are you saying that our future health is in the toilet ?
Apple thinks in “Apps”, not APIs necessarily. I think the way this would be implemented is similar to Passbook where it ties in and connects to other approved apps that feed into it.So HealthBook could be your health dashboard and entry point, and it might collect data from other more specialized apps that are peaked in their own domain.
Nothing in Apple’s past — or in its skillset — says they’ll open up the data. Would love to hear your thoughts on the start-up opportunities assuming they do not, Fred.
does a vc-backable business model in jailbreaking iOS exist (serious question)?
i don’t think sothere is a VC backed investment in Android modding http://www.cyanogenmod.org/i don’t think that’s possible with iOSi sure wish it was
noooo….don’t think Data. Think Apps. The Apps will access the data.
and apps in the cloud are going to need an app on the phone to grab the data and send it to the cloud where it belongs?seems so silly to me
I’m thinking like Apple does. App to App, and cloud in between.An App that talks to HealthBook might let you download your data if that’s you’re thinking, but I don’t expect Apple to let you do that. Their users don’t want spreadsheets of data, they want easy to use apps that use the data.
and if Facebook apps and Apple apps and Google apps don’t share the health data each is collecting … (FB clearly moving to multi-apps cf. Paper … Google buys Nest … one of ’em buys fitbit…), then…. .
Creating a product that requires jailbreaking won’t scale. And as I’ve said before I personally think it’s a really really bad idea. You need accountability for the product and doing something like that is a good way (and legitimate imo)  for the mfg to say “sorry we won’t fix it because you fooled with something that you shouldn’t have”.And while everybody thinks this is one big game it’s not. There are legitimate reasons why a manufacturer doesn’t want you changing things in a way that makes it impossible for them to cover all bases and keep a product working. Here’s a small example with toner. I have a printer. I bought a re-manufactured toner cartridge from Staples that is “guaranteed” to be the same as the genuine HP cartridge. But it’s not. Because it doesn’t print out fine screens the same way as the HP cartridge does. That’s not HP’s fault it the fault of the cartridge mfg. HP should not have to cleanup the mess and make the printer work with any and all toner. Only with the toner that they sell.
Personal analytics are not nearly a mainstream phenomena (despite the fact that “everyone you know got a Fitbit for the holidays”). Assuming users can get past the many, real privacy concerns, the best way to create a broad appeal will be the passive collection of this information, without requiring any user action. Imagine then we have some approximation of the lifestyle data of every iPhone user in the world, you’ll be able to do some very interesting things.
Apple will have to allow authorization to get data out of health book for one simple reason…Android. Google will surely add health and fitness monitoring to Android and it will be open to authorizing data out. Google will fold the Motorola unit which can create such capabilities into the Android unit.
I don’t see the phone itself (iOS/Android or Windows) being able to gather all the data it needs to make a accurate assessment of your health, at least it’s not from a technological standpoint.It needs to be associated with iWatch (fitbit and jawbone, watch out) or like Brian suggests an iToilet (going to copywrite that one 😛 ). If Apple moves in that direction would be, imho, the biggest innovation they ever did towards consumers.
If so , Google can gauge user response.
Many of the comments so far reflect the importance of allowing trusted developers and clients (in the REST sense) to consume and analyze data. Linnea Passaler is right, the data isn’t valuable yet because we *don’t know what it is or how we will be able to use it.* The more data we get, the more useful it will become, in the aggregate.That said, even if the data isn’t valuable yet in terms of monetary value or applied health, it is still sensitive and needs to be private and secure. Hence the importance of “trusted” parties.I work on what might be the least sexy idea in all of tech: HIPAA regulatory compliance for healthcare developers. But we’re really excited about this because our goal is to help developers become trusted parties.It’s a tricky problem, making data private and open at the same time. Healthcare is just one domain where this tension exists.
That is a really interesting service Chas, it can save us a lot of time 🙂
least sexy and most important
As a dev who’s come up against trying to integrate with the big parties (Epic et al) being a trusted party has been much lower on the totem pole of things preventing us from integrating than: long, misleading sales cycles, lack of financial incentive for them to open up data, and other reasons.HIPAA compliance is something that should be easier so from one dev to another: thank you for what you’re doing.Also I wrote up some thoughts the other day on the need for a health records API: http://noblepioneer.com/pos… — lots of good convo on its USV post: http://www.usv.com/posts/th…
Thanks, we’re trying to make HIPAA compliance less like the Spanish Inquisition and more like doing your taxes.Epic strikes me as just another silo. Push only? Not RESTful? No thanks. Your post is spot-on.
🙂 thanks. if you’re ever in SF say hi [email protected]
Epic has bidirectional available. It’s actually pretty straightforward and structured once you get the correct approval. Native web Services are SOAP. Happy to provide the lowdown any time. We’re actually working on a vendor neutral, RESTful set of services for a handful of EHRs, Epic included.
.In the long run, the low hanging fruit is going to be wellness programs wherein an individual is able to be motivated to exercise, eat better and anticipate illnesses when they are inexpensive — get treated for congestion before it becomes bronchitis.This is the nexus of health, wellness and health insurance. Real life. Real life outcomes.It is a big issue and requires a bit of genuine thoughtfulness.There is some irony when the President, or as I have taken to calling him The Father of Obamacare, says something stupid about his personal use and comfort with marijuana.That statement may be at peace with his personal abuse but it is a disastrous statement as it relates to the health and wellness implications of a hot carcinogenic smoke which has clear implications for health, wellness and health insurance.We need to be smart, very smart, about transforming society both from the perspective of encouraging wellness and harnessing technology to deliver medicine.There is a huge pile of capital currently being wasted that can be recovered and refocused on better outcomes. This likely the only way the hockey stick curve is going to be bent into submission.JLM.
you can eat weed and avoid the carcinogenic smokethere are also vaporizers now that work very differently than smoke. they work for both tobacco and weed.technology is not only changing our ability to be well, but our ability to manage our vices betteri don’t smoke weed, eat weed, or vaporize it myselfbut as you know, i agree with the President on this issue and most issues and i think Obamacare will do many great things and is doing many great things to allow these necessary changes in health and wellness to happen Blue Button, an API for our health data, is part of the Affordable Care Act as are many open data initiatives, including incentives for implementing EMRs early and penalties for implementing them latethe individual mandate, one of many Republican ideas in the Affordable Care Act, is the first move, but certainly not the last one, to move our country toward a health care system where individuals pay for and are in charge of their healthcarethe exchanges, although they were poorly rolled out, are also a Republican idea, that will lead inevitably to an open and transparent market for health care insurance in this countrythe big thing missing from the Affordable Care Act is individual tax deductibility of health care premiums. if we could get that, which I believe is yet another Republican idea, we would really have something the interesting thing is so many of the good ideas on health care (and many things) come from the GOP, but for some reason it takes liberals like Obama and Clinton to get them into law
.The characterization of “ideas” as either Republican or Democrat is unfortunate. Cancer does not differentiate in a similar manner.Therein lies much of the problem — the debate is not really about healthcare, it is about healthcare insurance and who is going to pay for it.I provided healthcare insurance — health, dental, vision, life — to all of my employees for over 33 years with no assistance from the government. These programs are now categorized as “cadillac” programs. Took too good care of my folks, apparently.OBAMAcare is based upon a financial algorithm which is not working now and will likely not work in the future. It is not just the notion that 20-somethings are not going to sign up in sufficient numbers to balance older folks, it is also that as an insurance product it pays for the “first dollar” rather than the “last dollar” cost of a catastrophe or loss — the manner in which property, casualty and auto insurance operates.The President’s utterances — which overlooked edible and vaporized marijuana — are truly unfortunate. He contradicted the NIH as to risks (cancer, diminished IQ, compromised intellectual development). He trivialized the subject.Face it, this administration has decided not to enforce Federal drug laws with no authority other than their own vanity.Kids will be saying: “Ah, Mom, the President says marijuana is no worse than a few beers. Come on, Dad.” Hopefully Mom and Dad are smart enough not to fall into that trap.The most powerful leadership characteristic is always example and will continue to be so. The President has provided a terrible example and when that bill comes calling it too will be horrific in terms of ruined lives, lost potential and the costs of rehab.It is not how an adult would handle things. I wonder when Sasha and Malia will get a chance to explore marijuana?It was irresponsible.I am not aware of any particular healthcare initiatives of Pres Clinton that were ever enacted. Hillarycare died a painful, slow death.OBAMAcare — with the President in full control of both houses of Congress — was written by insurance companies for insurance companies and while enacted into law did not stand the scrutiny of good legislation given its failure to follow “regular order” (subcommittee hearings, committee hearings, floor debate, failure to post for review, party line vote).Even the Democrats did not know the extent and portent of the law. It is likely to die in the same manner that it was born.JLM.
My reference to Clinton was not specifically on health care. I was referring to his welfare reforms which were most certainly coming from the right not the leftIf Obama were truly courageous about marijuana he would push for legalization. Like he did with gay marriage, he is mamby pamby about it when others are doing the hard work of changing laws.Putting kids who deal an eighth of weed into jail for years is one of the most terrible ideas ever.
.Much of what Pres Clinton enacted was the work of the Republican Congress and he just had the wisdom to sign it.Pres Clinton had two years of a very weak Dem majority and then six years of a Senate and House Rep majority.One of the interesting things about Pres Clinton was that he was pragmatic. When he read the tea leaves, he got in line with the outcome.People sometimes forget that Pres Clinton was not elected well — he won both times because of Big Ears (Ross Perot) who siphoned off enough support in both elections to get Pres Clinton elected and re-elected.This had a lot to do with what he signed and did not sign.The business about long sentences for marijuana is a total red herring. Here is what happens.The Federal sentencing guidelines for many crimes have mandated sentences. The marijuana Federal sentencing guidelines are comparatively very lax [thank Pres Nixon for this].Nixon changed the law to one year at the discretion of the US Attorney and the US Attorney could substitute rehab and probation in its place. Richard Milhous Nixon did this.In plea bargains therefore, US Attorneys will allow a criminal to plead guilty to a marijuana charge as a means of delivering a sentence which would be otherwise unavailable to other crimes.Talk to a US Attorney as this is the root for most Federal marijuana sentences. Plea bargains pertaining to crimes for which there are otherwise much longer mandatory sentencing guidelines.Where there exists a real injustice is the comparative LOCAL sentencing of cocaine v crack. Cocaine is seen primarily in white communities while crack is seen primarily in black neighborhoods.The sentences for crack are much more stringent than the similar cocaine sentences.This is a LOCAL problem and is patently unfair.JLM.
I agree with everything in this reply.I would argue that Obama has become very pragmatic in the past three+ years since he lost control of congress in 2010The significant decrease in red ink at the federal level in the past three years and the recent bipartisan agreement on the budget are really hopeful signs.If we can get bipartisan agreement on comprehensive immigration reform we will really be making progress
.We definitely see things from a different perspective.Only the sequester — the product of some hard knuckle brawling with the Republican House — has had any real impact on spending.The attached graphs show the truth of it. It is ugly and it will get a lot uglier before it gets any better.The National Debt is always a good big picture arbiter as it shows the impact of intra- and inter-government transfers. These are real dollars.The recent budget deal was purely a cynical Republican political stratagem to tee the 2014 mid-term elections up on a single subject — the effectiveness of OBAMAcare.It will likely turn out to have been a good tactic but it’s a long way until November. We shall see.I didn’t see anything particularly pragmatic in the President’s SOTU speech.The nonsense about enacting a $10.10 Federal “future” minimum wage is just a stick in the eye. It accomplishes nothing.If Pres Obama were pragmatic — we would have a fence on our southern border and we would have tort reform.JLM.
.Sorry, forgot the graphs.JLM.
Here is a more meaningful graph. Be careful what you wish for, old bean.
.I am not advocating for the use of credit cards only comparing them to the perceived benefits of Bitcoin.Two things that would make the world a better place economically would be higher rates of savings and lower credit balances.Both bring us to living in the present and not living in a murky future.JLM.
There’s a wire crossed somewhere — I didn’t think we were talking about credit cards or bit coin.
.Sorry, completely right. I was actually responding to something else. Hey, it happens.JLM.
.There is a terrible irony that today Philip Seymour Hoffman is reported dead of a drug overdose in NYC.It is this loss of human potential that lies at the bottom line of all of the calculations that pertain to drugs, gateway drugs and the failure to see the human cost as being unbearable.http://www.washingtontimes….JLM.
You are talking about addiction. That is a disease he struggled with for a long time. I lived across the street from him for three years. He was a really nice guy and I saw him walk his kid to school often. But he had problems.Addiction rears its ugly head in alcohol, tobacco, and heroin. They can all kill and do. Two of them are legal. One is not. One does not die from overdosing on weed.
.”One does not die from overdosing on weed.” is the equivalent of “the first beer does not get you drunk.”Both are strawman arguments intended to deflect attention from the reality that bad outcomes are a series of bad decisions in a chain.To cheat the outcomes, you have to break the chain or never allow it to get started.Drug use is always the basis for drug addiction.I watched Boone Pickens mourn the death of his grandson and namesake because his grandson had tried heroin for the first time while high on marijuana.A beautiful child with his life ahead of him enjoying being a TCU student. Now he lies in the cold ground.That is the stakes for getting this wrong and for wagering that there is a middle ground somewhere.We will have no shortage of tragedies to cite and mourn before this is all over.JLM.
Like guns, the issue with drugs is mental health not prohibitionYou see that on the issue of guns but you don’t see it on the issue of drugs
.I agree completely that “one” of the issues is mental health.There are, however, some drugs that must be prohibited because the first use scenario is deadly.The most important thing for anyone is to have the best possible information and make the best possible decisions.It helps if one’s default position is to not jump off the bridge in times of uncertainty.As to marijuana, the issue with me is more fundamental — America does not need to encourage more folks to be living detached from realty.As an aside, an interesting thing is happening in Colorado. Rec marijuana is selling n Denver for $400/ounce subject to a 29% tax. Med marijuana is selling for $200-250/ounce with a simple sales tax on it.The cartels were selling marijuana for $150 and will likely continue to do so.The big change in the law in January was the ability to sell marijuana legally. It had been and continues to be legal to possess marijuana with no apparent requirement that it be purchased legally.Obviously someone can gift you some marijuana.JLM.
> the issue with drugs is mental healthMaybe “mental health” is the “issue” but it is nextto useless down to really bad as a solution. The”mental health” community has poor safety andefficacy even for much simpler problems than drugs.E.g., one of the favorite things of the mentalhealth community is to take a patient in a clinicaldepression thinking of suicide and give them aserotonin reuptake inhibitor long well known tocause suicide.Another of their semi-, pseudo-, quasi-bright ideasis to take such a patient with self-esteem on thefloor, make them dependent and feel worse aboutthemselves, and then threaten to cut off treatment(that is, break the dependency leaving the patientfeeling alone and abandoned) unless the patientsubmits to psychiatric hospitalization which willfurther lower their self-esteem and further increasesuicidal thoughts. Then in such hospitalization itis still too common to administer electro convulsivetherapy to make scrambled eggs out of a brain.
The thing about public health and regulation is that there are always trade-offs between good policy and personal liberty. The data tells us that smoke is bad, as is gun ownership and not wearing seat-belts or bicycle helmets. Marijuana possession, like alcohol possession was criminalized. During prohibition DUIs went down, etc. which is obviously a great accomplishment, but is it worth the time and resources to enforce and the spillover negative consequences of jailing and/or monitoring individuals who break the laws?Some things were under-regulated (tobacco smoking) and some things were overly-criminalized (marijuana smoking) and I think we’re now finding the appropriate middle ground on these.
JLM- It’s a known fact that preventative healthcare, wellness habits and lifestyle choices are WAY cheaper than treating the illnesses or conditions, AFTER they appear.Trick is these all require self-discipline and a personal choice. That’s where the education needs to happen.
.In one company I ran for over 10 years, I had a wellness program which paid cash incentives for exercise, weight loss and before annual physicals were paid for by insurance — an annual physical.I also provided 5 sick days per year and ransomed them from anyone who had not used theirs at the rate of $100 per unused day.I also provided free flu shots before that was fashionable.It does not take a government mandate to act prudently.Why did I do this?Simple — I owned my employees problems. PERIOD. In this manner, I reduced the costs dramatically with one exception — having babies.JLM.
You were ahead of the curve. That’s the way to do it. Well done.
Great. I’ll keep this in mind once I need it.But you didn’t solve the problem for everyone, andmaybe we need a solution everyone or nearly so.My view about ObamaCare is that it was neverintended by Pelosi, Reid, Obama, etc. to be abouthealth care at all. Instead for the powers thatpassed the bill, the whole effort was just aboutpolitics. Yes, the Karen Davis like crowd andSenator Kennedy’s old health care staff may havehoped for something good from ObamaCare, but thatwas no more promising than a paper mache boatcrossing the Atlantic.ObamaCare was never carefully designed; it wasessentially just a paper mache boat never intendedfor anything real. It’s a lot like the TSA –health care politics theater instead of securitytheater.In the fifth grade a girl kept telling me myhandwriting was illegible. So I wrote over and overand finally in block capitals which she alsopronounced illegible. It was a fifth grade littlegirl manipulation, and I was gullible. To me,ObamaCare is political manipulation no more realthan what that fifth grade girl was doing, and totake ObamaCare as more than just a manipulation isto be gullible, as I was in the fifth grade.Obama? He never knew anything, not even the firstgrade, about US health care and didn’t care. E.g.,during the debate before the bill passed, he shothis mouth off about costs of some surgicalprocedures, and promptly the American College ofSurgeons cut him off at the knees with high contempt– “uninformed, illinformed, completely wrong,dangerous”, little remarks like that. Yup, thestatement is still on-line at http://www.facs.org/news/ob…Obama’s contributions to US health care areoperations with a dull, dirty, rusty pocket knife.Before the ObamaCare bedpan load hits the fan, Obamawill be out of office and leave the mess to someoneelse. In the meanwhile Obama gets benefit fromObamaCare as some pie in the sky for the bye andbye.My view of Obama is that he is contemptuous of theUS, really doesn’t much like the US, likely actuallyhates the US, and is by far the most cynical andirresponsible president back through at least FDR –I don’t know enough about the details of earlierpresidents to go back farther.Obama is showing how to be president without reallytrying: (1) Be cynical about problems — mostlyjust ignore them. (2) Forget about opportunitiesfor progress. (3) If something appears in theheadlines as a problem, then have the speech writersdraft a collection of platitudes and cliches andhave the PR staff arrange some photo ops; then letthe problem leave the headlines and just f’get aboutit. (4) Before actually doing somethingsignificant, wait until there is a huge consensusand then maybe do a little. Otherwise, cover up,cover over, smile, delay, and work on the jump shotand golf swing. Basically he just doesn’t give evenhalf of a bedpan load.
What do you think of this http://www.castlighthealth….”Castlight helps employers introduce transparency solutions and advanced benefit designs that fully engage employees in health care decision-making.”
This pursuit makes lots of sense for Apple, they always focus on big markets and health is one of the largest and most pervasive globally. There are enormous extensions and possibilities and from my account, this is the starting point for health care reform – patient/doctor touch points, and treatment will clearly be redefined.There’s still lots of fire in Apple and this obviously explains why they have remained namely silent in sharing whats the next big thing…
My question would be, doesn’t the person have to allow the phone to collect the data? If so then it seems that the people who take care of their health care already will be willing to do it. Much like the trackers, the people wearing them are already in good shape or working at it. There is a bit of preaching to the converted no?I love my fitness tracker –it’s been a game changer for me. But when I show it to those who could really use it they are appalled and want nothing to do with them.People who smoke, drink and don’t exercise – I think – will continue to stay as far away as possible from them and my guess is not allow their info to be shared.
yep, yep, yep. very similar to financial health.
What you don’t measure you don’t change. I learned this early but really grasp it now.I’d become uncomfortable with my weight the last few years. I was 155 in high school (6’1″) and 175 in college. After school and when I started my company I quickly ballooned to over 200, mostly staying in the 202-205 range. The past few years though I was in the 215 range over the winter and then last winter 220. I also turned 40 in September and sensed it was either time to get a handle on it or expect 240 by the time I’m 60, which was motivating.I lost 30 pounds in two sets. The first was June-August. This was all exercise, mostly long bike rides. I dropped from 220 to 207 but then couldn’t lose anymore weight.In November my wife suggested an app called MyFitnessPal, which we both started using. (My wife had lost too much weight — teeth pulled and braces — and needed to track to maintain her caloric intake.) The minute I started to track a light bulb switched on for me. Being hyper-aware of calories made me want to exercise more (so I could eat more) and control my eating so I could still have a cookie in the evening.I weighed in at 189 last week. I lost two pounds per week for nine weeks. I stopped mostly because I needed a break physically but expect to pick up where I left off this summer and try to drop another 5-10 pounds. I now have a stack of clothes 5 feet high that I don’t fit into anymore.Without the app and my iPhone none of it would have been possible. It not only made me aware of calories but also sugars, sodium and cholesterol as well. (I have high cholesterol so particularly focused on it.) It isn’t perfect. I long for a day when I can point my iPhone at my plate and it can tell me the nutritional breakdown and calories about to be consumed of the food I’m eating.I happen to be pretty anal retentive so painstakingly entering and looking up foods wasn’t/isn’t a huge problem for me. But if you aren’t, the current solution is horrible even with a service like MyFitnessPal which has thousands of foods set up already. Anything Apple, Google or any other company can do to make this easier would be a huge win, both on the exercise and caloric intake sides of the equation.
Good. Apple and Google (for most part) are companies that makes things easier for us and I have always their innovations are completely aimed at simplifying things.
How did teeth pull mean lost weight? (I’m curious, because I am debating getting 2 of my 3 wisdom teeth out…)
She had teeth pulled to prepare for braces and ended up with dry socket. Either way her mouth was sore and she lost a bunch of weight because she couldn’t eat anything solid for a while. Then she got braces and every month they tighten those bad boys down and she is too sore to eat anything too solid again. She put on clothes she fit into in middle school! (Don’t ask me why she still has clothes that fit her in middle school, but whatever.)
How do you do that? I don’t have any troublelosing weight as long as I’m willing to be tooweak to get any work done. The last time Itried, I lost 11 pounds in a month, but, again,I was darned weak.I tried exercise, running 10 miles a week inthree parts. When that didn’t cause anysignificant weight loss but did get me insomewhat better shape, I increased to20 miles a week, and then I was losing weight. However soon I wiped out myAchilles tendons — got calcium spurs betweenthe tendon and the heal bone. Had thespurs removed (Ouch!) and had sore tendons for years. No more running.
Ugh. Sounds painful. 11 pounds in a month is a lot of weight. I was told a max of 2 pounds per week. Maybe a slower approach would work? Aim for 1 pounds per week?
typically 1-2 pounds is the recommended range but it really depends on your situation. i was very overweight after college + rugby. i lost 20 pounds in one month and then 20 pounds the next month. just ran 20-30 mins 6 days/week and did bodyweight exercises 3 days/week and ate only nutritious things. i also have a pretty high metabolism naturally so that helped.
I think this is actually far more complicated than it looks.Most medical apps that integrate with doctor equipment (like,x-ray machines) are very very windows based (and often full of bugs). The EHR if they choose to have one, is often driven by the equipment buys.Doctors are also on a very slow upgrade cycle mostly because of their equipment. I’m not sure how apple will make it work as a result.So I really don’t know how Apple will make it happen.
Not sure that’s what Apple is going after. Are you thinking Apple would be sending data back to doctors? I’m confused why Apple would have to deal with doctors directly at all.Also, nitty gritty details aside, I think similar could have been said about integrating with the big music incumbents pre-iPod and -iTunes.
No, but you will have to pull data from these machines. Very Very finicky machines(EG: It would really amazing if I got my mammorgrams compared to between years – you can’t because of the way the data is saved…)
you can’t because of the way the data is savedThe EMR vendor your doctor uses can. Yes I realize that’s not the same. My point is that it’s not the technical side that’s blocking innovation.Re: pulling data from the machines: that’s not what Apple is allegedly building toward. They’re allegedly building a device with built-in sensors that tracks activity, sleep, etc. Integrating with devices in hospitals and clinics is an entirely different value proposition and not really in Apple’s playbook (by which I mean it’s focused on a niche experience, not a broadly-available product marketed to consumer masses).
Without integrating into those machines Apples product is just a novelty item.If I can’t fix both ends, I’m not necessarily going to fix my problems., no?
Depends on what your problems are.I’ll reserve judgment until I see Apple’s product.
working as a medical statistician looks like becoming a sexy profession. who’d have thought that was ever possible?
A few friends are working on something similar to what you’ve proposed – called Human API (www.humanapi.co).With health data, the value is really created with wide sets of data – so hopefully Apple chooses to open their data. Its the combined data from different sensors and sources that answers health questions.It will be interesting to see what sort of sensors end up in smartphones and smartwatches. At the moment, they’re primarily motion-based, which is quite limited in the quality of information for “health”, and still a bit of a streach for fitness. I think the key for so many of these devices is they have to be passive, that is requiring minimum user input and not disrupting the user’s usual routines. A smartphone is ideal because its no (or little) extra hardware, and its always with the user.
very interesting project, thank you for sharing.
I’m an invasive/clinical cardiologist in a large Cardiology group in the greater NYC Metro Area. At the risk of being labelled a “Luddite”, I don’t see large yields coming from many of the topics discussed here. Most of the ‘biometrics’ that Apps could yield via continuous heart rate telemetry, breathing rates, and blood pressure variations are actually not that useful and/or don’t add too much to what is already cheaply available. (At CVS you can buy a good BP cuff and take all the BPs you want, store them, and send them to your Doctor any way you wish….ambulatory telemetry has been ubiquitous for years .Saliva samples for DNA analysis sound cool, but witness the problem that gene sequencing companies like 23 and Me are having. Very smart people are running those companies, but the outputs have been highly questionable. No breathroughs. The human genome project, completed years ago has not yielded much because complex computational biology and further discovery over decades will be necessary to make sense of the combinatorial possibilities of 20,000 genes, which gets into the quintillions. While computers like Watson have won jeopardy and beat chess champions, Esoteric diagnoses are just that (rare and esoteric), and (sadly) don’t have enough market-share to warrant attention from computer apps investment….these occasional diagnoses will also require advanced imaging in many cases, and won’t be done on-line.So, I don’t really see a niche. The only merit from the comments I can glean is whether Nurses should work along-side Primary Docs in the future or not— not a hi-tech question.
Hi Bob. How are you? Thanks for jumping into this discussion. I believe it is really important to have the people on the front lines (doctors like you) involved in this discussion/debateI have a couple reactions to your commentsThe first is that we can’t focus on what is possible to measure noninvasely today. I expect that to change a lot over the next decade. So getting the data flowing to the right places in anticipation of that is importantSecond point is that instrumenting yourself changes behavior. I have seen it first hand with friends and family over the past couple years. I imagine you’ve seen it with some of your patients too. The easier it is to do that the more behavior will change. I’m not going to CVS to get a blood pressure monitor but when my phone measures my blood pressure automatically I will pay attention to it. 23andMe telling me I have a high likelihood of prostrate cancer means I will make sure I get tested more often. Behavior change is the biggest thing I see that will come of all this.Those of us in tech business are guilty of overestimating the power of the stuff we work on. But that’s a good thing. If we didn’t, we might not work on it
Fred, your visionary aptitude has been extraordinarily impressive over the years, and so I am very prone to consider that you are correct in your belief that this could be the next big thing. But I coming from a medical perspective, I still have questions about this. For example, your comment about 23andMe for prostate cancer screening and behavior change is illustrative. Even these very ‘well done’ gene sequencing companies have produced erroneous results, as you are aware. Much of this has to do with the disappointing findings that ‘one gene’ is seldom the cause for one disease. Indeed, in most situations, the biologic factors alone can be in the trillions or quadrillions in permutations due to the interactions of multiple genes, epigenetics (non-sequenced genetic changes), feedback loops, operons, gene splicing of introns and exons, etc. Quantum computing will one day help.Then, there is the problems of clinical screening, itself Even if 23andMe could one day give you a perfectiy accurate risk assessment, you would might hit serious roadblocks about what to do. We are aware of the great debate about PSAs and prostate screening, and this field has years to go until we get the biology understood correctly to provide the ideal screening test with regard to sensitivity, specificity, positive pred. value, negative predictive value. The stakes are high with regard to real undesirable side effects from needless prostatectomies versus under-treatment in young men who go on to develop metastatic disease.So, from an investors’ perspective, I am concerned that this is all very, very premature (Go Broncos)
Having an open API so data can be shared with medical professionals is key.What’ll make the iOS devices and other wearable devices truly beneficial to consumers is if a feedback loop between consumers and physicians is created. Knowing your average heart rate, caloric burn and exercises done in a week is good but it would be much better if a physician can look at your data and give you health and fitness recommendations. Information is much more useful than data.Unfortunately many of today’s devices and apps stop short of creating this feedback loop because of the burden of HIPAA compliance. Our startup, TrueVault, started as a HIPAA compliant Parse for healthcare apps, but more and more frequently our customers are using us as a data exchange or a data hub between users and doctors and between other healthcare entities. What’s trending now is both patients and physicians want this feedback loop to exist so better healthcare can be prescribed.Fred is right, being able to share data outside of iOS devices is key. Apple is in an enviable position to do a lot of good.
My first post here but I’m a big fan! As a health tech entrepreneur in this space I agree completely, and in fact as others have indicated Samsung has done something similar with their S Health App…the custom device is likely going more and more niche while the masses use the device they have for more functions. One business I’m involved with now is combining data from EMR’s with patient generated data acquired from various edge devices to create a new view of the whole patient. Exciting times ahead Fred, and I’m glad to see you are aware and excited about the huge opportunity. A few more of my thoughts and observations posted here from a recent guest post I did post CES: “A storm of personal healthcare data is coming…” http://www.digitalraj.com thanks for all you do!
what’s the name of the business combining EMR + patient generated data?
Hi Tyler, the company is Mana Health (www.manahealth.com) – patient integrated data comes from QS integrations and PHR data is coming from integrations with HIE and EMR players. The idea is to give patients (and professionals) a holistic view rather than disparate systems. Mana won the bid for the statewide patient portal for NY in late 2013 that will launch early this year. check it out! best, raj
Sorry Apple, but the trademark and domain name Healthbook is already taken (http://healthbook.com/), contact me for a licensing deal 🙂
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+100 Charlie.There is good work to be done making information transparent and usable to the general public.The more I work with certs the more the tip from compromise to bullshit.
Why do I feel like GMOs are not the enemy – it is how they are used.I’m really ok with GMOs feeding India and creating a middle class there.I’m not ok with GMOs changing the market structure for corn in the US. Or being used for food preservation/shippiability/roundup-readiness versus tastyness/full of phytonutrientsnessBut why is there no middle ground….(sorry, I just needed to rant about this)
it would be very nice.you could start with organic food, and water bottled in glass at a verified natural spring source. air is a tricky one. electric cars will be a huge step forward for civilisation.
You have the “what” exactly right, what Healthbook, and mHealth apps in general, bring is the “how.” Specifically, how does one change behavior? BJ Fogg would say ‘use lots of small incremental steps that are rewarded along the way’ but the immediate reality is that it is tough to beat cake or cookies as an immediate reward. To answer this question many have tried to gameify healthy behaviors and automate the data entry function with devices, but the phone is the ever-present companion that can do this best. I know for projects on our site many times the would be backers have demanded automated data capture, entry, and sharing, but there was no real defacto standard for this. One of our projects, Avado, later bought by WebMD, was attractive for just this functionality.I agree with Fred that having an open API is critical for success here and would be a real game changer. There are over 20,000 mHealth apps, capturing and managing that data is a genius solution as big as the app store was, but not just for our listening pleasure, this time for something that really matters, our health. @alexbfair
do you eat GMO food?
You are joking… So you are saying that GMO’s should feed countries like India with Genetically modified food or let me say.. in you point of view GMO should use people from India as Guinea pigs but US should feed on organic
“I’m really ok with GMOs feeding India and creating a middle class there.” What you are saying is that it’s OK to sell your life and the lives of your offspring for money. I say that because GMO’s are NOT the product of REAL WISDOM. They are NOT the product of someone who knows how this Universe works. They are the product of COMMERCE. They are a hack-job that, if tested under favorable conditions, can appear to be beneficial. They are good enough to fool the regulators. There is Perfect Justice in this Universe, and sooner or later, all LIES will be exposed. -zato gibson
GMOs definitely do not create a middle class in India, they have zero contribution to that. Ironically, companies like Walmart, opening stores in India and improving the food distribution chain and cutting out the middle men between farmers and retailers will do a lot more for farmers than GMO crops.I don’t know if there’s any proof/assertion that somehow India has more food because of GMOs either.
I’m sorry Charlie but that is an anti-science argument. We have been doing seed breeding since Mendel’s time but today we simply have better tools.You’re dangerously misinformed if you believe that herbicides receive no government regulation. It takes manufacturers seven years to get a new herbicide licensed for sale and that’s because of all the government testing.If you look at the funding for the Center for Food Safety you will see it is headed by a known anti-science critic and receives its funding from those in the organic food movement.http://www.activistcash.com…
Depends where. I’m not ok with roundup, I’m ok with breeding for better and tastier yields.
I don’t agree that selective breeding and genetic modification are the same thing.Not a scientist, not a dope neither but to my reading they are not equal.Government regulation are an exercise in compromise bordering often on the absurd. When certified organic can be comprised of 30% GMO materials, the baseline is a fantasy metric.
Traditional and organic agriculture is perfectly fine as long as we want to feed at most 1.5 billion people from all the possible land on this planet.You’re allowed to say that agrichemistry, pesticides and GMO shouldn’t be used – as soon as you come up with a list of which people shouldn’t receive food.
choosing where to shop can help with that. my ‘real food’ shop has a total ban on GMO, and pulls products off its shelves when the manufacturer gets bought out by the bad corporations (Nestle, P&G, et.c.). It’s good to get to know people who are dedicated to rooting out unethical producers. it’s worth taking that time.
Of course, you are allowed to say what you want – but wanting things doesn’t make them true, even if these are very nice things such as desiring ‘nice, clean, traditional agriculture’ to be compatible with ‘growing 10 times as much food per acre per year as traditional agriculture tends to produce’.On your post you argue against “pumping up soil with nitrogen” – and it is a perfect example of an invention that is not optional; that pumping was a major breakthrough that at the time allowed great increases in farming yields, in order to feed the growing population.”traditional agriculture” in the organic sense, when it was practiced, yields enough food for ~1 billion people. Now we have more farmland (but arguably more depleted) , so it would be like 1.5 billion. Okay, we maybe could push to 2 billion, but nowhere close to the current population level – in fact, mass scale adopting of the “non-healthy” farming practices is the sole reason why the population growth was possible; before them high-population countries were starving with half as many people as they have now; and without them they would be starving again. Selective seed-breeding wouldn’t help – the modern varieties are very efficient in sucking everything out of the soil, so if you abandon intensive agrochemistry, then you either avoid the high-yield varieties or you’ll rapidly deplete your soil.Sure, you can argue about traditional farming from a first world perspective. We can feed the 1% with perfect organic food, but if you require *ALL* farming to be done this way – then most of the planet needs to stop eating.
Yes. And you can have an organic gmo and a non organic heritage breed(which also has had its genes heavily manipulated through selection and crossbreeding habits). Cavendish bananas are heavily heavily inbred, for example, and you definitely can get them organic. Same with honey crisp apples.It’s not an a versus b thing. Different issues for different parts of the discussion, as well as different economic incentives to why we have a monoculture heavily reliant on pesticides.We could have active breeding programs for flavor, nutrition, location suitability, and natural pest resitances. We don’t do that now….